The federal government considers cannabis a Schedule I substance: a drug with no medicinal value and with a potential for addiction as strong as heroin. But one doctor believes that cannabis is not only safe, but that it’s far safer than what’s in your medicine cabinet.
Dr. Christopher Prince is a Michigan-based physician who specializes in emergency medicine, and now provides medical care in rural areas of the United States. Prince has seen plenty of drug overdoses during his career, but not once has he seen an overdose on cannabis.
“In 33 years of practice, I’ve never seen anyone come in with a pure problem from a marijuana overdose,” he said. “I’ve worked in the ER enough, I’ve seen [more] people who need liver transplants from Tylenol overdose.”
According to a report released in 2014, 67.8 percent of emergency room visits were attributed to drug overdoses, both illicit and prescribed. Based on his own observations, Prince is concerned about the overall clinical approach towards pain management, and the safety of medications being prescribed.
“We as physicians have found that people that are getting addicted [to painkillers] have been [doing so] because of our own treatment plans,” Prince said. “It isn’t because we [as physicians] don’t know what we’re doing, it’s because of how we’ve been pushed to treat pain. When you start comparing [current pain treatment] to marijuana, a lot of these other things are far more addictive.”
Prince is among the millions of doctors who have not witnessed a single lethal overdose of cannabis. This is because overdosing on cannabis is impossible. “The lethal doses of marijuana are so astronomically high that a human couldn’t consume that much in a single sitting,” he said. What Prince is seeing is painkillers at work, all of which reduce the amount of pain a patient experiences, but in many different ways and with different side effects.
Acetaminophen has been used for centuries to treat pain, but even modern medicine isn’t completely sure how it works in the body. The closest theory is that it blocks a particular enzyme called cyclooxygenase, also referred to as COX. Researchers have known about this enzyme for quite a long time, and it seems that the human body likes to use this enzyme to tell the brain something is wrong, resulting in pain. Aspirin functions similarly, and has been used even longer than acetaminophen. These two drugs are considered save enough to sell over the counter, but have long-term side effects like liver damage and and stroke.
“Tylenol and aspirin, in my opinion, are two of the most lethal painkillers out there, because you can self-medicate, and there’s no prescription required,” said Prince. “They work well, but you start dealing with the abuse potential.”
But the more significant concern for health care providers are opioid painkillers. Opioids work by blocking opioid receptors in the brain and spine. What makes these medications addictive is the amount of dopamine released while the drug is active. Taken over time, the brain becomes dependent on the amount of dopamine being released.
This effect is similar to how cannabis works in the body, but with some notable exceptions. While there are both opioid receptors and cannabinoid receptors in the brain, the location of them differentiates the effect they have on the body. Unlike cannabinoid receptors, those for opioids are located in areas of the brain responsible for essential bodily functions, like respiration, which is why opioids can be lethal and cannabinoids, effectively, are not.
Even after these differences are established and other substances are deemed more dangerous, cannabis is still viewed as a gateway drug that leads the user to more harmful substances. But Dr. Prince believes that gateway appears earlier in a patient’s history of addiction.
“If you think about it, the majority of the people that use harder drugs started out using marijuana,” said Prince.
“Because it was their first drug, people assume that’s what led to them wanting a bigger high. If you start thinking about addiction, start thinking about alcohol and tobacco, because they’re both more addictive than cannabis.”
Although mainstream medicine has yet to acknowledge the potential for cannabis to treat pain, Dr. Prince is cautiously moving forward with cannabinoid-based therapies for his own patients.
“[Medical marijuana] has been working well for several of the patients [my practice has] been seeing,” he said. “How much of that is marijuana or other medications [they are taking] is anyone’s guess.”
This post was originally published on July 17, 2017, it was updated on October 5, 2017.