Marijuana vs Opioids: Which Is More Dangerous?

By Matt Schneiderman and David Mills

What would you rather have your kid hooked on?

Prescription pills or marijuana?

A lot of parents might lean toward those prescription painkillers that they themselves use.

But are medications such as oxycodone and hydrocodone really the lesser of two evils?

Both marijuana and prescription opioids have been targeted by the White House.

The Trump administration has made it clear there will be renewed scrutiny of marijuana laws.

In particular, recreational marijuana laws are being targeted for “greater enforcement,” according to White House Press Secretary Sean Spicer.

Attorney General Jeff Sessions also opposes recreational marijuana.

President Trump has also promised to do something about the opioid epidemic sweeping across the country.

However, the Republican health plan he supports reduces funding for a lot of addiction recovery programs.

With the debate over the health effects of both marijuana and prescription painkillers, you might wonder which is actually doing more harm to the United States?

Healthline decided to take an in-depth look.

Officially, marijuana is more dangerous

Although eight states have passed laws legalizing recreational marijuana use, and 29 states have legalized medical marijuana, federal law still labels marijuana as an illegal substance.

The DEA classifies marijuana as a Schedule 1 drug, defined as having no accepted medical use and a high potential for abuse. Other Schedule 1 drugs include LSD and heroin.

On the other hand, Schedule 2 drugs, which include crystal methamphetamine and cocaine, have been accepted as medical treatments in the United States.

Prescription opioids, which include morphine, fall into this category of drugs — legal when prescribed by medical personnel.

Dr. Thomas Strouse, medical director of the Stewart and Lynda Resnick Neuropsychiatric Hospital at the University of California, Los Angeles (UCLA), thinks the classifications are a bit ridiculous.

Although marijuana can cause health problems if used in excess, he said, there are no known cases of somebody dying from a marijuana overdose. The same cannot be said for opioids.

The CDC reports that overdose deaths from opioids have quadrupled since 1999. In 2015, more than 15,000 Americans died from overdoses involving prescription opioids. Those prescription pills now account for nearly half of all U.S. overdoses from opioids.

In addition, an average of 1,000 Americans are treated in emergency rooms every day for misusing prescription pills.

Overall, the use of prescription medication far outdistances the use of marijuana.

According to the CDC, doctors in the United States write 259 million opioid prescriptions a year. The sales of these drugs have more than quadrupled since 1999.

As for treatment, Strouse says withdrawal from a marijuana addiction is significantly less severe than withdrawal from an opioid addiction.

Strouse said marijuana’s designation as a Schedule 1 drug has more to do with historical and political reasons than any hard data.

“I believe [the drug classifications] should be based on science,” he told Healthline. “It does not make sense to me that cannabis is a Schedule 1 drug.”

Marijuana health effects

Marijuana won’t kill you. Not from an overdose anyway.

But is it healthy for you?

A recent study sought to qualify the purported harms as well as benefits of marijuana.

Dr. Marie McCormick, professor of maternal and child health in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, professor of pediatrics at the Harvard Medical School, and chair of the study, says the widely cited negative side effects of cannabis are hard to substantiate.

“The classification of cannabis as a Schedule 1 drug makes it very difficult to acquire research-grade samples,” McCormick told Healthline. “There are a lot of questions about the quality of the existing data. Existing studies are variable, even in terms of the concentrations of the cannabis. It’s hard to sort out the data.”

Still, the recent report did determine relationships between smoking marijuana and health problems.

According to McCormick, “What appears is that smoking does lead to bronchitis, smoking during pregnancy does lead to lower birth rates, and initiating cannabis use at an early age is a risk factor for problematic use.”

She said there is testing in the workplace, but there’s no data associated with workplace injuries as a consequence of cannabis use.

Even the widespread concern that marijuana causes poor academic performance among young marijuana users isn’t necessarily correct.

“Early use of cannabis leads to academic failure is the assumption,” McCormick says. “But the questions around cannabis use are asked of students retroactively. We don’t know how the student was doing before the cannabis use.”

The literature is mixed on whether marijuana use leads to abuse of other, more harmful drugs.

“Usually they’re talking to someone who has another drug problem and asking what they did before,” McCormick says. “What they don’t know about are the people who start cannabis and don’t go any further. There’s no evidence of it being a gateway drug.”

The report investigated cannabis use and 11 types of health issues, including heart attack and schizophrenia, but could not find strong evidence of a relationship between them.

However, a report released over the weekend at the American College of Cardiology said marijuana use is associated with an increased risk of heart disease and stroke.

Strouse said that heavy use of marijuana can lead to psychological disorders in some people.

He added that marijuana also can do damage to the developing brains of people under the age of 25.

“The impact of heavy marijuana use on a developing brain is no small matter,” he said.

On the other hand, McCormick’s report did identify several therapeutic uses for cannabis, including treating chronic pain and treating chemotherapy-related nausea and vomiting in cancer patients.

The National Organization for the Reform of Marijuana Laws (NORML) touts two recent studies involving marijuana and opioids.

The first study, released this month, reports that statewide legislation that permits medical marijuana use is associated with a reduction of opioid-related hospitalizations.

The second story, released last month, states that patients with legal access to medicinal marijuana reduce their use of opioids.

“The data is clear. Cannabis is effective at treating pain, including hard-to-treat pain conditions like neuropathy, and arguably represents a safer alternative to opioids,” Paul Armentano, deputy director of NORML, told Healthline.

Ultimately, the McCormick report recommends a lot more study, including the development of a standard set of questions to ask research participants so data can be consistent across studies, and a review of marijuana’s status as a Schedule 1 drug.

“As a Schedule 2 drug, cannabis would be treated like opioids like morphine and codeine,” McCormick said.

The effects of opioids

As most opioids are legal, there is much more research about their efficacy and potential harms.

Dr. Don Teater, medical advisor at the National Safety Council from 2013 to 2016, authored the report The Psychological and Physical Side Effects of Pain Medications, which addresses the national epidemic of opioid abuse, addiction, and overdose.

“Compared to marijuana, opioids are much riskier, much more dangerous,” Teater told Healthline.

“Opioids cause more problems than they’re worth.”

Opioids prescribed for pain bring fast relief and an accompanying sense of calm. Both effects quickly wear off, however, and a higher dose is necessary to regain the same effects due to increased tolerance to the drug.

“They’re not effective for ongoing improvement of chronic pain,” Teater said.

“A lot of people are in pain,” Teater added. “And social and emotional factors affect pain and how we deal with it. The pain is made worse by poverty, stress at work, depression, and anxiety. People are looking for a killer medicine to fix it. Behavioral therapy is the best solution — get them exercising, improve mental health, reduce catastrophizing — but everyone is given pills.”

Teater said quality of life goes down the longer you use prescription painkillers.

“Opioid receptors in our brains work to keep us motivated, confident about getting things done, and energized to do and finish projects,” he said. “Chronic use of opioids decreases the number of opioid receptors and our own opioids, as the brain quits producing these. We wind up with less motivation, less happiness, and less success. Opioid users have twice the rate of depression as nonusers.

The longer you take them, the worse off you’re going to be.”

It can be a downward spiral.

“Life for a user revolves around opioids,” Teater said. “Thus begins a difficult relationship with the prescriber. Every visit focuses on pain and the opioids. Doctors have seven or eight minutes with each patient, a prescription is demanded, and it’s easier to give it to them than to explain why it’s not good for them.”

Teater suggests there are only two appropriate uses for opioids, both short-term.

The first is acute trauma, as with soldiers with wartime injuries.

“The sooner they get morphine — and its tremendous calming effect — the less likely they are to develop PTSD,” Teater said. “Opioids keep memories from searing into the consciousness.”

The other time opioids may be called for is at the end of life.

“The calming effect of opioids will help dying patients deal with the pain,” Teater said.

Otherwise, he says, over-the-counter medications can be just as helpful as opioids for pain relief.

“One ibuprofen is as effective as two Percocet,” Teater says. “Opioids aren’t even as effective as Tylenol or acetaminophen. No one should be getting an opioid prescription for dental procedures, strains, or sprains. People think opioids are the strongest for pain relief but really it’s the calming effect that they want. It doesn’t have so much to do with the pain.”

Drugs and children

There are also concerns about opioids in relation to children.

Two studies published Monday in the journal Pediatrics dealt with the topic.

In the first study, researchers reported that poison control centers average 32 calls a day connected to young children accidentally ingesting prescription pills.

In the second study, researchers said most teens abusing prescription opioids had been given them at a younger age for medical reasons.

Marijuana isn’t great for young children either.

A study published last year reported that accidental exposures of children to marijuana were rising in Colorado after that state legalized medicinal marijuana.

The researchers said the exposures were mainly due to parents leaving marijuana in places where young children could find it.

Most of those exposures involved food laced with cannabis.

The children admitted to the hospital suffered from vomiting, dizziness, drowsiness, and respiratory problems. There were a few cases of seizures.

However, no deaths were reported.

Officials at the Pharmaceutical Research and Manufacturers of America (PhRMA) did not respond to Healthline’s requests for an interview for this story.