Medical Solutions for the Opioid Epidemic
Next month the Food and Drug Administration is expected to approve a medicine called Epidiolex, which is a purified form of cannabidiol (CBD) extracted from marijuana, for use to treat rare but deadly forms of childhood epilepsy. The FDA’s scientific advisory committee unanimously agreed that the medicine was effective with minimal side effects. They also found that the medicine had “negligible abuse potential,” since CBD—unlike the THC component of marijuana—does not cause a high. Once approved by the FDA, however, Epidiolex could be prescribed for other conditions such as inflammatory and autoimmune disorders, for which CBD has also been shown to help. CBD also blocks the effects of opioid drugs more effectively than methadone—often dispensed to drug abusers undergoing treatment—and thus could be used to help patients recover from opioid addiction. CBD has already proved effective in helping smokers trying to quit by reducing cravings, anxiety, and the numbers of cigarettes they smoke. The advantage of Epidiolex—compared to a CBD-containing product you might buy at a medical marijuana dispensary—is that its purity and dose are rigorously controlled. It may take some time before local doctors or health departments are willing to prescribe Epidiolex for drug treatment or for other health conditions, so the medical marijuana dispensaries may be the only immediate choice. Even so, CBD-containing dispensary products do help: opioid overdose deaths are consistently lower in states that have approved medical marijuana.
Further down the road are new forms of opioid medicine that act on the brain’s receptors for pain, but not on those for tolerance (which is what causes addiction) or that suppress breathing (which is what causes overdose deaths). Receptors are complex molecules on the surface of brain cells to which most medicines attach, and which then signal the cell in ways that change its properties or behaviors. They are so fundamental to human health that the scientists who first discovered their molecular structure were awarded a Nobel prize. In fact, there turns out to be at least four different receptors for opioid drugs, and scientists had determined that one called the kappa opioid receptor controls the response to pain. Then, just a few months ago, an international scientific team was able to determine the molecular structure of that receptor when activated by an opioid-based compound—and to also establish that the opioid compound did not activate the other receptors. In effect, the discovery amounts to a proof of concept that non-addictive, non-breathing suppressing opioid drugs exist, and gives drug companies an initial drug discovery candidate to tinker with and improve before starting clinical trials. Realistically, it will be years before such a drug could be approved by the FDA—but eventually, there will be a far better, safer way to treat pain.
Common Sense for the Eastern Shore




