Dr. Nick Spirtos isn't sold on pot. He's an oncologist at the Women's Cancer Center of Nevada in Las Vegas, and he's never used it, even though when he was growing up in Southern California in the Sixties and Seventies, everyone else was. He's not convinced about the science of medical marijuana either.
"It's unsettled in a way that I would be uncomfortable with as a scientist," he says. "I'm not happy with the current data."
However, as the CEO of The Apothecary Shoppe, a Las Vegas marijuana dispensary, he's hoping to change that lack of information. His patients, some of them who have been prescribed opioids, kept telling him marijuana was helping with pain and other conditions, so he decided to launch a study of his own.
"That spurred my interest that this is real medicine, not just, 'Go smoke a joint and go down to the beach in Malibu,'" he says. Apothecary is conducting trials using a marijuana-based syrup they developed which they believe can help patients replace opioids, joining a growing chorus of researchers and policymakers exploring whether marijuana could be a key tool in reversing the opioid crisis, which kills roughly 115 Americans a day.
Medical marijuana is legal in 29 states, and recent research indicates it leads to fewer prescriptions, fewer overdoses and effective, non-addictive pain treatment. It probably won't end the crisis, but doctors, researchers and advocates say Americans can't ignore it any longer. And, according to two major studies published in April's Journal of the American Medical Association, the more marijuana access a state allows, the bigger the reduction in opioid prescriptions.
"[Drug addiction] is so strong that even the person who desperately wants to stop, they can't," says one scientist.
One, which examined opioid users on Medicare between 2010 and 2015, found states saw 2.11 million fewer daily prescribed doses per year after legalization – and 3.7 million fewer when the law allowed for medical dispensaries, not just home cultivation. The other study concluded states with medical marijuana had 5.88 percent lower opioid prescription rates on Medicaid. That jumps to 6.38 percent lower when states also had recreational pot.
Jason Hockenberry, a health-policy professor at Emory University who co-authored the Medicaid study, cautions research like this shows trends, not cause and effect – but he's thinks pot has real potential. Researchers must now explore how and why these drops happen, he says, and what the consequences of long-term pot use are on public health. "It's got to be on the table as a discussion point," Hockenberry says. "This is one of the top two or three health policy questions of this generation."
Other new evidence suggests more marijuana can mean less opioid overdoses too – though it depends on how people are getting their pot. In February, researchers at the RAND Corporation and University of California Irvine confirmed similar, past findings, discovering a roughly 20 percent drop in opioid deaths after states legalized medical marijuana, but the effect disappears after 2010.
RAND's David Powell, one of the authors of the study, says there are a couple explanations why. First, after 2010, states continued to legalize medical marijuana, but to lower the risk of federal prosecution, laws became stricter about who actually qualified for it.
"It could be, even states with dispensaries now don't have quite as much access to medical marijuana," he says. "The other possibility is that the opioid crisis has changed." Since 2011, Powell says, the main driver of opioid deaths has been illicit use of heroin and fentanyl, not prescription opioids, and people using those drugs might be less willing to swap them for pot.
Whatever the case, doctors and scientists believe marijuana – and CBD in particular, a chemical component of pot which doesn't create a high – holds promise for replacing a key function of opioids: treating pain.
Yasmin Hurd, director of the Addiction Institute at New York's Mount Sinai Hospital, says there's growing evidence that CBD could be a good long-term painkiller.
"When you're going to the emergency room with a nail in your hand, you want to have an opioid," she says. "It's the chronic inflammation, all of these different aspects of chronic pain, where the cannabinoids can definitely be effective."
A comprehensive 2017 of 10,000 studies by the National Academies of Sciences, Engineering and Medicine concluded there was evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms.
Despite federal restrictions, Hurd is also one of the few researchers in the country conducting human trials with CBD to see if it helps combat the building blocks of opioid addiction itself.
"Many people who use drugs and never became addicted, they can't understand why someone would continue abusing a drug that they know is dangerous and has completely messed up their lives," she says. "That craving is so strong that even the person who desperately wants to stop, they can't."
Hurd is developing CBD-based medication she hopes will tackle the anxiety and cravings that perpetuate this destructive cycle.
Many believe marijuana holds promise for replacing a key function of opioids: treating pain.
Still, marijuana remains illegal at the federal level, limiting what scientists can discover. Pot, like heroin or LSD, is marked Schedule I under the Controlled Substance Act, which means the government thinks it has a high potential for abuse and no accepted medical use.
"We recognize that there is interest in developing therapies from marijuana and its components," Michael Felberbaum, a Food and Drug Administration spokesperson, told Rolling Stone in a statement. "We continue to assess whether there are appropriate and effective therapeutic uses of marijuana and its components and believe the drug approval process using scientifically valid and well-controlled clinical trials is the most appropriate way for this to occur."
Chinazo Cunningham is a doctor and public health expert at the Albert Einstein College of Medicine. She's conducting the first long-term, federally funded study exploring marijuana as an alternative to opioid pain treatment in humans, but she wishes she could do more.
She's tracking a group of 250 patients, some HIV-positive, registered in New York's medical marijuana system, but federal restrictions mean she can't actually prescribe which weed they use. She says security requirements and a limited supply of government-approved pot make it all but impossible to do the large-scale, double-blind studies common – and necessary – for testing new medicines.
"Here we are in this situation where the majority of states have medical marijuana, and more will soon, yet we're unable to do the studies that need to be done to understand how best to use it," she says.
That hasn't stopped millions of Americans from swapping opioids for marijuana anyway, and they say they're seeing results.
Chris Lopez, from Manchester, New Hampshire, is paralyzed from the waist down after falling off a deck in 2011. Doctors prescribed opioids for her pain, but she hated them. She says they made her feel drained and forget things people just told her. After six weeks, she switched to pot.
"It truly was like colors coming back into the spectrum," she says. "I still have chronic pain, but it lessens that, and I also experience severe muscle spasms, so it also helps me to relax."
She's not alone. Richard Miller, head of outreach and education at A Therapeutic Alternative, a medical dispensary in Sacramento, California, says they see around 30 patients a day using cannabis to get off opioids.
"We do need more research," he says. "But the fact of the matter is anecdotal proof is enough evidence for me when I see patients coming in on a daily basis, saying, 'You've changed my life.'"