After five-plus years of deep-researching potential medicinal uses for marijuana, Sanjay Gupta — neurosurgeon, professor at Emory University School of Medicine in Atlanta and, most famously, medical correspondent for cable news giant CNN — has settled firmly on this conclusion:
Weed works. Not for everybody. But for a lot of people. It can ease pain. Reduce inflammation. And for many who struggle with opioid addictions, it can help them kick their habits by tamping down the nausea, insomnia and other symptoms that characterize opioid withdrawal.
Very possibly, marijuana may heal brain damage caused by opioids, too.
Gupta has not always believed this. He wrote a piece for Time magazine in 2009 outlining his opposition to the legalization of pot, even for medicinal use. His turnabout since then has made him an unlikely ally of the pro-marijuana crowd and put him publicly at odds with a government that still places marijuana in the same class of drugs as heroin and LSD.
Dr. Sanjay Gupta, CNN star, practicing brain surgeon and medical marijuana advocate. Who would have thunk it?
"I don't really know that I see this as being an advocate," Gupta says. "I think for me, it was not advocacy journalism as much as it was evidence-based journalism that hopefully spoke truth to power."
Gupta's about face on marijuana — maybe it's better described as a slow, steady, deeply thought-out awakening — is grounded in years of indefatigable journalistic research, highlighted in the CNN documentary "Weed." The fourth installment of the series, "Weed 4: Pot vs. Pills," debuted on April 29, 2018 (and is still available on demand) and examined the use of medicinal marijuana to help solve America's addiction to opioids.
It's a crisis crying for answers. According to the National Institute on Drug Abuse, more than 115 Americans die every day from opioid overdose, usually prescription painkillers, heroin or synthetic opioids (like fentanyl). One study puts the economic burden of the epidemic at more than $78 billion a year.
At least part of the solution to combating the opioid crisis, to a growing number of researchers and doctors, including Gupta, is marijuana, the long-derided favorite of stoners that is derived from the cannabis plant.
Those researchers and doctors are just beginning to unlock what happens when pot hits the brain, and how that can break an addiction to opioids.
How Marijuana Can Break Opioid Addiction
Opiates block the transmission of pain signals to the brain, and they're very good at it. The problem is that the drugs are highly addictive: Users need more and more to get the same relief, making them extremely dangerous. They can, Gupta explains in "Weed 4," actually "turn off" the body's natural instinct to breathe, leading to tens of thousands of deaths a year.
"Opiates tend to cause this disruption in an area of the brain around these glutamate receptors, Gupta says. "I liken it to [having] two big cities, New York and Chicago, and you need to send these signals back and forth via airplanes to these two cities and suddenly all the transportation is down."
Once hooked on opiates — that can happen as quickly as a couple of weeks — addiction is very difficult to break, possibly because of the damage the drugs do in a certain area of the brain, the prefrontal cortex.
"That part of the brain is sort of a judgment area, where you start to learn things," Gupta says. "Some of the wisdom that has come out recently is that even if you stop [taking] the opiates, you don't necessarily heal that part of the brain. You still are at risk of relapsing. In some ways ... the brain is not able to remember the negative impact of the opiates."
The Role of CBD
Cannabis, like opiates, also blocks pain signals, Gupta says, but it also reduces inflammation that can lead to further pain. And the real advantage of cannabis for opioid addicts, Gupta says — and here he points out the groundbreaking research of Dr. Yasmin Hurd, the director of the Addiction Institute at Mount Sinai in New York — may be that the CBD compound of the plant can fix the receptors damaged in the brain from opioid use and make communication in the brain whole again.
"The idea that CBD can heal the diseased brain of an addict was the real takeaway for me," Gupta says. "There's nothing else that we know of that can really do that the way CBD does."
One of the more than 400 chemical compounds of the cannabis plant, CBD (cannabidiol) is used often for medicinal purposes in children for diseases like epilepsy and is legal even in 17 of the most marijuana-opposed states. CBD does not contain the psychoactive part of the plant, known as THC, that produces the "high" of marijuana use.
The pro-marijuana crowd points out that no one ever has overdosed on marijuana or CBD, making it infinitely more preferable to other addiction-breaking therapies that use opiates like Suboxone or Methadone to wean addicts off stronger opiates like heroin. Still, cannabis use is not without its dangers, especially for younger people with developing brains, Gupta says. Marijuana can be addictive, too; the psychoactive part of the plant can impair motor function and judgment.
Despite marijuana's negatives, the biggest hurdle weed advocates face is clear: The plant remains a federally regulated Schedule 1 drug. Though many states have legalized CBD and have approved marijuana for medicinal uses, and some have even OK'd it for recreational use, it is still illegal on the federal level. Many in the current presidential administration seem hell-bent on keeping it that way.
Head-to-head With the Feds
The nation's top drug-enforcement official, Attorney General Jeff Sessions, has spoken out forcefully against the legalization of marijuana and seems defiant in his opposition to the work of Mt. Sinai's Hurd and others.
"I'm astonished to hear people suggest we can solve our heroin crisis — have you heard this? — by having more marijuana," Sessions said in a speech in 2017. "How stupid is that?"
Sessions' apparent reluctance to look at the potential good of marijuana is not unusual. Many people still see cannabis as a "gateway" to harder drugs, a theory that has been debated for years, debunked by some and revived by others.
Through the work of Hurd and many others, though, it's becoming much more difficult to blindly accept the old way of looking at marijuana.
Gupta stands as one of the more public examples of someone who has accepted new evidence, and he's glad to share his findings with the powerful. In April 2018, he wrote an open letter to Sessions after the AG repeatedly turned down Gupta's requests for interviews.
The Next Steps
Research by Hurd and others, including University of California-San Diego anesthesiologist Mark Wallace — who has been looking at cannabis as an alternative pain reliever for more than 20 years — continues even though studying the medicinal uses of cannabis is difficult because of its status as a Schedule 1 drug.
"I think that it's one of these situations where everybody who is responsible in this whole discussion wants more data," Gupta admits. "The situation I think we find ourselves in is there isn't a real mechanism by which to obtain that data, given the regulations right now around medicinal marijuana."
The debate on how to research marijuana — or even if we should study it — continues, too, though a showdown may be coming. In April 2018, a U.S. Food & Drug Administration committee unanimously recommended approval of a cannabis-based drug — Epidiolex — for the treatment of epilepsy. That puts the FDA in a strange position; a federal agency giving the go-ahead to a cannabis-based drug even as it remains illegal on the federal level. The FDA will vote on the drug's final approval in June.
"If it does get approved by the FDA, which it's likely to do, I think it will probably be the most glaring hypocrisy at that point to continue having cannabis remain a Schedule 1 drug while at the same time having a cannabis-based drug be FDA approved," Gupta says. "That may be what it ultimately takes for [cannabis] to be rescheduled [from a Schedule 1 drug]."
Rescheduling would make research easier and, perhaps someday, unlock more federally approved uses for a plant that may yet play a major part in bettering — even saving — thousands of American lives from opioid addiction.