Even though cannabis (or marijuana) remains illegal at the federal level, more and more states—the majority, in fact—have decided to legalize it to one extent or another. This puts cannabis in a sort of gray area legally with opinions regarding the plant’s status as a controlled substance likewise split. 

Currently, there are two views concerning cannabis and whether it should be a controlled substance, which are as follows: 

Until recently, the “cool kids” were spectrumists who sang the merits of cannabis on high because the drug wasn’t addictive. But now that we know that’s not true, most rational people split the difference between the two... Because what happens when additional complications are introduced into your situation? More specifically, what if someone with a history of opioid addiction starts experiencing chronic pain? 

The question is this: If you're at risk of addiction or have a history of addiction, then is medical cannabis even an option for managing chronic pain? Is it enough that cannabis is undeniably less dangerous than prescription painkillers, or are you simply choosing the lesser of two bad situations? Is there even a situation in which a person in recovery might be a good candidate for medicinal cannabis?

What is Cannabis? 

Cannabis—also known as marijuana, weed, pot, and reefer—has gone by many names over its thousands of years of cultivation and use. Of the different strains, cannabis sativa is the most common both medicinally and recreationally. Its flowering plant was native to eastern Asia although it is now cultivated all over the world. 

But it's not just used in products we consume. Cannabis and its byproducts have a multitude of uses, including as paper, fuel, upholstery, textiles, and rope.

The psychoactive part of cannabis is actually more than 100 different “cannabinoids,” but the one most known to intoxicate is delta-9-tetrahydrocannabinol, or THC. A variety of cultures cultivated this plant for its psychoactive properties for centuries, a legacy that remains to this day.

Data shows that cannabis use is definitely on the rise, more than doubling from 4.1 percent to 9.5 percent in adults between 2001-2002 and 2012-2013. This same period coincided with a stream of pro-legalization political leanings from younger generations: 60 percent of adults support both medical and recreational cannabis use, 31 percent support onlt medical use, and less than 10 percent oppose legalization altogether. 

The Benefits of Medical Cannabis 

Despite what some claim, cannabis has proven benefits, particularly when its unique properties are utilized appropriately. While the long-term complications associated with cannabis use are not yet well-understood, the benefits are objectively real. 

In medicine, cannabis is most commonly prescribed as an alternative to narcotics, particularly in a post-opioid epidemic world. Studies have found that cannabis and its extracts, such as CBD oil, are often as effective or even more effective than the prescription medications they’re replacing. Moreover, the majority suffered fewer side effects compared to when they were taking pharmaceutical medication. The results of these studies aren’t insignificant; clearly, there’s evidence that medical cannabis can make a real difference. 

Most Commonly-Treated Conditions 

According to a harm reduction journal citing almost 3,000 patients, cannabis can be used to treat a wide variety of different conditions although it’s important to remember that cannabis isn't a cure-all. If cannabis presents medical benefits, doctors prescribe it with the same care and scrutiny as with other medications. This means watching out for signs of danger (more on that later). Per the data, medicinal cannabis results in the following:

• Pain relief accounted for more than two-thirds of patients 
• Antidepressants made up another one-fourth 
• Arthritis medication was the next common at 20 percent 

Cannabidiol—The Source of the Benefits? 

Research connects one specific chemical to medical marijuana's many benefits. Although their names sound similar, cannabidiol, or CBD, is a different chemical from THC. Notably, CBD doesn’t intoxicate the user and shows little to no addictive properties. And yet CBD oil accounted for two-thirds of the users studied. 

The frequency with which CBD use seemed to coincide with therapeutic benefits suggested that patients should probably use CBD directly rather than consume typical recreational drugs. This fed into a surge in the popularity of CBD products, which has since grown to encompass an entire industry of products that promises all of the benefits of CBD.

But this doesn’t mean CBD is completely safe. The reality is that we simply don’t know enough about long-term CBD consumption. Compare this situation with CBD to aspirin, a substance about which we know a lot: We discovered the active component of aspirin in willow bark, which our ancestors chewed in its raw and unprocessed form for millennia. Eventually, we realized that we can isolate the chemical with the medicinal benefits and synthesize it. 

This illustrates the process that has to unfold for us to understand not just the effects of a substance but to actually isolate the different effects to specific chemical components. Because while CBD is not yet proven to be dangerous, marijuana has been.  

The Dangers of Medical Cannabis Use 

• Significantly decreased respiratory health
• Increased proneness to illness
• Increased proneness to developing co-occurring substance abuse disorders
• Increased frequency of accidental injury
• Impaired driving and auto accidents
• Increased (and escalating) frequency of use
• General cognitive and physical decline

To be fair, there are just as many contradictory studies out there, including a study that showed a decrease in both crime and drug rehab intakes related to harder street drugs after medical cannabis was legalized in the area. But it doesn't matter if you fall onto this side or that one; the bottom line is that marijuana is dangerous because it's addictive and certainly has certain health risks associated with its use. Even in situations where medicinal cannabis makes sense, we have to remember that cannabis presents a very real and clear threat to users.

Medical Cannabis & History of Addiction 

As we’ve shown, medicinal marijuana is not a foolproof alternative to narcotics or other addictive medications. For someone with a prior family or personal history of addiction, approach medicinal cannabis with the same, or perhaps even greater, care as with any other prescription medication. 

But even more importantly, make sure that cannabis is even a legitimate form of treatment for your diagnosis. Numerous studies of patients with pain, anxiety, or depression reported no improvements after taking cannabis. Meanwhile, those suffering from mood disorders faced greater vulnerability to addiction once cannabis was introduced into the situation. Because as with most drugs, the individual’s tolerance increases over time. 

Cannabis is frequently referred to as a “substitution” for many treatments with medical professionals often deferring to opiates for pain treatment. It may be more reasonable to see medical cannabis not as a miracle cure for the opioid epidemic, but as “the lesser of two evils." While not currently en vogue, the gateway hypothesis is a consideration as well. Long-term cannabis use, even for medical reasons, increases the chances of opiate misuse further down the line.  

Ultimately, this is a complex issue that necessitates more research to properly understand. 

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