[It is important here to reiterate that the Weekly’s editor is not a spokesperson for the Board of Directors of the American Society of Addiction Medicine but selects and discusses topics that may be of interest to the readers.] 

At last count, 29 states have given permission for the use of cannabis in the management of a number of chronic and progressive syndromes. Many state legislatures have considered extending this authorization to the management of opioid use disorders (OUDs). Consistently, this has been in response to the perception that there are inadequate means of treatment.  The usual arguments that are offered include:

Cannabis may or even should be used in the management of opioid use disorder, whether in the withdrawal phase or at other points on the timeline of recovery.
Cannabis efficacy has been demonstrated in such treatment.
Cannabis is implicitly safe for use in the management of substance use disorders.
Contrary concerns are apparent:
None of these arguments has been convincingly demonstrated.---
The implicit moral purpose of these laws has been relief of suffering. While that purpose is commendable, its achievement must include procedures for validating both efficacy and safety.  The history of medicine is replete with examples of raw plants (slippery elm, cinchona bark, foxglove, papaver somniferum) which contain therapeutically useful substances (aspirin, quinine, digitalis, morphine) but which are themselves toxic and inconsistent in content.  A medication’s dynamics, effects, safe therapeutic range and route of delivery, and adverse effects must be known before it is used.  Otherwise it is unregulated research with an uninformed subject.
By acknowledging substance use disorders, and specifically opioid use disorders, as chronic or debilitating diseases does not automatically qualify them for management withcannabis.  This is equally true of other chronic, disabling illnesses.  The indications for treatment with a pharmaceutical agent are efficacy and demonstrated safety.
There is no body of evidence that compellingly supports the use of cannabis or its components in the management of opioid use disorders. The requirements of such research are: respect for persons; beneficence; and justice.  Admittedly, a great obstacle to the development of cannabinoid research has historically been the federal government itself, which in criminalizing use of cannabis has profoundly complicated access and use in humans.  In the absence of adequate studies supporting use this then would constitute uncontrolled and unregulated research in humans.
Human subjects research must conform to The Common Rule, which addresses in detail the requirements for ethical research.  The Common Rule provides guidance for the federal Health Resources and Services Administration (HRSA) in its determination of safe research practices. 
Perhaps the foremost concern is this:  Use of an unvalidated approach risks de-railing those seeking care from treatment with appropriate and validated medications, based on our experience with many other such substitutions (in oncology, in behavioral health, others).  Those with substance use disorders are particularly vulnerable to offers of a quick fix, particularly one with the possibility of euphoria.  For opioid use disorders, the medications with known effectiveness include methadone, buprenorphine, naltrexone.
4. Research which determines both the safety and efficacy of the component chemicals within cannabis warrants support.

Editor-in-Chief: William Haning, MD, DFAPA, DFASAM