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Science & tech

America’s Opioid Crisis: Can High-CBD Cannabis Combat Pain and Reduce Addiction Rates?

October 14, 2016

Those fortunate enough to only know the word “opioid” outside the context of personal tragedy may not realize what this addiction looks like up close. Opioid abuse is a scary-sounding statistic, with something to the tune of 19,000 Americans dying of overdose in 2014 alone, and a four-fold increase in opioid prescriptions written since 1999.

But for Stephen Mandile, an army veteran who served in the U.S. military for seven years before injury dismissed him, opioids represent a decade of struggle with pain – the kind of physical and emotional pain that has you leaning against the fence between life and death, wondering what could possibly be worse than an existence that seems a mockery of the word “life.”

“I was getting about two hours of sleep every few days, not caring about anything except for my next dose,” Mandile said. “Counting my pills all day to make sure I had enough of everything else for when my fentanyl would wear off, and I would go into withdrawal. I just wanted to die.”

In 2012, Mandile received a medical cannabis authorization in Massachusetts and waited three years for dispensaries to open their doors. “I was amazed at the pain relief I got from cannabis,” he recalled. “It helped with my migraines, my anger, my depression and my anxiousness. Within five months, I was finished with most of my VA meds.”

Number of opioid prescriptions by state. Some states have more prescriptions than people. (Click to enlarge.)

In 2014, a study found that states with medical marijuana laws saw 25% fewer deaths from opioid overdose compared to states without. Is this a mere correlation, or could there be more stories like Stephen’s that demonstrate how cannabis can help reduce opioid dependence? What’s most fascinating about this link, however, isn’t just that cannabis can substitute for opioids by virtue of its own analgesic properties. Studies are showing that one of its non-intoxicating constituents, cannabidiol (CBD), may actually treat symptoms of addiction.

The Story of Stephen Mandile

Stephen Mandile served in the U.S. military for seven years until he was injured in a motor collision.

“My time in Iraq is hard to describe,” Mandile began, recalling his time as a sergeant in the National Guard. “I felt honored to be around some great people, and proud to be serving America.”

Having ranked at the top of the civil service test in Massachusetts for police and firefighting, Mandile had a bright future ahead of him. But in 2005, a motor collision in Baghdad left him with five ruptured discs, sciatic pain, a narrowing spine, degenerative disc disease, spinal arthritis, lumbar radiculopathy in both legs and feet, traumatic brain injury, and major depressive disorder.


The best cannabis strains for pain

“[I was told] that I would end up in a wheelchair before I was 50 years old,” Mandile said, “So at 28 years old, I was left to figure out a new plan, but that never happened because of the lack of care, and an abundance of opioids.”

Awaiting his medical discharge at the “Wounded Warrior Unit,” with an expected wait time of 18 to 24 months, Mandile soon left, opting for an Honorable Discharge instead. “After a few days of seeing guys getting drunk, trading and overdosing on pills every night, and suicide attempts, I decided I needed to get out of there.”

Over the years, the VA would prescribe Mandile 57 different drugs for pain and depression: nine opioids including morphine, fentanyl, Vicodin, codeine, Percocet, oxycodone, and methadone; seven different muscle relaxants; six benzodiazepines including Xanax and Valium; seven antidepressants; and many others.

Opioids make up an enormous percentage of total drug overdoses in the U.S. (Click to enlarge.)

“I was a zombie.” Mandile said. “Five years of fentanyl left me with no desires of any kind. I was angry and depressed, with a temper and mood swings that put my wife through hell. But she always took care of me no matter what. I wished for death so I would stop burdening her.”

“After choking on a handful of oxycodone and fentanyl, it triggered something in me that made me realize I’m not taking these drugs, these drugs are taking me,” Mandile said. “Taking me to the grave if I kept doing it.”

That’s when Mandile took to the Massachusetts Statehouse to change the laws that nearly cost him his life.

Opioid Addiction Examined

This collection of pill bottles is symbolic of the many medications senior adults and chronically ill people take.

The reason why addiction is so hard to kick is the cyclic nature by which its symptoms occur. Opioids produce pleasure and euphoria, activating the brain’s reward pathways. With continued use, sensitivity to the drug decreases and more is required to achieve the same effect. At a certain point, cessation of the drug gives rise to withdrawal symptoms, or adverse effects like pain and anxiety. This encourages re-administration, leading to relapse.

The grip of opioids is particularly strong as they induce intense withdrawal symptoms – pain, nausea, vomiting, anxiety – while tolerance builds quickly. Opioid addiction is also characterized by particularly high relapse rates.

Cannabis has long been associated with its predominant psychoactive component, THC, but the second most abundant molecule, CBD, is taking center stage as a compound of immense clinical potential. Best known for its therapeutic benefits in pediatric epilepsy, CBD is now demonstrating its utility in treating addiction.

Most people tend to think of opioid addiction as occurring at the level of opioid receptors in the brain. However, multiple neurological systems are involved – systems that CBD also interacts with.

CBD interacts, either directly or indirectly, with many different receptor systems in the brain, a subset of which are shown here. For the treatment of addiction, CBD’s influence on serotonin receptors is the best studied.  (Click to enlarge.)

Addiction, CBD, and the Brain

Active receptor isolated on blue.

We learn by association. The brain attaches meaning to otherwise meaningless aspects of our experience. Just as Pavlov’s dogs learned to salivate at the sound of a bell indicating food was coming, people create strong associations from good and bad experiences. For example, a sound or smell might trigger a traumatic memory in a PTSD patient. A place or friend might trigger an urge to drink in a recovering alcoholic. These types of triggers – technically known as “cue-induced cravings” – are often the cause of relapse.

Scientists have found that CBD can help dissolve these associations through interactions with the serotonin system. Serotonin is a neurotransmitter commonly associated with mood, but it also plays a role in addiction. Preclinical research shows that CBD can reduce drug-seeking behavior, diminish withdrawal symptoms, and limit cravings.


CBD (cannabidiol): What does it do and how does it affect the brain & body?

A common way neuroscientists study addiction is to set up an experiment where a rat is trained to press a lever to receive a reward. The reward can be a drug like morphine or an electrical zap into one of the brain’s pleasure centers. Rats will do lots of lever-pressing for big rewards, but when researchers add CBD to their systems, rats don’t do as much.

Drugs of abuse like morphine are said to be “reward-facilitating” because they make animals work harder than they otherwise would for zaps to their pleasure center. For example, a rat might press a lever five times in a given period, receiving five zaps of pleasure from a stimulator in its brain. If you give that rat morphine, it will press the lever even more. Thus, drugs like morphine make animals even more sensitive to rewards than they are naturally.

Giving rats CBD actually blocks this effect of morphine. On its own, a rat might work for five zaps of pleasure. With morphine in its system, it might work for ten. But if you give it CBD before giving it morphine, it will work for five, like it did with no drugs in its system.


Is Cannabis Better for Chronic Pain Than Opioids?

CBD’s interaction with the serotonin system is critical for its ability to block morphine’s effects on reward-seeking behavior. If a specific serotonin receptor is blocked, CBD no longer has this effect. Since we know that CBD can directly stimulate serotonin receptors, this means that its ability to help treat addiction likely depends on its actions at serotonin receptors.

“Currently most medications for opioid abuse directly target the endogenous opioid system,” researchers have written, weighing the clinical importance of such findings. “CBD could thus offer a novel line of research medication… helping to reduce side effects normally associated with current opioid substitution treatment strategies.”

CBD in Human Clinical Studies

A scientist examines a sample in a modern laboratory.

Building on animal research, pilot studies in humans have been conducted. At this stage, researchers evaluate the safety and side effects of treatments. In a double-blind, placebo-controlled phase I trial, CBD co-administered with fentanyl was well-tolerated and had no adverse effects. Once a drug’s safety profile has been established, it can be tested in larger groups.

Next, a small study was conducted to investigate CBD’s effects on drug cravings in heroin-dependent individuals. Basically, they gave heroin addicts a dose of CBD or placebo on three consecutive days. They then showed them opioid-related or neutral video cues and measured cue-induced drug craving. They did this one hour, one day, and one week after CBD/placebo administration. CBD decreased cravings and anxiety at all time points.


How cannabidiol (CBD) works for treating anxiety

In other words, these small pilot studies in humans are consistent with animal research showing that CBD can diminish cravings and anxiety triggered by drug-associated cues. This is key, because drug relapse in recovering addicts often follows exposure to such cues. A therapy that diminishes an addict’s response to these triggers is what we desperately need.

The potential CBD has shown is remarkable, and it’s no coincidence that fentanyl manufacturer Insys is running clinical trials on CBD while simultaneously funding anti-legalization efforts in its home state of Arizona.

Ending the Opioid Epidemic

Marijuana buds organized into a weekly pill case.

It’s difficult to untangle from our national consciousness the negative messages emitted by anti-drug campaigns over the years. Nonetheless, public approval of cannabis legalization has never been higher. Part of the reason for this comes from research that has disproved time and time again that cannabis is not what the failed War on Drugs describes.

But there’s another reason for cannabis legalization – one that speaks to the stories of veterans, parents, and patients who have found hope in cannabis. For Stephen Mandile, the fight for legalization continues.

“My young daughters definitely prefer Daddy now, compared to Daddy on opioids and pills,” Mandile said. “Cannabis allowed me to ignore the pain and withdrawals of fentanyl, oxycodone, and Xanax. Without cannabis, I’m sure I would have overdosed or committed suicide by now.”


Can Cannabis Help Treat Painkiller and Heroin Addiction?

“In June, I was forced to go back on fentanyl because I could not afford cannabis or birthday presents for my daughters,” he continued. “I begged the VA to give me medical cannabis instead.”

When Mandile had an opportunity to speak with Massachusetts’ Governor Baker, he shared his story and asked for help in addressing the problems with veteran care. “I told him we need to stop the opioid epidemic and stop the 22 veterans suicide that occur every day, many of which occur by opioid overdose. He agreed to talk with me because he believed they were serious issues, yet I still haven’t heard from him.”

Never standing down, Mandile spent several days and nights outside the Statehouse attempting to reach the lawmakers who could help him achieve reform. He’s also started a non-profit charity – Veterans Alternative Healing – to help veterans with opioid addiction through a variety of different therapeutic options.

Legalization and the Hope of Change

Photo credit: Ed Schipul/Flickr Creative Commons

United States drug policies are the vehicle by which the opioid epidemic was injected into America. Legal painkillers are killing our loved ones by the tens of thousands. Many more live pill-to-pill, trying desperately to extinguish the very pain that those pills were prescribed to treat.


Cannabis Legalization 2016: America Votes

Meanwhile, the only destroyed lives attributable to cannabis are those caused by the War on Drugs itself: the bodies left in the wake of black market drug operations; the children with epilepsy who, without CBD, are left comatose by their prescription medications; the Americans who spend their lives in prison at disproportionate rates based on race; the countless other people dedicating their lives to fight for a world made better by this plant.

When you’re looking at the November ballot, wondering whether or not to legalize cannabis, know that this is not only a battle many fight for freedom, but for life itself.


Hurd YL, Yoon M, Manini AF, et al. Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center Stage. Neurotherapeutics. 2015;12(4):807-15. [PDF]
Ren Y, Whittard J, Higuera-matas A, Morris CV, Hurd YL. Cannabidiol, a nonpsychotropic component of cannabis, inhibits cue-induced heroin seeking and normalizes discrete mesolimbic neuronal disturbances. J Neurosci. 2009;29(47):14764-9. [PDF]
Katsidoni V, Anagnostou I, Panagis G. Cannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addict Biol. 2013;18(2):286-96. [PDF]

Bailey Rahn's Bio Image

Bailey Rahn

Bailey is a senior content manager at Leafly, specializing in strains and health. She's spent 7+ years researching cannabis products, spreading patients’ stories, and exploring healthy ways of integrating cannabis into daily life.

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  • @nsmartinworld

    There is nothing wrong with opioids, which have been used for thousands of years. The problem is prohibition that lends itself to irresponsible usage and bootleg products. Portugal decriminalized opioid use in 2001 and now has almost no overdose deaths. It is inappropriate to demonize opioids to make the case for cannabis.

    • Bailey Rahn

      Thank you for making this important point! I’d like to clarify that the purpose of this article is not to demonize opioids, but to bring attention to the fact that thousands of people are struggling with abuse and addiction, and we may have something that can help. The example provided by Stephen Mandile is one story, and of course it doesn’t represent an entire nation’s experience with opioids (but you can see from the statistics, similar experiences are disturbingly common). At no point did the article call for criminalization of opioids or anything like that — simply pointing out that certain alternatives are being withheld legally from the people who need them, people who *are* struggling with opioid addiction.

      But there’s another important point here — the cannabidiol research. The case for cannabis can absolutely be made when the scientific studies being discussed are specifically about CBD’s effect on opioid addiction. These aren’t loose connections being tied up by the wishful thinking of cannabis activists — we have significant research here saying that CBD has the potential to help people who are struggling with a problem that’s only getting worse here in the U.S. Think of what that could do for someone who needs opioids for their pain. This isn’t about opioids vs. cannabis, but about curbing one very unfortunate consequence of powerful opioid medications which are being prescribed at incredible rates (see: map graphic).

      To your point about Portugal: they decriminalized cannabis as well as opioids. In many states in the U.S., opioids are legal (with a prescription) while cannabis is not. So we have a complicated comparison here with a lot of other details to unpack! But the impact of drug policy on consumer behavior is important, no doubt! Hope that helps clear things up — appreciate you reading and weighing in.

    • Anna Ketley Becker

      Actually it is NOT inappropriate, but your opinion is based on misinformation and propaganda from the pharmaceutical industry and its obvious–you don’t research to support your opinions based on fear vs. knowledge. You also show 0 knowledge about addiction and of course–0 knowledge of understanding this article. The article clearly states ” With continued use, sensitivity to the drug decreases and more is required to achieve the same effect. At a certain point, cessation of the drug gives rise to withdrawal symptoms, or adverse effects like pain and anxiety. This encourages re-administration, leading to relapse.” Allow me to help you understand this article better. This quote captures the description of Opioid addiction then continues on with real research that anyone using google scholar and pull up and understand if you are not already addicted to mind altering pharmaceuticals–especially the psychotropics.

      • @nsmartinworld

        Of the thousands of years that people have used opioids, the pharmaceutical industry has been around about 100. The profiteers of the drug war include law enforcement, lawyers, physicians, addictionologists, hospitals, prison unions, and politicians. They have profited to the tune of hundreds of billions of dollars, and unlike the drug companies, they control both the legal system and medical care.

        One need not struggle to find current information about drugs and “addiction.” Simply google up the web site (and other sites discussing the work) of Columbia University’s Carl Hart, who researches “neuropharmacological effects of psychoactive drugs in humans.” Hart is chairman of the Dept. of Psychology, and a member of the National Advisory Council on Drug Abuse. He agrees with me, not you.

        Your suggestion that my view might be based on drug use demonstrates the extent to which the drug war is a witch hunt, as Thomas Szasz described in Ceremonial Chemistry.

  • Jeff Dirubio

    Thank you guys for taking on the huge task of simply educating the public about how drugs interact with the body. I saw you do it for the cannabis industry and I love that you just put out an article about how cannabis can help with the opioid epidemic. Obviously nothing has really worked in the past for treating an opiate addiction so we must try new things. This is a great first step towards starting to seriously consider CBDs to help with opiate addiction.

  • Fredric Ward

    Kratom, my friends.
    It’s saving people’s lives from opiate addiction now.

    • Gregory Garris Sr.

      how do you get kratom

      • Fredric Ward

        I’m actually a vendor.
        oduskratom dot com

        So you could get it from me.

        • DancerTiffy

          Actually,, I do believe that the DEA just outlawed kratom a few days ago..
          Here we have a plant that has the potential to assist people as they recover from opiate abuse or addiction and make that whole process easier on them and: the DEA bans it. Absolutely amazing. What an insidious and disproportionate amount of power the dea has. They don’t like a particular plant: BAN IT. Just like that—-gone. Pitiful.

          • Fredric Ward

            it ain’t over yet.
            they are opening a public comment period until Dec 1.
            There was a lot of push back on this so they backed off a lot.
            i guess time will tell

          • Anna Ketley Becker

            Yes,they did. There are strains/dosages that will replace it however–but you must talk with a regular MD who has studied the research and who knows dosage/strain that will work.

          • Pashta

            No, they did not. They backed off because of public comments and are studying it more before deciding.

        • Fredric Ward

          Most of it is from the island of Borneo in Indonesia but i’ve gotten some from Malaysia, vietnam, thailand, Bali, Sumatera, etc
          Southeast Asia basically.

          • Anna Ketley Becker

            I’d be very worried about injesting anything grown in another nation. Most Americans including Dancer in this post, do not know that well over 80% of our pharmaceuticals are made in China and India with over 40% made in China with 0 regulations and 0 quality inspections thereby creating pharmaceuticals that kill people as a result of pharmaceuticals wanting quick profit and 0 responsibilities for their killing drugs.


        We just got some medical marijuana and Cbd/Thc oil from Dr peter hurt via Phone number +18045370917

    • Gregory Garris Sr.

      Where do you get kratom

  • MG Deegan

    I am medical marijuana patient it help do my choices and I smoke flower it better drinking and smoking cigarettes hernion achole /medical marijuana? I next to study cocaine myth I read more for program?

  • DancerTiffy

    I have never experienced any pain relief from cannabis, and I have smoked a lot of cannabis.
    On one notable occasion I had a bike accident and suffered a compound fracture of my ankle.
    I was out in the countryside and all I had was 2 joints—-which I consumed while almost passing out from the pain.
    The pot provided no relief whatsoever and I was in agonizing pain until the ambulance showed up 30 minutes later.
    Then—-I got some immediate pain relief from fentanyl on the way to the hospital and once there I received more opiates at the hospital.
    Anyone who thinks that we can get rid of opiates and replace them with pot is not thinking clearly.
    I would not encourage anyone to falsely believe that pot will save them from severe pain; it will not. At least not for me.

    • Anna Ketley Becker

      You took the wrong strain and the wrong dosage. I have a condition called Porphyria and was born with it and as my body aged–so did my liver and other internal organs making me highly sensitive to pharmaceuticals and I literally died from a doctor prescribed pharmaceutica and was resusitated. I don’t drink alcohol either as Porphyria patients cannot injest nor breath chemicals of any kind, not even the bonders and fillers in most OTC’s and prescribed medications. A bout with polymyalgia (like Fibromyalgia) a few years ago and lowest dosage possible of Prednizone left me with neurological Dysphonia or inability for my vocal chords to produce sound in order to talk and now I must get a Botox shot every 3 months. When I had invasive surgery also a few years back and tried to take doctor prescribed meds, I began having the same life/death conditions that I had previously died from taking the doctor prescribed dosage. Oregon did not have legal medical marijuana, but my son found some for me and in total desperation and excruciating post surgery pain, I smoked it. It not only totally took care of my pain, but I actually stopped my nonstop vomiting and dry heaves for hours on end and actually could keep water and food down and had an appetite. Now with the knowledge that legal medical marijuana dispensaries have along with medically trained PHD’s in Medicine–usually internists–who can literally recommend a specific strain and dosage(start low dosage anyway), there has been a plethora of good medical marijuana in Oregon that cures every condition imaginable. Pharmaceutical??? Not in my life even if I were diagnosed with cancer. Also. the research is there–take doctor prescribed Opioids=Dementia!!

      • @nsmartinworld

        You repeat the false claim that opioids are associated with dementia. There is no evidence supporting that.

      • Carmel Maalouf

        Well maybe you just think it is crazy to take opioids for Fibro because research has ruled them out as the drug of choice for this condition which causes chronic pain. Better choices are cannabis, anti-seizure meds, muscle relaxants, cymbalta. Lyrica, or Neurontin. But narcs don’t cause dementia even if they make people do stupid things sometimes.

  • Anna Ketley Becker

    My beloved German Shepherd Heidi was showing more and more weakened hip conditions and pain as she was born with Hip Displacia. I’ve had her on naturals ie, MSM with joint supplements and elk velvet antler since birth which has greatly lessened the painful arthritic condition of Hip Displacia and allowed her to be pain free until recently. Also recently she was diagnosed with a mammary gland tumor which we have elected surgery to have it removed. As my sister’s dog has the most aggressive form of cancer and knew about CBD for dogs to shrink and eliminate tumors including cancerous ones, she encouraged me to check it out. I did the research and found out that research does exist in how CBD for dogs decreases pain immensely AND decreases tumors as well. The first day after giving her 1/8 recommended dosage–as I wanted a very very low dosage for her so she would not react negatively to too high of a dosage–she climbed the stairs to our bedroom without her usual zig zagging to decrease pain of climbing the stairs. As it was highly effective for treating her pain even at a very low dosage, I’m sure it will greatly decrease tumor growth as well and it is well worth trying as I already see drastic relief from pain in her and her life is much better as a result. The pharmaceuticals for dogs that I always had to put them on in their later years, actually created more pain and a much shorter life for them as such pharmaceuticals damage the liver, kidneys and internal organs just like the Opioids do in people.

    • Johnny oneye

      #CBD for inflammation
      Dogs back legs gave out old age high doses no problem
      HARLEQUIN oil
      Homemade works great

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  • william brandt

    Think of the money lost to Big Pharma and you`ll find out why this is not accepted

  • Perla Amezcua

    That the same her in my life since i was in lock down hospital a number of their meds were in trial and force to me as well other and yes a cup full and the number of time i n the day and simply the wake up call the lack of movement as well to being done no other way then that old doctor that believed eleto make eas ctrical shocks were a form of mental treatment to putting battery acid for a pill to dose you but yes my trust medically is hurt and yes i worked in the medical department doctors lack of patient care or the over abuse of medical fund in isurance company to be told am over wight and their lack of quick to order insulin and still deal with the every day issue i carried personally if it was on meth, their drug pill, to know weed to the high levels of weed from what it stronger ist it no differrnt then what we as medical marijuana do and star getting soit was a clone form to get and to be done i believe so science took it that far wow that each one know of pain in different was if the fire ,water,wind , and the earth could explain it to a ark point it would make it or simply destroy were we stand to am homeless you could say hard headed from being independent since a teen parent and know an adult of grown and independent am in my mid 30 what cure a know the pain of my heart ……………to as well deal with to effect of comfortable to not happy moment cure to my added painin my body or the ark of my feet ……….

  • lovingc

    Did Sessionss get a copy of this? I would like to see his face when he has his nose rubbed in the fact that he has been wrong his entire adult life.

  • Reducing the number of opioid prescriptions is a crucial step in addressing the crisis. And medical marijuana could make it happen. If you reside in CA and are suffering from chronic pain, visit to get a recommendation.

  • Jason Barker

    Having leafly write about things like this ( I’m going for all substance abuse not just opioids )would be a huge help : Petition: Requesting The Inclusion Of A New Medical Condition: Substance Abuse Disorder

  • Chrissy

    I am in the process of tapering off Methadone. I was at 120mg for 4 years and used opiates for 6(2 of which while I was taking Methadone) now I am at 6mg. The Methadone has seeped into my bones and like the quote in the article much of my day is dedicated to waiting as long as possible for my next dose. I recently began taking CBD capsules to alleviate the withdrawal. I was smoking indica but with the taper I’ve increasingly gotten lost into a vortex of thoughts(regret, sadness, anger) from all the things I’ve done and haven’t done. The THC was making that worse so I’ve started to just take the CBD capsules twice a day. It has been a miracle in my life as well as having a support group. CBD relieves the nausea, the endless thoughts that rattle in my brain, the muscle tension, the anxiety and the depression. I’m able to function somewhat normally throughout the day. Methadone detox and opiate detox can drive a person crazy. I recommend that anyone going through this give CBD a try. It’s amazing and safer than any benzodiazepines and non addictive.


    We just got some medical marijuana and Cbd/Thc oil from Dr peter hurt via Phone number +18045370917

  • Johnson
  • james

    Happy Weekend to y’all. Guava Gelato Ready??????. GG effects are indica-forward. Very effective when combating stress, daily aches, pains and nausea .
    Every stoner should try this.
    Play with fire
    We stack different.
    PM for Orders.
    wick id ..hugobuds

  • Mark
  • kracker

    Opioids may be the only thing that works for some. What I don’t like is the all out war on opioids as many Chronic pain patients will commit suicide without them especially in states that do not have Medical Marijuana. I agree with the one poster that calling it Medical is silly but who cares really as life by as it works. The Big Pharmacy people will develop pills etc… and commercialize the movement into a cash cow. The games these people play with lives I hope they all burn in hell