2/16/2016

Can Marijuana Solve the Opioid Epidemic?

The legal and emotional back and forth of using marijuana to help opioid addition patients.

By Mark Pew

There is a great deal of interest in the use of marijuana for medical purposes around the world, and many studies indicate potential benefit from its use for certain conditions, including helping patients overcome opioid addiction. But is it a substance that will help solve the opioid epidemic or not?

The studies either prove or disprove a point, and often the proven or disproven point is influenced by the bias of the reader. The case for or against medical marijuana is complicated and controversial, and it lacks consensus, largely because the evidence often does not fit the most rigorous standards.

Advocates for legalizing medical marijuana point to its potential for alleviating symptoms related to a variety of health conditions. When qualifying conditions for legalized medical marijuana are listed, they are similar to what Minnesota implemented in 2015:

  • Cancer associated with severe/chronic pain, nausea, or severe vomiting or cachexia or severe wasting
  • Glaucoma
  • HIV/AIDS
  • Tourette’s Syndrome
  • Amyotrophic Lateral Sclerosis (ALS)
  • Seizures, including those characteristic of epilepsy
  • Severe and persistent muscle spasms, including those characteristic of multiple sclerosis
  • Crohn’s Disease
  • Terminal illness, with a probable life expectancy of less than one year.

Chronic and intractable pain will be added to Minnesota’s list effective Aug. 1, 2016. Influenced by personal stories from pain patients claiming to benefit from marijuana, Minnesota Commissioner of Health Ed Ehlinger made this decision against the recommendations of an eight-member panel of medical professionals, according to a Dec. 3, 2015, StarTribune article. Other states also include chronic pain in their lists of conditions despite not having any methods to quantify or qualify that subjective analysis.

According to the Dec. 2, 2015, edition of New Mexico’s Medical Cannabis Program statistical report, 28 percent of the 19,629 medical marijuana patients reported their qualifying condition as “chronic pain.” This was second only to post-traumatic stress disorder (PTSD) at 45 percent, so PTSD and chronic pain account for 73 percent of all patients. Cancer, the third most prevalent condition, registered at only eight percent.

A consensus of evidence-based medicine (EBM) indicates that opioids can be appropriate for the acute and subacute phase of pain, cancer, and end-of-life care. EBM likewise has reached consensus that opioids typically are not appropriate for ongoing treatment of chronic pain. “The Legal Drug Epidemic,” published in the Washington Post, estimated that more than 175,000 people died in the U.S. from prescription drug overdoses between 1999 and 2013. There is no single answer to the opioid epidemic because both the cause and effects are multidimensional. If opioids and other prescription drugs with adverse side effects are not the best choices for dealing with chronic pain, is marijuana an answer?

Four recent studies may—or may not—show that marijuana could be effective for treating conditions where opioids are often used, suggesting that this treatment option could reduce the overuse and accidental deaths from opioids.

The Journal of the American Medical Association (JAMA) published an article by Dr. Marcus A. Bachhuber in August 2014 that drew the conclusion that “states with medical cannabis laws had a 24.8 percent lower average annual opioid overdose death rate compared to states without such laws.” This led to other articles proclaiming that marijuana could be the solution for the opioid epidemic, even though Dr. Bachhuber specifically stated that “a direct causal link cannot be established.” According to the Evidence Based blog, a detailed reading of the full study uncovers that the opioid overdose mortality rate is actually consistently higher for states with medical cannabis laws. So which headline, and conclusion, is most accurate? What some may find to be the answer causes others to find only more questions.

Another JAMA article, published by Dr. Kevin P. Hill in June 2015, opined that “use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence.” However, its findings also indicate “several” (not all) of the trials had positive results and that cannabinoids “may” (not will) be efficacious. Still, this study has been used by some for medical evidence that marijuana can be utilized to treat chronic pain.

The National Bureau of Economic Research published a study in July 2015 titled “Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?” which found that states permitting medical marijuana dispensaries “experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.” The authors used treatment admissions for opioid pain reliever addiction from the Treatment Episode Data Set and state-level opioid overdose deaths in the National Vital Statistics System as the statistical source.

 “Cannabis Use Linked to Improved Treatment for Heroin Addicts,” a study conducted by Columbia University, showed that smoking marijuana reduced withdrawal symptoms for opioid and heroin addicts during a detox process using naltrexone. In addition to reduced withdrawal symptoms, the study said, “Outpatients who used cannabis had reduced sleeping problems, less anxiety, and were more likely to finish treatment than those who didn’t.”

While those are all relatively impersonal studies, the following is a personal example to consider. A 56-year-old male with chronic pain was weaned from all opioids, which were replaced by medical cannabis with exotic names such as “silver haze,” “sour willie,” “raspberry kush,” and “white shark.” The treating physician’s progress report stated, “The patient felt much better without the opioids and the marijuana helped with pain, appetite, attitude, and anxiety.”

It would be difficult to argue with this patient or his treating physician that marijuana is not a better clinical option. From children with epilepsy to cancer patients, these stories are repeated across the country. But are anecdotal stories enough to drive public policy?

According to Dr. John Peterson, president of the Illinois Society of Addiction Medicine, “For every disease and disorder for which marijuana has been recommended, there is a better, FDA-approved medication.” Is medical marijuana “reasonable and necessary”? The starting point should be whether all conservative mainstream options have been tried and have failed. But once they have failed, what is the next step?

So, can marijuana solve the opioid epidemic? It is a perplexing and intriguing question. Not only is it a complicated question, but also it can be an emotional question for proponents and opponents. It is currently a legal question, too, since marijuana remains a Schedule I drug. But if the FDA or Congress makes it legal, that argument goes up in smoke. The answer may be dictated by the biases of the one who is asking the question. Due to marijuana legalization momentum, the U.S. likely is going to find out the answer to that question in the very near future.  



Mark Pew is senior vice president for PRIUM. He has been a CLM Fellow since 2011 and can be reached at mpew@prium.net, www.prium.net.

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