Contributed by Ashanthi Mathai
The debate continues. There are valid points being made on both sides of the federal argument on whether or not to legalize marijuana for medical use. At the center, we hope that unbiased studies, data, and evidence will bring everyone together to do a thorough review and draw fact-based conclusions. After all, the US is facing an opioid crisis today, with around 115-120 people dying daily from an overdose. Over two million people had an opioid use disorder in 2016 and tens of millions of citizens suffer from pain every day.
The truth is, we are lacking conclusive clinical trials. That is indisputable. As is the fact that we are not going to have the opportunity to see such trial results in the near future. Yet, there is evidence—considerable evidence at that—which necessitates thoughtful consideration. And, now prominent voices are putting this firmly on the table. For example, ten days ago, Dr. Sanjay Gupta, CNN’s Chief Medical Correspondent, penned a letter to Jeff Sessions, imploring that “medical marijuana could save many addicted to opioids.”
“Not only can cannabis work for a variety of conditions such as epilepsy, multiple sclerosis and pain, sometimes, it is the only thing that works. I changed my mind, and I am certain you can, as well. It is time for safe and regulated medical marijuana to be made available nationally.” –Dr. Sanjay Gupta, CNN Chief Medical Correspondent
Countering the numbers for opioid use disorder, marijuana use disorder affected close to four million people in the US in 2015 of which 138,00 voluntarily got treated. Between 2004 and 2011, the ED visit rate increased from 51 to 73 visits per 100,000 population aged ≥ 12 years for cannabis-only use and from 63 to 100 for cannabis-polydrug use. More troubling to note is that the highest increases occurred in the adolescent (12-17 year) group.
How does this all balance out? Two studies published on April 2, 2018 in JAMA Internal Medicine that Gupta and others cite, found up to a 14 percent decrease in opioid prescription fills in states that instituted medical cannabis laws. While correlation and causation are two different things, these studies, along with the myriad of other mainly anecdotal evidence that compelled 29 states along with the District of Columbia, Puerto Rico, and Guam to legalize medical marijuana, shouldn’t be ignored.
A concern long voiced by NIDA, is that marijuana could become a gateway drug. Dr. Mark Olfson, a professor of psychiatry and epidemiology at Columbia University, lead authored a study published in September, 2017 in the American Journal of Psychiatry that Cannabis use appears to significantly increase the risk of developing nonmedical prescription opioid use and opioid use disorder. This study was the basis for the negative review of marijuana in the Presidential Commission’s final report last Fall that drew criticism. Professor Olfson himself acknowledged shortcomings in the data used in the study and noted that the criticism is valid.
He sums up the situation accordingly in a quote provided to NPR: “A young person starting marijuana is maybe putting him — or herself at increased risk,” Olfson says. “On the other hand there may be a role — and there likely is a role — for medical marijuana in reducing the use of prescribed opioids for the management of pain.”
Marijuana classified as a Schedule I substance along with heroin makes it difficult to study more broadly. As is the limited source of research-grade cannabis being restricted to just one site at the University of Mississippi until August, 2016 when the DEA relaxed that enforcement but another site has yet to receive approval.
Let’s move this along. Answering the question, “Is Marijuana a Better Alternative to Opioids?” will have a major influence on pain management. Understanding in more rigor the nitty gritty details such as side effects and risks for Cannabis will help keep populations safer.