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Cannabis and the Opioid Epidemic: What Some States Are Doing

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For years, the United States has been in the throes of an opioid epidemic. Abuse rates of opium-derived painkillers like morphine and oxycodone as well as illegal drugs like heroin and fentanyl continue to climb.

Approximately 47,600 of the overdose deaths that occurred in 2017 involved opioids, making up two out of every three overdose deaths. Much of the East Coast and most of the Deep South saw a statistically significant increase in opiate-related overdoses between 2016 and 2017. East Coast, Midwest, and Southwest states have some of the highest opioid abuse rates in the nation.

While comprehensive action is taking place throughout the U.S., some states are looking beyond the usual actions – like filing lawsuits against opioid manufacturers – to address the public health crisis more effectively. For several states, cannabis legislation has played an integral role in reducing the scope and effect of the opioid crisis.

Can Cannabis Replace Opioid Therapy?

While cannabis cannot replace powerful opioids in all cases, it has been shown to be effective for many chronic pain conditions. Moreover, it has a much lower potential for dependence and abuse compared to opium-derived drugs.

Part of the opioid crisis begins with patient-doctor interactions. Patients who experience chronic pain don’t think of themselves as opioid abusers, and doctors often act against their better judgment, prescribing ever stronger painkillers to meet patient needs.

As the need for increasingly powerful painkillers continues, doctors soon run out of alternative options that can provide sufficient pain relief. Almost 80% of heroin users report using prescription opioids before trying heroin.

As long as doctors do not have another, equally powerful tool at their disposal, the decision to prescribe opiates becomes an ethical one with no clear answer. Either the doctor exposes the chronic pain patient to the potential risk of developing an opioid dependency – or to the certainty of continuing pain.

In some states, however, doctors do have another tool at their disposal. Research suggests that medical cannabis can reduce pain as effectively as opioids in certain cases, including multiple sclerosis, which many states already treat as a qualifying condition for medical cannabis use.

Another study found that almost half of its opioid-using patients successfully discontinued using opioid drugs seven months after beginning to use cannabis. The results show that in some cases, cannabis provides a safer alternative to opioid drugs. Further research is required to create a comprehensive list of conditions it could relieve the symptoms of.

Where Cannabis Legislation and Opioid Abuse Intersect

Some states have enacted legislation geared towards treating cannabis as an alternative to opioid drugs for certain conditions. Promising early studies have shown that states with medical cannabis laws saw a nearly 25% lower annual rate of opioid overdose than states lacking such laws.

At first, it might seem like cannabis legislation may simply hide the problem rather than directly addressing it. But as Dr. W. David Bradford explains, “physicians cannot prescribe cannabis; it is still a Schedule I Drug. We’re not observing that prescriptions for cannabis go up and prescriptions for opioids go down.”

Instead, researchers are observing the changes that occur in a patient-oriented economic environment when legislation is enacted. Illinois, New Jersey, New York, and Pennsylvania are among the first states to implement legislation addressing the opioid crisis using cannabis:

  • Illinois legislation allows opioid prescription-holders to swap their prescriptions for medical cannabis while also reducing fingerprinting and background check requirements for medical cannabis users.

  • In New Jersey, as of 2019, opioid addiction is on the list of qualifying conditions that patients can purchase cannabis to treat. The state is also planning to open six new dispensaries, doubling the existing number.

  • New York governor Andrew Cuomo signed legislation adding opioid addiction to the list of qualifying conditions in late 2018. However, patients must be enrolled in a certified opioid treatment program in order to benefit.

  • Pennsylvania also added opioid addiction to its list of qualifying conditions, with the caveat that the patient unsuccessfully tried all other available treatments. Additionally, cannabis must be prescribed alongside traditional opioid abuse therapies.

Many other states have considered legislation that would follow in these states’ footsteps. Arizona, Massachusetts, Hawaii, Maine, and New Mexico have put the idea to the ballot but did not approve the measures. As of May 2019, Maryland and Colorado are debating opioid treatment measures in their respective governments.

What Does the Path Forward Look Like?

The fact that four states are confronting the opioid crisis with cannabis points to a promising future. They may now approve and fund clinical studies designed to test the effectiveness of cannabis to treat opioid addiction. The findings of these studies will steer physicians, patients, and lawmakers across the country closer to the truth about cannabis’ potential effects on opioid users.

Large-scale, institutional clinical studies will help show how effective cannabis treatment can be for opioid addiction and how it is best administered. Until now, cannabis studies of this sort have been extremely difficult to initiate and have almost always consisted of small study groups.

In the near future, we may finally unravel the secrets of cannabis’ effectiveness in treating opioid disorders and the conditions that lead people to seek opioid drugs in the first place. Further studies will help physicians across the country better understand which conditions cannabis is best-suited to treat as well as allow medical professionals to make the appropriate judgment calls.

At the same time, factual studies will help convince lawmakers of the use of medical cannabis in an opiate abuse-reducing capacity. While there cannot be a single, wholesale solution to the opioid epidemic – the problem has too many complex social and economic dimensions  – we may soon see one piece of the puzzle being filled through intelligent, fact-based medical cannabis legislation throughout the United States.


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