"Could medical marijuana help fight opioid abuse? It’s complicated"

The title of this post is the thoughtful headline of this article from Illinois thoughtfully discussing the issues surrounding the relationship between opioid use and marijuana access.  Here are excerpts:

Tom Utley says medical marijuana allowed him to reduce his use of prescription painkillers by 98 percent over the past year and a half. “It has given me control of my life,” said Utley, 42, a Mason County resident whose chronic pain after a car crash 27 years ago used to require him to swallow Vicodin and OxyContin pills four times a day.  Now he takes prescription opioids only a few times each month.

Utley, who works part time running a gymnastics tumbling program, has found relief in marijuana-infused topical lotions and patches, as well as smokable cannabis, from Springfield’s HCI Alternatives dispensary. Unlike prescription opioids, marijuana doesn’t come with the unwanted side-effects of constipation, cravings and cloudy thinking, he said....

Utley is among those who see expanded access to medical marijuana for people in pain as one solution for the nationwide epidemic of addiction to legal opioid painkillers and illegal opioids such as heroin and fentanyl.  There were about 2,000 fatal and 14,000 nonfatal opioid overdoses in Illinois last year. “I think it would be a way-better alternative,” Utley said of medical cannabis....

The Illinois General Assembly is considering a bill that could vastly expand the number of people qualifying for the state’s medical marijuana pilot program.  Senate Bill 336 would allow people who have been or could be prescribed opioids to apply for acceptance into the program.  The science surrounding the therapeutic benefits of marijuana is far from conclusive. But those shades of gray are missing from descriptions of both the benefits of cannabis from supporters of SB 336, and the drawbacks cited by opponents.

“Public policy is light years ahead of the science right now,” said Ziva Cooper, a research scientist who is associate professor of clinical neurobiology in psychiatry at Columbia University in New York. “There seems to be this nationwide experiment on the effects of cannabis that is happening in the absence of rigorous studies.”

SB 336 passed the Illinois Senate on a 44-6 vote April 26.  The bill is expected to receive a vote from the full House by the end of the week....  A spokeswoman for Gov. Bruce Rauner, a Republican, didn’t respond when asked the likelihood that Rauner would sign the bill into law if it reaches his desk.

Supporters of the legislation cite studies that have documented a correlation between a reduction in opioid-related fatalities and opioid prescriptions in states that allow the use of marijuana for medical or recreational purposes.  “The science is generally supportive of the concept,” said state Sen. Don Harmon, D-Oak Park, the bill’s chief Senate sponsor. “People don’t die from cannabis. I don’t feel like we’re doing much harm.”

But those studies, as well as numerous anecdotal reports from patients, don’t necessarily prove that expanding medical marijuana use leads to positive outcomes for the general population, Cooper said.  Results also aren’t conclusive when it comes to the negative implications of cannabis use reported in other legitimate but non-definitive studies, she said.  Those studies, publicized by Springfield-based Illinois Church Action on Alcohol and Addiction Problems, suggest marijuana is associated with an increased risk of prescription opioid misuse and addiction, and actually may contribute to the opioid epidemic....

Cooper said, “There is correlational evidence on both sides of the argument.” ...  The studies do make a compelling argument that more and more-rigorous follow-up studies are needed, she said while declining to comment on SB 336. “It’s just going to take time for us to do the studies that will yield the actual data that support some of these things we’re hearing about in the media,” she said.

Cooper was a member of a committee convened by the National Academies of Sciences, Engineering and Medicine that issued a report in January 2017 on the current state of evidence surrounding the health effects from cannabis and chemicals in cannabis known as cannabinoids.  The report said there is “conclusive” or “substantial” evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults. “But there are a couple of caveats,” she said.  For example, she said, the report didn’t say there’s conclusive evidence that cannabis is more effective than opioids in helping patients deal with pain....

Data from the state indicate that 3 million Illinoisans obtained an opioid prescription in 2016, according to Chris Stone, chief executive officer of HCI Alternatives.  Even if just 10 percent of those patients sought temporary access to the state’s medical marijuana program under the provisions of SB 336, up to 300,000 people would join a program currently serving 36,800 people, he said....

Illinois, unlike most states with medical marijuana programs, doesn’t allow a general diagnosis of pain to qualify patients for the program, Cassidy said.  The Illinois Department of Public Health is appealing a Cook County judge’s January ruling ordering the department to add “intractable pain” to the list of qualifying conditions for medical marijuana.

IDPH director Dr. Nirav Shah has said there was a lack of “high-quality data” to justify adding pain to the list of more than 30 conditions, which include cancer, AIDS, spinal cord injury, seizures and fibromyalgia. SB 336 isn’t designed to add pain patients to the program for the rest of their lives. “This is really about folks who are looking at a six-month period of time of needing these medications or a three-month time period — for those folks who are very much at risk of addiction,” Cassidy said.

Some (of many) prior related posts:

• Two new papers provide further evidence of marijuana reform aiding with opioid crisis
• "The Case for Pot in the Age of Opioids: Legalizing medical marijuana could save lives that may otherwise be lost to opioid addiction."
• "Can medical marijuana be used to treat heroin addiction?"
• Yet another study suggests link between medical marijuana availability and decreased opioid use
• "Legalize marijuana and reduce deaths from drug abuse"
• "Obama’s Opioid Offensive Again Ignores the Cannabis Solution"
• "Is marijuana a secret weapon against the opioid epidemic?"
• "Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report"
• "The use of cannabis in response to the opioid crisis: A review of the literature"
• Still more talk, from notable conservative outlets, about possible benefits of marijuana reform amidst opioid crisis