Can medical marijuana alleviate the opioid crisis?

We are facing an opioid epidemic. After losing another friend to an opioid overdose last week, I wanted to learn more about this crisis and the possible solutions to curtail its horrific effects. This series of short writings will present the findings of my research. In 2015, over 43 people in the U.S. died every day from prescription opioid overdoses. This initial piece explores how increasing access to medical marijuana may help reduce the number of prescriptions written for opioids, thus limiting the supply of opioids. I recognize that the opioid epidemic is a complex problem with neither quick fixes nor easy solutions. I do not mean to offend anyone with what I write and I will attempt to present the facts in an unbiased manner. I welcome all feedback and constructive dialogue. The best way to reach me is twitter @uptownelijoseph. Thank you. EK

On Thursday, August 10th, President Donald Trump told reporters that “the opioid crisis is an emergency…a national emergency.” President Trump is correct, the United States is in the middle of an opioid epidemic. From 1999 to 2015, over 183,000 people in the U.S. died from overdoses related to prescription opioids. More worrisome than the total number of overdoses is that opioid overdoses have quadrupled since 1999, resulting in 33,091 deaths in 2015, 16,000 alone from prescription opioid pain relievers.

FDA Commissioner Scott Gottlieb said the opioid epidemic “is the biggest crisis facing the agency and is going to require dramatic action.” The Comprehensive Addiction and Recovery Act of 2016 and the bipartisan Opioid Addiction Prevention Act of 2017 — a bill that limits opioid prescriptions for acute, non-chronic, pain — show that Congress recognizes the severity of this epidemic.

State governments are also active. In 2016, state legislators considered over five hundred bills related to opioid abuse. Several states, including Arizona, Alaska, and Massachusetts, have recently declared states of emergency so they can add emergency resources to the resources already committed to fighting the opioid epidemic. Yet the number of deaths from opioids continues to rise.

Insufficient federal and state government action can not be blamed for the ongoing opioid epidemic. Public health crises require both treatment and prevention and have no single cure-all solution. Regarding treatment, one former Assistant Surgeon General says we need “more emphasis on and funding for treatment rather than punishment” and “better training for first responders, police, and medical professionals.”

Limiting the supply of opioids is one of the challenges facing prevention of this epidemic. In the U.S., opioid analgesics — painkillers — are the most commonly prescribed class of medication. In 2012, 259 million prescriptions were written for opioids, enough to give every adult in the country a bottle of pills.

Opioids are frequently prescribed for chronic non-cancer pain management. Though a popular treatment, prescribing opioids for chronic non-cancer pain remains controversial due to concerns about side effects, long-term efficacy, outcomes, and the potential for drug abuse and addiction.

Further, while opioids are a proven treatment for chronic cancer pain, clinical trials for chronic non-cancer pain management do not provide adequate evidence of opioids’ long-term effectiveness. The CDC recommends that, given associations among opioid prescribing, opioid use disorder, and overdose rates, health care providers should carefully weigh the benefits and risks when prescribing opioids outside of end-of-life care and should consider non-opioid therapy for chronic pain treatment.

Methods for reducing supply of opioids include better physician education about appropriate opioid prescribing, increasing accountability to prevent inappropriate prescribing, creating regulations limiting prescriptions, imposing heavy fines or punishments for doctors caught improperly prescribing opioids, and providing alternate sources for pain management drugs.

Chronic pain is the most common reason patients apply for a medical marijuana prescription. A 2015 review of twenty-eight clinical trials on medical marijuana found high-quality evidence supporting the use of marijuana for chronic pain management. And, a 2017 study by the National Academies of Sciences, Engineering, and Medicine concluded that cannabinoids found in the marijuana plant can be an effective treatment for chronic pain.

In 2016, a University of Michigan study found that patients using medical marijuana to control chronic pain reported a 64 percent reduction in their use of prescription opioids. If access to medical marijuana reduces the likelihood that someone suffering from chronic pain gets a prescription for opioids, then increasing access to medical marijuana may help limit the supply of opioids.

Even though medical marijuana may be a better alternative for chronic non-cancer pain management than opioids, 21 states have not legalized it, resulting in greater access across the country to opioids than to medical marijuana. A 2014 study published in the Journal of the American Medical Association found that states with medical cannabis laws had a 24.8% lower opioid overdose mortality rate than states without medical cannabis laws. Considering that 29 states and the District of Columbia have legalized medical marijuana, there is an opportunity for expanding medical marijuana access for chronic pain sufferers in 21 states.

The Federal government is already beginning to recognize this opportunity. On August 8th, NIH awarded a five-year, $3.8 million grant for the first long-term study to test whether medical marijuana reduces opioid use among adults with chronic pain. Following NIH’s lead, Federal and state legislators need to consider nontraditional solutions for solving the opioid epidemic. When considering solutions for the opioid crisis Congress and state legislatures should evaluate legalizing medical marijuana.