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By: Micah Bucy and Nathan Vrabel
It’s no secret we’re in the midst of an opioid crisis. In 2017, according to the Centers for Disease and Control, more than 115 people died of an opioid overdose per day in the United States. This loss is felt most deeply by family members and loved ones of the person who died of the overdose. But there are also economic costs to this crisis. The estimated economic burden of this crisis is $78.5 billion dollars per year in healthcare costs, addiction treatment costs, legal fees, and lost productivity.[1] To lend support to how large this problem is, take for example the statistic that from 2006 to 2016 more than 20.8 million prescription painkillers were dispensed to the community of Williamson, West Virginia, a town with just over 3,100 residents. That’s 6,500 painkillers per person over that ten-year span. In Pennsylvania in 2016, according to the National Institute of Health (NIH), there were 2,235 opioid-related deaths or 18.5 deaths per 100,000 people which is 28% higher than the national average of 13.3 deaths per 100,000 people.
In the fall of 2017, the opioid crisis was declared a “public health emergency.” However, since President Trump did not authorize any additional funds to actually combat this “emergency,” it left only $56,000 (that is not billions or millions it is only thousands of dollars) to deal with the entire crisis nationwide. Simultaneously, with naming this epidemic as an “emergency” but providing no funds to combat it, President Trump suspended a separate provision in our law that allowed Medicaid funding to cover many drug rehabilitation facilities.
We can call the opioid epidemic an “emergency” or “crisis” but without real solutions, these words ring hollow. In summary, this issue impacts all of America and is costing families, communities, and our country devastating amounts of lives and money and there is no foreseeable help coming from the federal government.
So how do we begin to handle this emergency on our own? First, we need to identify the best methods for combatting it. For many, opioid addiction begins under the most innocent of circumstances – an injury or post-surgery treatment requires pain management efforts and the patient is prescribed painkillers. But these drugs are powerful and alter a person’s brain chemistry which can devolve into an addiction. Naloxone or Narcan – an expensive rescue medication for opioid overdoses – is widely used to assist in the fight against opioid abuse but it acts to reverse the effects of an opioid overdose and does not prevent or curb an addiction problem. Another ad hoc measure is to offer safe injection sites where people with drug addictions can use drugs in an environment where help is readily available in the event of an overdose. But like Naloxone, safe injection sites do little to curb the epidemic and some critics argue it exacerbates the problem.
In March 2018, the President unveiled his plan to combat the epidemic which focuses heavily on increased law enforcement measures seeking to cut supply and lower demand. Incarceration does not help stem the addiction. Most experts agree that combating the opioid crisis takes the following:
- Alternatives to opioid when managing pain
- Effective rehabilitation treatment
- Education
- Innovative new treatments
Narcan is a new innovative treatment and has saved thousands of lives, but it does not stop the addiction so it does not stop the crisis. There is another innovative answer that has the ability to actually stop the addiction – medical marijuana. Medical marijuana may be the ready-made solution to combat and maybe even reverse the opioid epidemic. Marijuana has a long history, dating back more than 2,000 years, of being used for medicinal purposes and fighting pain. Today legalization of marijuana is supported by over 60% of all Americans with the legalization of medical marijuana supported by 94% of Americans.[2] Medical marijuana has been legalized in 29 states and the District of Columbia. Because medical marijuana is still considered “illegal” under federal law, a patient’s access to medical marijuana differs based upon the state statute authorizing its use and the type of qualifying conditions authorized by the individual states. For instance, in 19 states, including Pennsylvania, opioid use and chronic pain are qualifying conditions eligible for a physician to recommend medical marijuana as a treatment option. But conversely, ten states do not make chronic pain or opioid abuse a qualifying condition. Why is this important? The first defense against opioid addiction is never using opioids. The next defense is helping people get off of opioids; medical marijuana can do both.
First and foremost, medical marijuana can provide physicians with an alternative treatment to opioids. In 2014 and again more recently, medical studies which have been published in the Journal of American Medical Association (JAMA) indicate that states with medical marijuana laws had nearly 25% fewer deaths from opioids than states that had no medical marijuana laws.[3] The studies examined the prescription rate for Medicare Part D patients in states where marijuana is illegal versus states where medical marijuana is legal. The study found that in states where medical marijuana is legal, prescriptions for opioids fell by 2.21 million daily doses per year. But the study further examined the effect of a structured, robust medical marijuana law, such as Pennsylvania, that provides for a marketplace to purchase safe, regulated, pharmaceutical-grade marijuana versus states that do not and found that states with a structured law, e.g. Pennsylvania, see a decrease in opioid demand by 3.74 million daily doses per year. What these studies demonstrate is that marijuana, rather than serving as the long-touted “gateway drug”, actually serves as a viable alternative treatment to harsher more addictive drugs such as opioids. Specifically, the NIH indicates that implementation of medical marijuana laws decreases opioid prescribing, decreases self-reports of opioid misuse, and decreases treatment admissions for opioid addiction. And finally, according to the U.S. Drug Enforcement Administration there “have been no reported deaths from overdose of marijuana.”[4]
Medical marijuana can be an effective treatment for more than just pain. Medical marijuana has been found to be effective in other conditions that typically warrant the prescription of opioids and other similar harsh drugs. Medical marijuana has been shown to be effective in treating epilepsy, multiple sclerosis, Crohns, and Parkinson’s.
Medical marijuana can provide more than an alternative to opioids; it can provide relief from opioid withdrawal symptoms and decrease the very cravings that lead an addict back to the drug. As Dr. Sanjay Gupta stated on CNN and in his letter to Attorney Jeff Sessions “As many know, there is longstanding evidence that cannabis helps chemotherapy-induced symptoms in cancer patients, and those symptoms are very similar to opioid withdrawal. In fact, for some patients, cannabis is the only agent that subdues nausea while increasing appetite.”
Medical marijuana can be an alternative to opioids; offer real relief to those trying to get off opioid use; and now researchers say it can even cure the opioid damaged brain. Dr. Yasmin Hurd, director of the Addiction Institute at Mount Sinai in New York City, has done studies on the brain damage caused by opioid use. According to Dr. Hurd, opioid abuse causes damage to the glutamatergic system within the prefrontal cortex of the brain. This is the part of the brain where we make our decisions; damage to this part of the brain eliminates an addict’s ability to regulate opioid consumption. Hurd, also looked at traditional rehabilitation treatments and found that they are still using “lesser forms of opioids” such as buprenorphine or methadone which continue to damage the brain and therefore prevent the addict from ever being free of the addiction. Hurd found that CBD, an element of medical marijuana, actually helps heal the brain at a molecular level.
Of course, additional studies are required but doing so is difficult as marijuana remains a Schedule 1 drug under the Controlled Substances Act which makes it a federal crime to manufacture, sell, and possess marijuana. But Pennsylvania grower/processors and dispensaries are in a position to further the research efforts of medical marijuana. Many operational medical marijuana grower/processors and dispensaries are currently engaging in research activities. Many are currently partnering with major research studies (for instance many of our current Pennsylvania growers/processors and dispensaries are participating in the University of Michigan research project conducted by Dr. Sue Sisley).
[1] CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://wonder.cdc.gov.
[2] https://www.fool.com/investing/2017/09/02/94-of-americans-support-legalizing-medical-marijua.aspx
[3] See e.g., JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005 available at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1898878?__hstc=9292970.8a6d480b0896ec071bae4c3d40c40ec7.1407456000124.1407456000125.1407456000126.1&__hssc=9292970.1.1407456000127&__hsfp=1314462730
[4] https://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf
