Should opioid addiction be an indication for the use of medical marijuana?
On July 12, 2018, the New York State Department of Health under the direction of Howard Zucker, MD, JD, Commissioner of Health announced emergency regulations adding Opioid Use Disorder and “any condition for which an opioid could be prescribed” as a qualifying medical condition for the use of medical marijuana in New York State. The commissioner was quoted as saying that “Medical Marijuana has been shown to be an effective treatment for pain and may also reduce the chance of opioid dependence,” which is a “critical step in combating the deadly opioid epidemic affecting people across the state.”
If this emergency regulation goes into effect OUD will join 12 other qualifying conditions such as cancer, HIV infection or AIDS, Amyotrophic Lateral Sclerosis, Parkinson’s Disease, Multiple Sclerosis, Spinal Cord Injury with Spasticity, Epilepsy, Inflammatory Bowel Disease, Neuropathy, Huntington’s Disease, Post Traumatic Stress Disorder and Chronic Pain for which medical marijuana can be prescribed.
While possibly well intentioned in the presence of the current opioid epidemic, it is our belief and that of several scientific organizations including the American Society of Addiction Medicine, the New York Society of Addiction Medicine and the American Society of Addiction Professionals that this action will have some unintended consequences in combating the epidemic.
It has been claimed (Executive Summary on the Assessment of the Potential Impact of Regulated Marijuana in NYS-DOH, July 2018) that “Medical Marijuana has added another option for pain relief which may reduce initial prescribing of opioids and assist individuals who currently use to reduce or stop use.” Furthermore, “It is an effective treatment for pain, greatly reduces the chances of dependence and eliminates the risk of fatal overdoses compared to opioid based medications.”
The fact is that there is no human data on cannabis efficacy in treating OUD. Clinical experience in New York and elsewhere has found no correlation between cannabis use and remission or recovery from OUD even though cannabis use is common among those in treatment for opioid addiction. It is also scientifically known that individuals with OUD are at a higher risk for addiction to cannabis given common neurochemical pathways.
Moreover, medical marijuana users are more likely to use prescription drugs medically and non-medically (Journal of Addiction Medicine July/August 2018). If anything, “medical marijuana users should be a target population in efforts to combat non-medical prescription drug use.”
The use of cannabis for pain also is not a universally scientifically sustained claim. In a recent Lancet study (July 2018) that followed the effects of cannabis use in people with chronic non-cancer pain found that those who used cannabis, “had greater pain and there was no evidence that it reduced pain severity or interference or exerted an opioid sparing effect.”
More marijuana used is correlates with higher rates of schizophrenia, and earlier usage correlates with an increase in schizophrenia risk. There have also been case reports of a causal relationship between marijuana and mental illness including depression and suicidal ideation. Heavy cannabis consumption in adolescence has been causally associated with a drop in overall intelligent quotients at least 10 points in teens testedby the time they reach adulthood.
Why would then Medical Marijuana be brought for consideration in the midst of the opioid crisis? After all, Medical Marijuana is not approved by the Food and Drug Administration as treatment for OUD alongside the three other medical options (Buprenorphine, Naltrexone and Methadone) and there are other more proven efficacious ways to stem the rise of opioid deaths in our country. And in Colorado, opioid deaths have increased, not decreased ever since that state legalized marijuana for medical use in 2000.
Unfortunately, there are other larger forces at play here besides political considerations such as the concerted national effort to legalize the recreational use of marijuana without consideration to the social costs that such a political step could impose in our communities. Already we are familiar with the costs that alcohol and nicotine dependence inflict on our health and communities; the combined annual national deaths associated with these two legalized substances far outpace the annual death toll caused by the current opioid epidemic. To offset the benefits from taxes generated by those two industries, significant dollars are spent in treatment for the negative effects they cause society, not including the human toll or despair associated with dependence.
Many people would say that there is a public majority in favor of legalizing marijuana yet what many don’t know is that how you ask the question is key to the response you would get. Most polls pose a binary question to responders, in the form of being for “legalization or criminalization” yet when you introduce additional options, polls change significantly and indeed support for legalization dips below 50 percent. Marijuana has been decriminalized in New York state since 1977 yet there is still over prosecution. Decriminalization is not the same as legalization.
So, by all means we urge our community to let our State Representatives, and Honorable Commissioner of Health, of our opposition to their misguided effort to have non-chronic pain and opioid use disorder as approved diagnoses for the use of medical marijuana. This step, if enacted, would not only be in effect critical in worsening the actual opioid epidemic, it would undoubtedly lead us closer to legalization.
The last thing our state needs is another problematic drug industry such as the tobacco, alcohol and opioid pain interests that have caused so much harm to our society.
Dr. Hector Biaggi is the medical director of St. Joseph’s Addiction Treatment and Recovery Centers.Bob Ross is the president and CEO of St. Joseph’s Addiction Treatment and Recovery Centers.