Would medical marijuana reduce opioid deaths?
The research is tantalizing, but the experts still urge caution
Colette Nycz was inside her Burnham Park home on Milwaukee’s south side the day she nearly died. Caught in the throes of addiction, she snorted a line of heroin and collapsed three steps from her door. The next thing she knew she was waking up after being revived by a dose of Narcan, a drug that reverses the effect of opioids.
“The doctors told me that if I’d been found any later I would’ve been dead,” said the 42-year-old Nycz. Fortunately, her longtime boyfriend discovered her and summoned help that day in October 2016.
Like so many others, her story of opioid addiction begins with a legal prescription to opioid pain pills. Pharmaceutical companies drove the first wave of the opioid epidemic, said Michael Miller, director of addiction program development and training for Rogers Behavioral Health, a treatment center based in Oconomowoc. “Physicians were asked by pharmaceutical companies to distribute more opioids. It was part of a complicated and sophisticated strategy by drug distributors.”
But what if, instead, Nycz had had an option not legally available in Wisconsin to treat her pain: medical marijuana? Would that have saved her from addiction? Recent research is promising: States where medical marijuana is legal have had fewer opioid deaths. But experts caution that it’s too early yet to declare marijuana a solution to the opioid epidemic.
“Those studies are certainly very appealing because people like simple fixes. I think it’s irresponsible to suggest cannabis as a treatment,” Miller said. “I’d be interested in seeing those products go through clinical trials and meet certain standards.” He believes there may be potential in the chemicals derived from cannabis.
An increasing death toll
Still, the findings so far are tantalizing and suggest that more research is needed as the bitter harvest of the opioid epidemic grows larger.
In 2016, 11.5 million people misused prescription opioids, according to data from the National Survey on Drug Use and Health. An increase in heroin use, which is sometimes now cut with fentanyl, an extremely potent synthetic opioid, has contributed to a dramatic increase in opioid-related overdose deaths in Milwaukee County and elsewhere in the state. Last year, the opioid death toll in the county was 337 and this year’s pace is similar, according to data from the Milwaukee County medical examiner’s office.
Through May 25, there were 96 drug-related deaths in Milwaukee County, 71 of which were opioid-related. Those numbers will likely increase significantly. Toxicology determinations are pending in 65 to 70 additional deaths, according to Karen Domagalski, operations manager from the medical examiner’s office. Through the same period last year, there were 126 opioid-related deaths and 148 drug overdose deaths in total.
Nycz began taking OxyContin and oxycodone after neck and back surgeries for fibromyalgia. If other options had been available to treat her pain, perhaps a potent form of marijuana, she said, maybe she wouldn’t have become an addict.
“I think that if there were more options to treat pain instead of just opioids then maybe less people would be dead. People don’t overdose on marijuana,” Nycz said.
Mireille Jacobson, a health economist and associate professor at the Paul Merage School of Business at the University of California-Irvine, just co-authored an aggregate study on this question published in the March edition of the Journal of Health Economics.
That study looked at the impact of medicinal marijuana laws, with researchers taking a close look at opioids, Jacobson said. What they learned from multiples studies on the subject strongly suggested that access to medicinal marijuana reduced opioid-related death rates. They also found that there had been some substitution from opioid prescriptions to legal marijuana, she said.
Those findings are nuanced, as marijuana laws differ between states and the correlation was stronger in states with increased access to dispensaries, added Jacobson, who is working with Louisville Metro Corrections and Duke Pain Medicine, an arm of Duke University Hospital, to develop strategies to address the opioid epidemic. The study, she said, possibly pointed out an unintended positive effect of medical cannabis laws that people elsewhere should consider.
“We’re certainly finding evidence that some people view it as an alternative. But it’s not enough to just allow medical marijuana, it has to be accessible as well,” Jacobson said.
Several other studies have similar findings, including one published in November in the American Journal of Public Health that focused on the impact of legalized recreational marijuana on opioid death rates in Colorado. That study concluded that legalization of marijuana was associated with a short-term reduction in opioid deaths.
Another study published in April in the Journal of American Medical Association, which analyzed Medicare Part D, found that filled pre-
scriptions for all opioids dropped when a state instituted a medical cannabis law.
Marijuana referendum
On May 24, the Milwaukee County Board approved a resolution to include a referendum on the November ballot asking voters in the county whether recreational marijuana use should be legalized in Wisconsin and whether they supported a sales tax and state regulation of marijuana distribution.
Ald. Michael Murphy, co-chair of the City-County Opioid, Heroin and Cocaine Task Force, said he’s interested in seeing more research on the issue and that he sees potential in marijuana legalization. Murphy thinks looking into the impact of marijuana legalization on the opioid epidemic could be a worthwhile job for the task force.
“Quite honestly, though, with a Republican Legislature I don’t see much changing,” he said. Gov. Scott Walker has said he doesn’t support marijuana legalization, seeing it as a gateway drug.
In Connecticut, the Board of Physicians is considering a vote on whether to allow those with opioid-use disorder to be treated with medicinal marijuana. As of yet, there are no Federal Drug Administration approved painkillers procured from marijuana.
Regardless, Miller of Rogers Behavioral Health said, viewing the drug as an alternative to prescription opioid pain pills or as treatment for addiction is premature. Most people who are addicted to drugs use other substances, including marijuana, methamphetamine or cocaine, he said. Miller said the effect of cannabis as a painkiller has been measured and is very small.
Donald I. Abrams, a professor of clinical medicine at the University of California-San Francisco, said a comprehensive study from the National Academies of Sciences, Engineering and Medicine found insufficient evidence to support the use of cannabis as an effective treatment in achieving abstinence from addictive substances such as opioids.
The study did find cannabis was an effective treatment for chronic pain in adults. Abrams said that data on the use of cannabidiol (CBD oil), which is derived from active chemical compounds found within cannabis, as treatment for chronic pain was inconclusive, although former Green Bay Packer Cullen Jenkins recently shared his story about how he turned to CBD oil to treat his chronic pain.
It would make sense that CBD or tetrahydrocannabinol (THC), another chemical compound found in cannabis, would be helpful since they interact with the endocannabinoid system, which helps modulate the experience of pain, Abrams said.
“The problem is that people don’t really know how to quantify its impact as a pain reliever and can’t say that it can reduce opioid use,” Abrams said.
Anthony’s story
Whether it ever becomes legal in Wisconsin won’t make much of a difference to Anthony, who asked not to be identified by his full name. He said he became addicted to pain pills after being prescribed them to treat back pain a decade ago. Since becoming addicted, he said, he lost his home near Jackson Park and wife of 18 years, after she grew tired of his addiction.
“She gave me six months to quit and I couldn’t,” he said.
Anthony, 37, is currently taking methadone and sometimes Suboxone to treat his opioid addiction but is now also taking Xanax, Adderall and diazepam. “I was on Percocet fives (milligrams) for eight years and then I got a new doctor who said that wasn’t enough and switched me to 15-milligram pills,” he explained.
Already addicted, the increase in dosage ensured that he would be a customer of pharmaceuticals for life, Anthony said. It is doctors and increasing the availability of treatment, not marijuana, that hold the key to stemming the epidemic, he said.
“I don’t take pills for pain. It hasn’t been about the pain for a while,” Anthony said.
And when you do find treatment, strict rules such as not missing a meeting or failing a random drug screen get you kicked out, Nycz said. Without help to deal with the emotions that have been numbed for years with drug use, relapse is inevitable, according to Nycz, who said she has been able to remain clean because she fears another overdose and doesn’t want her 9-year-old daughter to suffer anymore.
“There are so many people out here like me who are teetering on the edge,” she said.
“There needs to be a solid plan to help people remain strong enough to stay clean.”
Intensive treatment requires resources that simply aren’t widely available, according to Jacobson. That’s a problem marijuana can’t solve, she said.
“There are many more issues that need to be addressed other than cannabis laws to deal with opioids. It could be part of a solution but marijuana is not the answer.”
Edgar Mendez is a reporter with Milwaukee Neighborhood News Service. He lives in Milwaukee.
How I reported the story
Reviewed these studies (links available at JS Online):
Do medical marijuana laws reduce addictions and deaths related to painkillers?
Medical Marijuana Laws Reduce Prescription Medication Use in Medicare Part D.
Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015.
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.
Interviewed:
Michael Miller, director of addiction program development and training for Rogers Behavioral Health.
Mireille Jacobson, health economist and associate professor at the Paul Merage School of Business at the University of California-Irvine.
Donald I. Abrams, professor of clinical medicine at the University of California-San Francisco.
Milwaukee Alderman Michael Murphy.
Data used for the story was obtained from the Milwaukee County medical examiner’s office.