Patient risk factor raised
Experts: More evidence needed of marijuana replacement’s effects
A coalition of doctors and addiction experts is voicing concern that the state’s recent expansion of medical marijuana for the treatment of opioid addiction is not based on evidence and could ultimately harm patients.
While the expansion also authorized marijuana as a replacement for opioids in pain patients, the main concern of these medical and treatment providers centers around its promotion as a treatment for opioid-use disorder. There is no basis in medical science for this, they argue, and worry it promotes the idea that marijuana is as effective as or preferable to established medication-based treatments for opioid addiction, such as buprenorphine, methadone and naltrexone.
“My opinion is that we will see a lot more failures and a lot more relapses among patients who have been in recovery on buprenorphine, naltrexone or methadone who now say, ‘Oh, well, now I don’t have to take that stuff anymore, I’m going to switch over to marijuana,’” said Dr. Michael Delman, president of the New York Society of Addiction Medicine.
The Medical Society of the State of New York expressed similar sentiments in an Aug.
16 letter to state Health Commissioner Howard Zucker, as did the Alcoholism and Substance Abuse Providers of New York State last week when it urged the state to send a clear message to the public that medical marijuana is not a suitable replacement for more established treatments like those listed above.
“It is critical that funding be dedicated to educate physicians and treatment professionals about this new law as well as the public at large, so that we do not increase the likelihood of relapse and overdose,” said John Coppola, executive director of the association. “The public should be able to trust that the treatment made available with state funding is evidencebased and effective. We have no basis to promise either as it relates to the use of marijuana to treat opioid misuse disorders.”
Response to epidemic
The state Department of Health on Tuesday defended the new law, enacted this month, which added opioid use disorder to the list of conditions for which health care providers can prescribe medical marijuana in New York. It cited early research suggesting certain formulations of cannabis may be effective at treating opioid use disorder.
“New York state is committed to exploring multiple and diverse options to combat the opioid epidemic, which is damaging so many lives throughout the country,” department spokeswoman Jill Montag said. “The Department of Health added opioid replacement and opioid use disorder to the list ... to give practitioners an alternative to prescribing opioids. The department does not advise patients or their health care practitioners regarding the most appropriate treatment option for the patient’s condition.”
Public health officials have become increasingly desperate to stem the rising tide of deaths from opioids, which have been at epidemic levels nationwide for roughly two decades now and show no signs of slowing. In 2016, more than 3,000 New Yorkers died of opioid overdoses, up from over 1,000 deaths in 2010.
Seeking evidence
Some medical professionals and addiction treatment providers question whether there’s really any evidence that marijuana could help curb these deaths.
One popular theory, supported by small-scale studies and passionate testimonials from chronic pain patients, is that when substituted for opioids, marijuana use relieves pain and carries a much smaller chance of dependence or overdose.
Several recent studies seemed to reinforce this idea, noting a positive correlation between states with medical marijuana programs and states with lower rates of opioid deaths and prescriptions.
But the response to those studies has been divided. Marijuana proponents cite them to support the argument that marijuana is a far safer alternative to opioids for pain treatment. Opponents, however, note the studies are not definitive and caution against drawing conclusions or enacting policy from them.
New York health officials and lawmakers cited these studies as justification for the new law. They also pointed to early research that’s come out on the role of cannabis in treating opioid addiction, though few studies have been conducted on humans due to marijuana’s classification as a Schedule I drug under federal law.
Among studies that have been performed on humans and animals, researchers noted that an active ingredient in cannabis known as cannabidiol, or CBD, seemed to reduce cravings and anxiety that contribute to heroin-seeking behavior.
Can it hurt?
But more rigorous studies and clinical trials regarding cannabis will be difficult to conduct until federal restrictions on the drug are lifted, researchers say.
To some in the medical and addiction fields, such research must be completed and sufficient evidence provided before states like New York start passing laws that will increase the availability of marijuana. One reason, according to Thomas Madejski, president of the state Medical Society, is that marijuana could worsen underlying psychiatric conditions in opioid-addicted patients.
“MSSNY is concerned that this untested method of treatment will result in patient harm even in certified (treatment) programs,” he said.
Another concern is that increasing the availability of an untested drug to a vulnerable population could possibly worsen the drug epidemic, given marijuana’s oft-debated status as a “gateway” to harder drugs.
“There’s absolutely no scientific evidence that marijuana use is in any way of value in preventing opioid addiction or in treating it,” said Delman. “And indeed the current literature shows that people who use marijuana are more likely to use other agents — illicit or otherwise. So that becomes a major problem, especially as it relates to our youth.”