By Steve Bruns, MPP, Staff Writer, Brief Policy Perspectives
Attorney General Jeff Sessions recently delivered a two-word verdict on medical marijuana as an antidote to the ever-growing opioid epidemic: “it’s stupid.” However, there are a lot of smart people who, based on a growing body of clinical research, would confidently disagree with Mr. Sessions’ assessment.
To be sure, curbing opioid abuse by replacing opioid painkillers with marijuana is not without controversy. Still, the ongoing opioid epidemic begs for effective, evidence-based solutions that move beyond conventional attitudes about marijuana. Research shows medical marijuana to be a less harmful and more effective substitute for opioid painkillers. In considering ways to address the opioid epidemic, policymakers and administrators should consult the emerging literature on medical marijuana’s effectiveness and promote additional clinical research on marijuana’s medicinal benefits.
The dire consequences of failing to address the opioid epidemic are in themselves a solemn call to action. From 1999 to 2015, overdoses of opioids like Percocet, OxyContin, heroin, and fentanyl claimed the lives of more than 195,000 Americans, and the death toll has risen every year.
In 2015 alone, 33,000 people died from opioid overdose. To put this number into perspective, the HIV/AIDS epidemic caused 43,000 deaths at its height in 1995 (Figure 2). These consequences demand an effective response targeting the underlying cause of opioid addiction. As a potential solution, President Obama signed the 21st Century Cures Act into law in December 2016. The law provides $1 billion in public health funding over the next two years for states to address opioid abuse, primarily by increasing access to substance abuse treatment.
However, increasing access to drug treatment, while potentially helpful to those who are already addicted, does not consider why those suffering from addiction sought and received a prescription in the first place: pain. A 2011 report from the Institute of Medicine revealed that at least 116 million U.S. adults—more than the number affected by heart disease, diabetes, and cancer combined—suffer from common chronic pain conditions. Prescription painkillers have proven mostly ineffective in alleviating this widespread pain. There is a lack of high-quality scientific evidence showing that opioid painkillers can treat chronic, long-term pain while the evidence of painkillers’ serious side effects is substantial. Prolonged use is associated with a higher risk of addiction, overdose, and death. Broader population statistics offer intuitive proof of painkillers’ ineffectiveness: sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there has not been a significant reduction in the amount of pain Americans report. In fact, Americans’ pain has gotten worse: 37 percent of Americans reported chronic pain in 2010, up from 27 percent in 1998.
The Centers for Disease Control and Prevention released guidelines in 2015 emphasizing non-pharmaceutical treatment as the preferred intervention for pain reduction and management. For instance, cognitive behavioral and exercise therapy can reduce pain and improve function for those who suffer from chronic lower back pain. However, despite positive outcomes, such therapies are not often covered by insurance, and access and cost can be barriers for patients.
For pain sufferers who cannot access non-pharmaceutical treatment, medical marijuana may offer relief. In January the National Academies of Sciences, Engineering, and Medicine reviewed more than 10,000 studies to evaluate marijuana’s potential benefits and concluded that there’s “conclusive evidence” for marijuana as a treatment for chronic pain. However, they also found “substantial evidence” linking marijuana to nonfatal risks such as respiratory problems if smoked: schizophrenia and psychosis, car crashes, and lagging social achievement in life. It is worth noting that, in comparison to opioids, the literature does not connect marijuana use with serious health complications, such as overdose and death.
There is also strong evidence suggesting medical marijuana can directly reduce opioid abuse. Researchers at the Philadelphia Veterans Affairs Medical Center in Pennsylvania found that the annual rate of deaths due to overdose on an opioid painkiller was nearly 25% lower in states that permitted medical marijuana. In 2010, that translated into 1,729 fewer deaths in those states. Additionally, David Bradford, a health economist at the University of Georgia, co-authored a study showing the use of prescription painkillers dropped significantly for Medicare enrollees in states where medical marijuana was legal. Bradford remarked, “medical marijuana might help divert people away from the path where they would start using an opioid drug, and of course if they don’t start, they’re not on that path to misuse and abuse and potentially death.”
Despite the evidence in support of medical marijuana as an effective pain treatment, due to regulatory burdens, there is a relative dearth of evidence from more rigorous clinical trials. A meta-analysis published last year in the Journal of the American Medical Association found just 28 randomized clinical trials investigating cannabis as a treatment for chronic pain. Because the Drug Enforcement Agency (DEA) classifies marijuana as a Schedule I drug – a drug with high potential of abuse and no known medical benefits—researchers must contend with long waiting periods to receive approval for marijuana research. Further, they are required to upgrade laboratory infrastructure to meet strict requirements, such as installing secure narcotics cabinets for storing marijuana and special ventilation systems. Additionally, because whole plants and natural extracts cannot be patented, pharmaceutical companies have little incentive to pursue their own clinical studies. In the interest of fully exploring the benefits and drawbacks of medical marijuana as a painkiller, the DEA should reclassify marijuana to allow for less burdensome clinical testing and patent laws should be amended to incentivize drug companies to test and develop marijuana’s medicinal potential.
The opioid epidemic poses an existential threat to the individuals, families, and communities whose pain issues have led to serious addiction and drug abuse. In the face of such a threat, policymakers and members of the current administration who dismiss promising, evidence-based solutions are shirking their responsibility to the people they were elected to serve. Medical marijuana alone probably won’t fix America’s opioid problem, but it’s certainly not stupid to think it can help.