Thomas J. Rachko Jr., MPA Staff Writer, Brief Policy Perspectives 

An advertisement displayed on a bikeshare dock near GW’s campus proclaims “Choose Plants Over Pills.” The advertisement is part of an educational series created by the National Holistic Healing Center, a Washington, D.C. and Maryland-based medical cannabis dispensary. The dispensary aims to share “both the anecdotal and scientific evidence showing how medical cannabis can drastically improve the Opioid Epidemic in the United States.” The Center for Disease Control and Prevention reports that 47,000 people died due to opioid overdose in 2017 and that more than a third of these deaths “involved prescription opioids.” Should policymakers allow people seeking pain management solutions to choose plants over pills?

The State of Medical Cannabis Policy in the U.S.

Washington, D.C. and thirty-three states in the U.S. have legalized medical cannabis to some degree, usually for a specified set of medical conditions. Missouri and Utah legalized it most recently through ballot initiatives in the 2018 midterm elections. Some states, including New York and Illinois, recently passed legislation that expands access to medical cannabis by allowing doctors to prescribe it as an alternative to opioids for pain management.

In summer 2018, the Food and Drug Administration (FDA) approved Epidiolex, the first federally-approved drug containing a purified substance derived from marijuana. Yet, the Drug Enforcement Administration still considers cannabis a “Schedule I drug,” defined as a drug that has high potential for abuse and no currently accepted medical value. Federal prohibition continues to impede patient access to medical cannabis and limits further research.

Evidence of Cannabis Efficacy in Pain Management

In a 2017 report, the National Academies of Sciences, Engineering, and Medicine reviewed decades of relevant literature on the health effects of cannabis and found that there is “substantial evidence” that cannabis is an effective treatment for chronic pain, a condition that leads patients to seek relief using prescription opioids. The authors note that “for this level of evidence…a firm conclusion can be made, but minor limitations, including chance, bias, and confounding factors, cannot be ruled out with reasonable confidence.” Additionally, media outlets have documented anecdotal evidence from patients attesting to cannabis’ role in relieving pain.

Studies Show Correlation Between Medical Cannabis Legalization and Reduced Overdose Mortality Rates

While substantial evidence supports the use of medical cannabis for the effective treatment of chronic pain, research has also investigated the impact of marijuana legalization on combating the public health epidemic of opioid addiction. Several studies in the journal JAMA Internal Medicine show a correlation between states that permit medical cannabis use and states that have seen a recent reduction in opioid prescriptions and related overdose mortality rates. A 2016 survey published in the American Pain Society’s The Journal of Pain found that medical cannabis users with chronic pain reported reduced opiate use and better quality of life. The authors of studies that examine this association are keen to note that this correlation does not prove causation and that more research is needed.

Some health advocates are skeptical that cannabis will play a large role in alleviating the opioid epidemic. Critics of this approach suggest that policymakers should focus on more heavily researched and politically feasible responses, such as medication assisted treatment and syringe exchange programs.

However, the severity of the opioid overdose epidemic calls for a variety of alternative pain management solutions. More Americans are are dying than ever before due to drug overdose, in part as a consequence of the opioid epidemic. Medical cannabis is not a singular or perfect solution, but rather one of several legitimate, evidence-based solutions. Medical cannabis presents one more promising and, most importantly, non-lethal alternative in policymakers’ toolkits.

Along with urgently needed social and reparative justice policy solutions pushed forth in the liberalization of cannabis policies, a continued public health approach can further explore cannabis’ role in the opioid overdose epidemic. The US government must assess the evidence and consider descheduling and decriminalizing the use and possession of cannabis so that more research can be done and so that patients can have access to what research shows can be a viable, safe pain management alternative.