Philly420: Cannabis may offer relief in opiate crisis

Chris Goldstein as a marijuana activist living in New Jersey

Some legislators are looking to cannabis for potential relief in confronting an unprecedented opiate addiction epidemic.  Senator Daylin Leach (D) mentioned the possibility during a Sept. 9 Philadelphia City Council hearing on Pennsylvania's medical cannabis law.

Growing scientific evidence may support him.  However, the restrictive cannabis program being implemented in the Keystone State may not.

In 2014, Dr. Michael Bachhuber MD, the Robert Wood Johnson Clinical Scholar at the Philadelphia Veterans Affairs Medical Center, led a team that discovered something very significant about opioids that have resonated ever since. They found painkiller overdose deaths were 25 percent lower in states with medical cannabis. It changed the mainstream conversation.

Dr. Bachhuber explained in an interview with news@ JAMA blog that something important was happening.  "Our study provides evidence of a possible unexpected public health benefit of medical marijuana legalization," he said.

"25 percent fewer overdose deaths ...," has since become a common catchphrase among legislators and advocates.

Missing from the landmark report were states with extremely limited laws, such as New Jersey.

Because they were looking at a ten year period from 1999-2010, the researchers studied states with robust programs such as California, Colorado and Oregon. Even states like Michigan had tens of thousands of registered cannabis patients at the time. All the states allow home cultivation and collective gardens.

New Jersey was the first of America's extremely over-regulated medical marijuana programs. It was signed in 2010 and handed to newly inaugurated Gov. Christie for implementation.

Christie's insiders micro-managed the program, which was also delayed by the N.J. Department of Health implementation process.  Moreover, some of Chris Christie's closest political allies ended up winning most of the six, coveted marijuana licenses.

Today there are five operating NJ dispensaries and less than 10,000 registered patients. Opiate addiction and overdose rates in the Garden State are three times above the national average.

Delaware, New York, Pennsylvania and Ohio all went on to pass medical cannabis laws with even further limitations than New Jersey. None of these states allow patients to keep a medical garden.

NY, PA and OH prohibit smoking and allow only edible oils, topical preparations, gelcaps and oils that can be vaporized in an e-cigarette. Whole plant cannabis remains off limits to patients.

Bachhuber's team also studied a group of states where any doctor can recommend cannabis therapy and patients register themselves.

The NJ, NY, PA and OH laws and regulations require physicians to meet certain requirements and register first. Patients must go through an approved doctor to get into the program. This has been a major bottleneck to getting patients signed up.

The National Bureau for Economic Research published data in 2015 that replicated Bachhuber's results on overdose deaths but also saw something new. NBER found that overall substance treatment admissions decreased in areas with cannabis dispensaries. The implication strongly suggests marijuana helps people exit addiction.

Yet, ever narrower medical cannabis laws are being passed here on the East Coast that limited access at every turn.

Earlier this year, researchers Ashley C. Bradford and W. David Bradford from the University of Georgia brought an impressive new perspective to the table when it comes to cannabis reducing pill use. Their abstract explains:

Using data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013, we found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly, once a medical marijuana law was implemented. National overall reductions in Medicare program and enrollee spending when states implemented medical marijuana laws were estimated to be $165.2 million per year in 2013. The availability of medical marijuana has a significant effect on prescribing patterns and spending in Medicare Part D.

This came as absolutely no surprise at all to those of us who had been around cannabis patients for years. People living with MS, cancer, HIV and chronic pain were the canaries-in-the-mine for what developed into our current prescription pill crisis. Once those patients could grow at home or had easy access to affordable cannabis, they were easing back on oxycontin without even trying.

At the same time, scientists and medical professionals had a tunnel-vision of sorts as they looked for data on how marijuana helped very specific conditions and symptoms. That's how the overall impact of reducing pills was almost overlooked.

Dr. Jahan Marcu studied the cannabinoid receptor system at Temple University and now advises Americans for Safe Access (ASA), a medical marijuana patient advocacy group. ASA has a white paper about cannabis alleviating opiate addiction.

"Administering THC-rich, whole plant cannabis along with an opiate cuts down on the short term 'rush' and helps to release the opiate over time," says Marcu. That may be why people use less pills when they have pot.

Amanda Reiman PhD even found that alcohol abuse was reduced in her survey of customers at Berkeley Patients Group, one of the longest running facilities in California. BPG is widely considered an industry standard with their patient-focused approach. The individuals surveyed at BPG had access for a condition, but many also made a conscious choice to use the plant to deal with a concurrent addiction.

"Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription and illicit drugs," concluded Reiman.

The key word is "substitution" because right now we need some rather immediate alternatives.

For the first time the Substance Abuse and Mental Health Services Administration (SAMHSA) collected data on prescription pills use alongside alcohol, tobacco and illicit drugs. The report released last week was a shock: 145 million Americans have been given very powerful and addictive drugs.

One in three Americans were prescribed a painkiller just last year.

What is being called an opiate epidemic actually goes much further. We are talking about sedatives, tranquilizers, anti-anxiety drugs, sleep aids and a whole array of pain meds.

These drugs were not sold on a street corner by an illegal cartel. They were developed and marketed by pharmaceutical companies, approved by the FDA and facilitated by insurance companies. These for-profit pills are the fuel rods that triggered America's current addiction meltdown.

Marijuana offers an alternative to that entire broken system.

Beyond the physiological methods of how cannabis helps addiction (and there are many), there is a more fundamental benefit. Doctors and the patients themselves have a chance to break free of the deadly cycle of pills.

If you follow the research a pattern emerges. Cannabis can help, but only if getting it is convenient and affordable. It takes ready access to whole plant marijuana, home cultivation and a wide variety of products for the reductions in addiction and substance dependence to materialize.

Pennsylvania and New Jersey are still enforcing marijuana prohibition, arresting tens of thousands of people every year for simple possession. States on the same path may actually suffer even more acutely during this addiction crisis.

"It's not just about having medical laws," says Dr. Marcu PhD, who's confident marijuana can be part of the solution, "it's about easy access to cannabis overall."