Elizabeth Warren’s call for the study of marijuana as a possible solution to alleviating our nation’s opioid epidemic garnered quite a bit of press as the respected progressive generates headlines for just about every policy position she takes, she even makes news when she doesn’t take a position. It caught my eye that a Roseburg, Oregon, Psychiatrist penned a Huffington Post oped supporting Warren as I’m afraid that too many Oregon patients will lose their access to medical cannabis due to recent regulations. Since most medical marijuana patients suffer from severe pain, I’m worried that we will see an increase in cases of opioid addiction, complications and deaths.
In the context of the epidemic of deaths by opiate overdose, an important study was published in 2014 in The Archives of Internal Medicine. It was found that in states in which marijuana has been made legal for medical purposes, including the treatment of pain, the numbers of deaths by overdose of opioid pain medications have dropped dramatically. They saw 24.8% lower mean annual opioid overdose mortality rates compared with states without medical marijuana allowances.
Some have dismissed that study as being merely statistical, and that it did not reveal what happened to specific individuals nor suggest any mechanism by which the access to and use of marijuana could have generated such effects. However, a new study by Dr. Simon Haroutounian of the Washington University School of Medicine, supports and helps explain the results of that study. In this study, individuals with severe, treatment resistant pain were allowed to supplement their only partially effective opiate pain medications with marijuana. The results showed the expected, modest additional pain relief with the marijuana. However, perhaps the most significant result was that by the end of the study 44% of the subjects had, on their own, stopped using opiates altogether, and many of those that continued the pain medications had reduced their intake. This would explain how the numbers of deaths by overdose of opiates is so greatly reduced in states that allow medical marijuana use.
No medication is harmless or without risk of side effects. However, to the best of my knowledge there are no reports in the literature of lethal or life-threatening effects of marijuana. In fact, as a psychiatrist who regularly prescribes medications such as lithium, clozapine, tricyclic antidepressants, and monoamine oxidase inhibitors, all of which can have lethal effects if not managed properly, I find it ironic that the relatively minor side effects of marijuana have aroused such great concern among those opposed to greater utilization of marijuana. Thus, I wish to support Senator Warren’s encouragement of the scientific community to pursue marijuana as treatment for pain and as a means to reduce the tragic increases in deaths by opiate overdose.
When we wrote the Measure 91 legalization measure, for which I was honored to serve as chief petitioner, we included language noting that the new law wouldn’t change the Oregon Medical Marijuana Act (OMMA). While M91 didn’t impact the OMMA, new legislation passed by the Oregon Legislature added new rules and regulations, making it difficult, if not impossible, for some existing medical growers to supply medicine to all of the patients they have been supplying over the years.
Now that it is legal for growers, retailers, wholesalers and processors to engage in commerce, the state has taken steps to impose rules and regulations to ensure public safety and discourage illicit activity. Many of these regulations are necessary and reasonable to follow the federal Cole Memo and protect the best interests of the state. There have been some bad apples who have abused the OMMA, as well as subsequent bad press, and it was only a matter of time before state officials clamped down on completely unregulated marijuana farms.
Some well-meaning laws sometimes have unfortunate, unintentional consequences. The need for regulation needs to be balanced against the health needs of sick and disabled patients and continually monitored. Patients battling poverty don’t have the means to hire high-priced lobbyists, so concerned citizens must remain vigilant.
If farmers are subjected to sensible regulations that track cannabis from seed (or clone) to sale (or donation), then why should compassionate farmers be forbidden from cultivating 96 (or 192) plants for 16 (or 32) patients on land that is zoned properly and neighbors don’t mind? Unfortunately, new rules will limit some medical grows to just 48 plants, limiting how many patients that can be assisted.
Medical marijuana might be a viable alternative to opioids for pain treatment, but truthfully, there’s a lot we just don’t know.
— Elizabeth Warren (@SenWarren) February 25, 2016
Hopefully, the state will take further steps in future legislative sessions to both allow compassionate farmers to assist patients and establish a fund to assist low-income medical cannabis patients, just as the government does for prescription drugs and food assistance programs. As Elizabeth Warren has advocated, medical cannabis may be a positive tool to help decrease the harmful consequences of opioid abuse. If you are a patient or grower, who wants to share your story (including off-the-record about the difficulty that new rules and regulations have caused you, please email me at email@example.com.