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Could Medical Marijuana Be the Answer to America’s Opioid Crisis?

Over the past year, opioids have killed more people across America than car accidents, guns or breast cancer. With up to 175 men and women falling victim to these drugs every day, this country’s long-festering addiction to prescription painkillers has finally grown into a full-blown epidemic. Yet even as entire communities are decimated by medications like oxycodone and hydrocodone or cheaper, illicit alternatives like heroin; the public response has been decidedly muted.

When death tolls from the AIDS crisis hit similar levels in the 1980’s, millions of people took to the streets in an effort to compel law makers to take much-needed action to curb the mortality rate. Unfortunately, the persistent stigma surrounding opioid addictions has prevented a similar outpouring of support against this growing epidemic. Even as experts predict up to 500,000 more deaths over the coming decade, only 10% of the estimated 2.6 million opioid addicts throughout the country have access to suitable treatment programs.

WHAT’S BEING DONE?
Lawmakers have traditionally been slow to react when it comes to nationwide healthcare problems. Even with the much more highly publicized AIDS epidemic, it wasn’t until 1990 that legislators actually got together to take concerted steps towards resolving the issue. However, after the establishment of the Ryan Care Act things did change, as billions of government dollars were pumped into medical research, prevention, support services and compulsory treatment programs administered through Medicare and Medicaid. Eventually, this increase in funding led to the development of a highly effective new class of anti-retroviral treatments that led to a drastic fall in AIDS-related deaths across the world.

But when it comes to opioids, only a couple of billion dollars have been dedicated to the problem thus far, with nowhere near the same coordination between federal, state and local bodies and healthcare providers. Indeed, a study from the Journal of Hospital Medicine showed that over half of non-surgical hospital patients are still being prescribed opioids over the duration of their stay.

Although doctors have been writing fewer opioid prescriptions over the past couple of years, and law enforcement agencies have begun cracking down on pain clinics where these drugs are prescribed fraudulently in exchange for cash. This fall in prescriptions has only led addicts towards far more dangerous alternatives like heroin and the Chinese-made fentanyl. The latter is widely considered to be up to 50 times more potent than heroin, in fact the drug is strong that it’s virtually impossible to dose correctly when pure. In most cases addicts have to cut the drug with a variety of other substances in order to make it safe enough to actually inject.

A COMPREHENSIVE PLAN
It’s clear that this sort of piecemeal approach to regulation will have little effect on such a complex, wide-ranging issue. Recently, experts have proposed a more comprehensive approach which includes recommendations such as:

· Requiring doctors to gain special certifications before they can prescribe opioids.

· Limiting the size of opioid prescriptions.

· Have insurance providers limit coverage for prescription opioids.

· Launch strong regulations controlling the pharmaceutical manufacturers that are turning a blind eye to blatant misuse of opioids.

· Get addicts into treatment and recovery programs rather than prisons.

· Increase access to medications like buprenorphine, methadone, and naltrexone that have been proven to help patients recover from opioid cravings.

· Increase investment in pain management.

THE OPIOID CRISIS IS ROOTED IN PAIN MANAGEMENT
At last count an estimated 100 million Americans, struggle with the inescapable reality of chronic pain. Usually, this pain is a result of serious, long-term conditions that are impossible to cure completely. Traditionally, powerful prescription opioids have been a frontline tool in the management of these symptoms. For years, many physicians and patients even worked under the misconception that these painkillers were largely non-addictive and as prescribed them in ever greater numbers. As a result, opioids became easily accessible to everyone from injured high school football players to stay-at-home moms recovering from dental treatments. With no oversight, and endless supply the opioid crisis quickly took hold in homes across the nation.

The truth is that medical professional bore little responsibility for the epidemic. As patients clamored for pain mainstream American medical schools offered scarce training in long-term pain management. As a result, doctors were largely ignorant to any alternatives already existing in the marketplace. Today, these same bodies are finally starting to take steps the change that reality. In March, the American College of Emergency Physicians (AMCP), introduced two bills in Congress in an effort to promote alternative pain management protocols. The Alternatives to Opioids in the Emergency Department Act (ALTO) proposes an investment of $30 million in alternative treatments that could greatly reduce the use of opioids in medical care.

IS MEDICAL MARIJUANA THE NEXT STEP IN PAIN MANAGEMENT?
Perhaps that level of investment isn’t entirely necessary. There may well be an easily accessible treatment that can provide all the benefits of opioids without any of the side effects. Recently, the American Medical Association’s Internal Medicine magazine published an article that looked at the findings of two massive studies into a painkiller that was proving to be highly effective in curbing opioid prescriptions; marijuana.

The first of these two studies looked at whether loosening marijuana legislations across the country had any effect on the level of opioid prescriptions for Medicaid enrollees between 2011 and 2016. The results were definitive, in areas where medical marijuana had been legalized; opioid prescriptions were seen to drop by at least 6%, with another 6% drop seen in regions where recreational marijuana had also been made legal.

Meanwhile the second study looked at the number of opioid prescriptions for elderly patients (65 and over), in areas where medical marijuana had been legalized. Here, the findings were even more staggering. In total, opioid prescriptions filed through Medicare dropped by an average of 23 million daily doses per year in States where medical marijuana had been legalized. This effect was even more marked in States where specialized dispensaries had been set up for easy distribution of marijuana. For W. David Bradford, one of the researchers who carried out the second study the conclusion was obvious. The weight of evidence in favor of medical marijuana for pain treatment now necessitated that physician’s should include the drug within their regular pain management protocols.

While highly publicized, these studies weren’t the only ones extolling the numerous benefits of marijuana legislation. Research carried out by Professor Daniel Clauw at the University of Michigan showed that medical marijuana could provide surprisingly effective in the treatment of patients suffering from chronic pain. In a 2-year study of medical cannabis patients, Clauw found that test subjects reported 64% lower incidences of opioid use in those suffering from chronic pain. The drug was also associated with an overall better quality of life amongst these patients. The study also showed that these patients were experiencing almost no side effects from their new pain management system and in fact, where using less medications overall.

Patients Prefer It
For their part, patients too seem to be on board. A North American survey of medical marijuana users indicated that the vast majority of respondents had a clear preference for cannabis over opioids. Meanwhile, 80% of medical marijuana patients in California said that using cannabis alone proved more effective for their pain management than using the drug in conjunction with prescription opioids. Over 90% of respondents admitted that they would choose medical marijuana over prescription painkillers if given the choice.

Even patient who have turned to illicit drugs for their pain management have reported on the benefits of medical marijuana. A survey of heroin users in California revealed that patients who reported higher cannabis use also indicated lowered signs of opioid abuse.

HOW MEDICAL MARIJUANA WORKS
One of the biggest problems with pain management is that pain is a highly subjective sensation. In many cases these sensations may not even be clearly linked to any sort of physical ailment, because pain is primarily experienced as a reaction through the brain. As a result, one person’s experience of pain can differ greatly from another’s, even if both of them have the same condition.

Opioids work by bonding to specific receptors in the brain which are responsible for creating feelings of euphoria and relief. Effectively, these chemicals block your brain from creating the sensation of pain. Unfortunately, the brain’s receptors can quickly become conditioned to accept these chemicals causing patients to increase their dosages over time in order to get the same feelings of relief. When this process continues unchecked, the result is often addiction.

Less dangerous pain management treatments such as NSAIDs and acetaminophen (Tylenol) work in a similar manner to block chemicals from triggering pain responses throughout your body.

However, medical marijuana works through a completely different path. When inhaled or consumed it incites peripheral pain receptors throughout the body that are highly sensitive to cannabinoids. These receptors have been further identified as CB1, which is mostly found in the nervous system, connecting tissues, glands, and organs; and CB2, seen predominantly in the immune system and linked structures. Instead of reducing actual sensations of pain, medical marijuana regulates the emotional reaction to pain, allowing patients, to deal with these sensations in a far more effective manner. This alternative treatment path prevents medical marijuana from becoming physically addictive like opioids.

Of course, these advantages can be highly variable. Currently, the most believable study into the actual clinical effects of medical marijuana was conducted on a group of 10 advanced cancer patients that had previously proved to be highly resistant to opioid treatments. These 10 patients were provided with THC pills in a number of different doses ranging from 5 milligrams to 20 milligrams. While patients indicated minimal pain relief at lower dosages, at dosages of 15-20 milligrams each individual reported significant pain relief. However, some patients reported that they simply felt calmer but experienced the same levels of pain, while others said that the level of pain had not changed but the intensity of the sensation had lessened.

Reported side effects included disorientation, temporary immobility and in some cases anxiety although on the whole patients reported a greater sense of well-being after taking THC compared to codeine.

THE EFFECTS
In the State of West Virginia, where at one point opioids had been prescribed at levels which actually exceeded the number of residents in certain counties, lawmakers were paying attention. Last year the State Governor signed a Medical Cannabis Act into effect, to provide legal medical marijuana access as a possible new method of pain treatment.

Of course, not every legislator shares the same instinct towards the common good. Current Attorney General, Jeff Sessions is an avowed critic of medical marijuana legislation, even going so far as to say the following, in a speech back in March.

"I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana—so people can trade one life-wrecking dependency for another that’s only slightly less awful.”

Mr. Sessions has further gone on to criticize legislations protecting medical marijuana users that were initiated during the Obama administration.

Despite these efforts from certain government hold-outs, it seems as if the march of progress is inevitable. In 2016, the Compassionate Care Act regulating medical marijuana in the state was amended to allow licensed to be issued for patients suffering from chronic pain, in November 2017 of the following year PTSD was added to the list of qualifying conditions. Public opinion too seems to be on the side of loose regulations, a recent poll showed that a 88% of New Yorkers favor more relaxed medical marijuana legislations.

ARE YOU SUFFERING FROM CHRONIC PAIN?

At MMR-NY we’re set up to help chronically ill patients gain access to medical marijuana in New York, conveniently and affordably. Our qualified practitioners can perform a comprehensive assessment and set you on the path to gaining your medical marijuana license in just one remote appointment. Contact Lauraine Kanders NP today, to find out more 516-570-7565.

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Lauraine Kanders

About Lauraine Kanders

Lauraine Kanders is a Board Certified Nurse Practitioner and NYS Medical Marijuana Practitioner with 25 years+ of experience in adult health and acute care. She operates a telemedicine practice to certify patients for medical marijuana in New York State who suffer from approved severe, chronic, debilitating and severe conditions . Her inspiration for this business came about while working with her primary care house call patient population.