Pubdate: Sun, 31 Aug 2014
Source: Baltimore Sun (MD)
Copyright: 2014 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Melissa Healy, Tribune Newspapers
Page: 11

STUDY: MEDICAL POT MAY HELP OPIATE ABUSE

Painkiller Overdoses Fell in States With Legal Marijuana, Study Finds

Could medical marijuana be an antidote for the nation's scourge of 
fatal overdoses caused by prescription pain medication? A new study 
suggests the answer is yes, and it's set off a flurry of medical 
debate over the risks and benefits of making cannabis more widely 
available to patients.

The new research, published Monday in the journal JAMA Internal 
Medicine, finds that deaths associated with the use of opiate drugs 
fell in 13 states after they legalized medical marijuana. Compared to 
states with no formal access to marijuana, those that allowed certain 
patients legal access to cannabis saw a steady drop in opiate-related 
overdoses that reached 33 percent, on average, six years after the 
states' medical marijuana laws took effect.

"The striking implication is that medical marijuana laws, when 
implemented, may represent a promising approach for stemming runaway 
rates of nonintentional opioid-analgesic-related deaths," wrote 
opiate abuse researchers Dr. Mark S. Brown and Marie J. Hayes in a 
commentary published alongside the study. "If true, this finding 
upsets the apple cart of conventional wisdom regarding the public 
health implications of marijuana legalizations and medicinal usefulness."

That apple cart has already been shaken by a growing body of research 
that suggests marijuana's psychoactive ingredients may enhance the 
pain-killing effects of opiate drugs, allowing patients using 
marijuana for pain to take lower - and less dangerous - doses of 
opiate medications.

"It's so apparent that our patients can decrease, diminish or wean 
themselves completely off of opiates, and that it improves their 
quality of life," said Dr. Donald Abrams, a University of California, 
San Francisco oncologist who was not involved with the study.

In a small study published in 2011, Abrams found that cancer patients 
taking morphine and oxycodone experienced greater pain relief at 
lower opiate blood concentrations when a vaporized form of marijuana 
was added to their drug regimen.

He has just begun recruiting for a study that will explore whether 
the same formulation can reduce pain, inflammation and opiate doses 
in patients with sickle-cell disease.

But those who have opposed expanding access to medical marijuana said 
they were not persuaded that cannabis - a plant designated by the 
Drug Enforcement Agency as having "no recognized medicinal use" - is 
a safer alternative to opioids.

"Clearly the study raised an intriguing hypothesis, but many 
questions still need to be answered," the National Institute on Drug 
Abuse said in a statement released Monday. The analysis "should not 
be oversimplified," the statement warned.

Patients in 23 states and the District of Columbia now have the 
option of seeking a prescription for medical marijuana. (Two of those 
states, Colorado and Washington, also allow recreational use of the 
drug.) Chronic pain is thought to be the leading indication for cannabis use.

The study authors, led by the University of Pennsylvania's Dr. Marcus 
A. Bachhuber, focused on the years 1999 to 2010. The raw figures 
collected from states' death certificates showed that rates of fatal 
opioid overdoses were higher in the states that had implemented 
medical marijuana laws than in those that had not.

But the researchers took those raw numbers and adjusted them so that 
it would be easier to make direct comparisons between the states. For 
instance, they accounted for the fact that each of the states that 
legalized medical marijuana during the study period did so on 
different schedules. In addition, they took into account a wide range 
of factors known to influence opioid abuse, including state 
unemployment rates and policies tightening access to prescription painkillers.

The results showed that after a state began to implement a medical 
marijuana law, the rate of its non-intentional opiate overdose 
fatalities fell compared to those of states without such laws.

And that comparative decline picked up steam over the first six years 
after the laws went into effect. On average, the statistical analysis 
showed, states passing medical marijuana laws saw annual reductions 
of roughly 25 percent in their opioid-related death rates compared to 
states with no such laws.

In their first year after implementation of the laws, the 13 states 
averaged an opiate-related fatality rate 20 percent lower than those 
of states without legalized medical marijuana. The average difference 
between the two groups of states widened at two and three years out, 
returned to 20 percent in year four, then rose to just over 33 
percent in years five and six.

About 60 percent of the nation's fatal opioid overdoses occur among 
patients who have legitimate prescriptions for their medications. The 
authors wrote that in states where access to medical marijuana is 
legal, legitimate opioid drug users may take lower doses of that 
prescription pain medication, making overdose less likely.

Others may use marijuana in place of benzodiazepine drugs - sedatives 
that make a fatal overdose much more likely. Still other patients who 
might initiate opioid medication use - and go on to risk overdose - 
may never start if they are able to get pain relief from medical 
marijuana, the study authors wrote.

"That connection may be intrinsically appealing - some might view the 
idea that people could use a milder drug versus an opiate as an 
improvement," said Kevin Sabet, director of the University of Florida 
Drug Policy Institute, in a statement. But the new study suffers from 
"too many uncertainties" to allow that conclusion, he said.

Dr. Mark Ware, a pain specialist and professor of family medicine at 
McGill University in Montreal, called the JAMA Internal Medicine 
study "very interesting, and methodologically robust." But, he added, 
"there's probably a temptation to extend the findings of this study 
to far broader conclusions than are justified."

The United States "is conducting a natural experiment" on a national 
scale, said Ware, who is executive director for the Canadian 
Consortium for the Investigation of Cannabinoids, an advocate for 
more research on marijuana's medical potential.

Before physicians and government officials can draw conclusions on 
the public health benefits of medical marijuana laws, he said, they 
need more detailed studies of how medical marijuana users take the 
drug and how its use affects physicians' prescribing decisions, 
especially for patients with chronic pain.
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MAP posted-by: Jay Bergstrom