Pubdate: Tue, 26 Apr 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Author: Colleen Barry
Note: Colleen Barry is a professor at the Johns Hopkins Bloomberg 
School of Public Health and co-director of the Johns Hopkins Center 
for Mental Health and Addiction Policy Research.
Note: Second OPED in a group of four under the title, "Is Marijuana a 
Gateway Drug? Does using marijuana lead to the use of more dangerous 
drugs, making it too dangerous to legalize? "


While opioid pain relievers offer critical benefits to certain
patients, such as those with cancer-related pain, the rise of opioid
prescriptions has had devastating public health consequences. The
C.D.C. recently urged physicians to be very cautious in prescribing
these drugs.

Meanwhile, access to medical marijuana has expanded rapidly - 24
states and D.C. have legalized its broad medical use - and chronic or
severe pain is the most common condition reported among those using
it. On it's face, this might seem to mirror the rise in prescription
opioid use.

But using state-level death certificate data from 1999 to 2010, my
colleagues and I found that the annual rate of opioid overdose deaths
decreased substantially - by 25 percent on average - following the
passage of medical marijuana laws, compared to states that still had

Could medical marijuana be a safer alternative to opioids for chronic
pain management? If so, it would potentially reduce harms from opioid

Our study opened the door to that possibility, but it did not
establish the causal mechanisms by which marijuana might influence
overdose deaths and was conducted before the massive surge in heroin
use and related overdose deaths.

Our study should also not be used to tout the use of marijuana to
treat opioid addiction, a particularly upsetting misinterpretation, as
the limited evidence available points to the opposite being true:
Quitting marijuana may strengthen recovery for individuals with opioid
use disorders. Further research is needed.

Similarly, we don't know whether the legalization of marijuana for
recreational purposes will have an impact - positive or negative - on
nonmedical use of opioids and heroin. Again, evidence is lacking and
will likely depend on how recreational marijuana is regulated. But we
do know that marijuana dependence has been linked to numerous other
negative health consequences independent of opioids.

And if the opioid crisis has taught us anything, it should be that
careful regulation, stringent oversight and ongoing evaluation are all
absolutely essentially to establishing an environment that protects
the public's health.
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