Pubdate: Sat, 03 Mar 2018
Source: Boston Globe (MA)
Copyright: 2018 Globe Newspaper Company
Author: Kevin P. Hill, New York Times


The United States is the midst of an opioid crisis. Ninety Americans
die each day from opioid overdoses on prescription opioids, heroin, or
fentanyl, and Massachusetts has not been spared. Many states are using
the best available tools to battle the crisis, with an eye on
developing better science and policy to put an end to the crisis. As
more states implement either medical or legalized recreational
cannabis policies, they should consider whether cannabis can play a
role in the opioid crisis.

The evidence suggests that it might. For years, patients with chronic
pain have reported that medical cannabis reduces the need to manage
their pain with opioids. This anecdotal evidence is supported by a
growing body of literature published in top scientific journals,
including Health Affairs and the American Journal of Public Health.
The scientific rationale for a relationship between cannabis and
opioids is not new - cannabinoid and opioid receptors affect common
brain pathways for pain and addiction.

Recent research has shown that medical or recreational cannabis
policies are associated with decreased opioid use and overdoses, and
deaths by overdose. A review in Health Affairs of Medicare Part D
prescription data from 2010 to 2013 revealed a significant decline in
pain medication prescriptions in states with medical cannabis laws
compared to those without. Another study, published in the American
Journal of Public Health, found that medical cannabis laws were
associated with a 25 percent reduction in opioid overdose deaths.
These findings were echoed by an analysis of monthly opioid-related
deaths before and after the legalization of recreational cannabis in
Colorado that demonstrated a significant reduction in opioid-related
deaths after legalization.

Cannabis is a polarizing topic, though, so some disagree about a
possible role for cannabis in the opioid crisis. The President's
Commission on Combating Drug Addiction and the Opioid Crisis chastised
"an active movement to promote the use of marijuana as an alternative
medication for chronic pain and as a treatment for opioid addiction,"
warning of an "uninformed rush to put another drug legally on the
market in the midst of an overdose epidemic." But the commission
conflated chronic pain and addiction. The evidence is building for
cannabis as a tool to treat chronic pain, while there are no studies
at this time that demonstrate cannabis as a treatment for opioid
addiction. Cannabis use is not without risk - the effects of chronic
heavy use include cognitive difficulties and addiction - but the
promising results in the context of the opioid crisis should stimulate
cannabis research, not slow it down.

Attorney General Jeff Sessions' decision to afford US attorneys full
discretion to enforce federal prohibition on marijuana will further
stymie critically needed research. After threatening action for
months, Sessions turned the legal cannabis landscape upside down by
abandoning the Cole Memorandum, issued during the Obama
administration, which discouraged the use of federal resources to
prosecute those who abided by state cannabis laws. Sessions' action
will likely hinder all activities related to cannabis, including research.

Unfortunately, cannabis research has not kept pace with cannabis
policy. Many on either side of the cannabis debate have highlighted
the need for research to evaluate medical uses or safety issues prior
to state votes, but research is rarely a priority afterwards. For
example, the Massachusetts Cannabis Control Commission requested over
$7.5 million for fiscal year 2018, but only $70,000 - less than 1
percent - for "mandated research."

Everyone wants to put an end to the opioid crisis. The solution will
likely have many parts; rigorous science will have to be a piece of
it. This means we must rely upon the available evidence while pushing
for more research. The evidence currently suggests a possible role for
cannabis in addressing a part of the opioid crisis. We must aim to be
evidence-based, not ideologically based, in order to clarify that role.

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Dr. Kevin P. Hill is director of the Division of Addiction Psychiatry at 
Beth Israel Deaconess Medical Center, assistant professor of psychiatry 
at Harvard Medical School, and author of "Marijuana: The Unbiased Truth 
about the World's Most Popular Weed."
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