Pubdate: Wed, 04 Apr 2018
Source: Vancouver Courier (CN BC)
Copyright: 2018 Vancouver Courier
Author: Sasa Lakic


Studies show controlled drug use can reduce consumption of street

As the opioid crisis rages on across North America, a number of recent
studies are pointing to cannabis and prescription heroin as viable
options in curbing the consumption of lethal street opiates, reducing
long-term medical and policing costs and extending the lives of users.

An analysis of opioid prescriptions in the U.S.published on Monday by
the American Medical Association showed a significant decrease in
opioid prescriptions in states that have adopted some sort of cannabis
legislation. Using data from 2010 to 2015, the analysis counted 3.7
million fewer daily doses of opioids prescribed in states that allow
weed dispensaries, while states that allow only home cultivation saw a
decrease of 1.8 million daily prescribed doses.

"Most opioid overdoses are associated with legitimate opioid
prescriptions," researchers wrote. "A growing consensus suggests that
cannabis can be used to effectively manage pain in some patients. If
initial licit prescriptions for opioids can be reduced, then there is
a plausible theoretical pathway to anticipate that opioid misuse and
abuse could also fall."

One report paper by Centre for Health Evaluation and Outcome Sciences
(CHEOS) published in the journal Addiction in late March looked at the
economic effects of the Study to Assess Long-term Opioid Maintenance
Effectiveness (SALOME) trials in Vancouver's Downtown Eastside. The
authors found that substituting street opiates with either
hydromorphone or diacetylmorphine (prescription heroin) may be
costlier than traditional methadone use, but in the long-run drug
users were not committing as many crimes to support their habit.
According the report, this can result in societal savings of $140,000
per patient, while prolonging the lives of people whose life
expectancy is relatively short by an average of three years.

"Our findings suggest therefore, that [hydromorphone] could be an
attractive use of health-care resources from the societal perspective,
if prices for [hydromorphone] can be negotiated effectively to reflect
its value," the researchers wrote.

Nick Bansback, associate professor at UBC's School of Population and
Public Health and one of the report's authors, said the results of his
economic analysis of the SALOME trials show that such harm reduction
policies save money in the long run.

"We spend lots of money on new drugs, which have marginal benefit and
add those to our formularies," Bansback said. "And when I look at
[hydromorphone therapy]Â… which has quite considerable benefitÂ… from a
tax payer perspective [it] saves us money."

Mayor Gregor Robertson has called for decriminalizing possession of
illicit drugs alongside new ways of treating those with opioid
addiction after Canada's public health agency estimated that roughly
4,000 people in Canada died of an overdose in 2017, mostly from opioids.

For its part, the federal government relaxed rules for prescribing
methadone and pharmaceutical heroin in late March. Health Canada also
announced it will put money towards finding new approaches to
treatment of opioid use, for which the Canadian Institutes of Health
Research will be responsible.

In an email, CIHR's media spokesperson David Coulombe said research
funding to the tune of $1.4 million will fund 14 projects to inform
upcoming cannabis legalization, including studying the plant's
products as a harm reduction method for opioid users. One of those
research projects at McMaster University has looked into how cannabis
can be used as an "exit drug" for almost 1,400 opioid users.

"This funding opportunity is designed to serve as an initial step in
laying the foundation for future studies on the impact of cannabis
legalization in Canada," Coulombe wrote.

He added that there is an additional $1.9 million for 22 projects to
work together with workers on the front lines of the opioid crisis "to
identify knowledge gaps and synthesize the opioid-related literature,
in order to rapidly enable evidence-informed decisions in Canadian
policy and practice."

In an on-going program in the Downtown Eastside, medical dispensary My
Eden and the BCCSU are studying the effects of substituting street
opiates with cannabis oil. Though the study is limited in size, with
only 16 subjects partaking since the start in January, Denise Brennan,
the program's director, said many of the participants have experienced
an increased quality of life.

One of the participants, she said, managed to reduce his alcohol
consumption by 60 per cent, which has prompted her to expand the
research team to focus on treatment of alcoholism, especially in First
Nations communities. She added the goal of the program is not complete
abstinence or sobriety, but harm reduction.

"It's specifically about reducing the usage part, which kind of
implies cravings, so one of the items in the opiate study is
essentially to head off withdrawal symptoms," Brennan said, adding
that study subjects are given two pills containing 25mg of
tetrahydrocannabinol (THC) oil a week and then questioned for the
effects. "Our feedback on that is that indeed it heads off withdrawal
symptoms, so people are able to go longer between opiate ingestion
because they're not getting the kicks."
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