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Can Medical Marijuana Fight the Opioid Epidemic?

In 2014, more people died from drug overdoses than in any other year on record. More than 6 out of 10 of these deaths involved opioids. These powerful medications are often prescribed to people for chronic pain relief, although they often fail at this purpose.

Where they do excel is in triggering addiction and subsequent overdose deaths — the rate of such deaths, including prescription opioid pain relievers and heroin, have nearly quadrupled since 1999.

According to a report from the U.S. Department of Health and Human Services, on an average day in the U.S. more than 650,000 opioid prescriptions are dispensed and 78 people die from a related overdose.

Further, each year $55 billion is spent in health and social costs related to prescription opioid abuse, and another $20 billion is spent in emergency department and in-patient care for opioid poisonings.

Could Medical Marijuana Replace Opioids as a Pain Reliever?

It’s clear that urgent action needs to be taken to fight the opioid epidemic, including finding safer, more effective options for pain relief.

Medical marijuana, which has far fewer side effects and is effective for pain relief, fits the bill, and a new study will finally pit the two against each other to test marijuana’s potential as a replacement.

This is newsworthy in itself, as hurdles to studying marijuana are immense. On a federal level, the herb is still considered a Schedule 1 controlled substance alongside other Schedule 1 drugs like heroin, LSD, Ecstasy, methaqualone and peyote.

Marijuana received this label in 1970 when the Controlled Substance Act was enacted. This act labeled marijuana as a drug with a "high potential for abuse" and "no accepted medical use" — the latter of which, in particular, is being increasingly disproven.

It’s a catch-22, however, because the Drug Enforcement Agency (DEA) has made it so difficult to conduct the marijuana research necessary to prove that it does have medicinal uses.

In the case of the upcoming study, which is being led by neuroscientist Emily Lindley at the University of Colorado’s Anschutz Medical Campus, it took two years to meet federal requirements imposed on researchers looking to study marijuana.

For instance, the university had to spend about $15,000 to create a secure storage facility to contain the marijuana being used in the study, lest it fall into the wrong hands.

Ironically, marijuana is legal in the state of Colorado, for both recreational and medicinal use, so anyone over the age of 21 can drive to a dispensary and purchase up to an ounce of the green herb, “no questions asked.”

As The Atlantic reported:

“The current status of medical marijuana research is rife with irony. As states have liberalized marijuana laws, they’ve created new opportunities: Lindley’s grant is part of $9 million Colorado awarded for medical research in 2014, using tax money from marijuana sales.

But since pot remains illegal at the federal level, researchers have to jump through regulatory hoops — lots of them — to do legitimate research.”

Opioid Overdose Deaths Decreased in States Where Marijuana Is Legal

Lindley’s study will involve 50 patients with chronic back and neck pain, who will receive marijuana, the opioid oxycodone or a placebo for their pain. They will be assessed for pain levels and treatment side effects in what will be the first study to directly compare marijuana with opioids for chronic pain relief.

The idea for the study came from a survey of University of Colorado Hospital Spine Center patients.

One-fifth of those who responded said they used marijuana for pain relief, and three-quarters of them said it worked as well as or better than opioid pain relievers.

There are other signs that marijuana makes sense for chronic pain sufferers as well. In states where medical marijuana is legal, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent after two years and up to 33 percent by years five and six.

Among seniors, legalizing marijuana resulted in a reduction in the use of prescription drugs “for which marijuana could serve,” according to a study published in Health Affairs, and even led to reductions in spending in Medicare Part D, which pays for prescription drugs.

Marijuana is still illegal to posses in the U.S. at the federal level, and people are still being illegally arrested for its use, even in states where marijuana has been legalized. The Daily Beast reported on the “still selectively draconian law enforcement approach to marijuana.”

“In September of this year a helicopter landed in the garden of 81-year-old Amherst woman Margaret Holcomb, as part of a series of such raids around the area.

Massachusetts National Guardsmen and state police promptly seized her single marijuana plant she had been cultivating to help her arthritis and glaucoma.

Earlier this summer, a similar raid was conducted on the home of an 81-year-old Martha’s Vineyard cancer survivor, Paul Jackson, who cultivated a number of plants for use in medicinal tea. Jackson had used the tea to help his wife, now deceased, deal with the pain of pancreatic cancer.”

Pain-Relieving Effects of Marijuana

Despite the popularity of opioids for treating chronic pain, they often fail to provide long-lasting relief while posing considerable risks of side effects and addiction. As noted in BMJ:

“Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy … the long-term effectiveness and safety of opioids are unknown.… Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short-term side effects are constipation, nausea, sedation and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction.”

Marijuana, on the other hand, contains cannabinoids that interact with your body by way of naturally occurring cannabinoid receptors embedded in cell membranes throughout your body. There are cannabinoid receptors in your brain, lungs, liver, kidneys, immune system and more. Both the therapeutic and psychoactive properties of marijuana occur when a cannabinoid activates a cannabinoid receptor.

Research is still ongoing on just how extensive their impact is on our health, but to date it's known that cannabinoid receptors play an important role in many body processes, including metabolic regulation, cravings, pain, anxiety, bone growth and immune function.

Some of the strongest research to date is focused on marijuana for pain relief. In one study, just three puffs of marijuana a day for five days helped those with chronic nerve pain to relieve pain and sleep better. Further, according to a study in the Journal of Pain Research:

“ … Significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia and cancer.”

As for the potential for abuse, a study published in Pain Medicine, which assessed rates of problematic use among people using opioids or medicinal cannabis (MC) for chronic pain, found:

“Problematic use of opioids is common among chronic pain patients treated with prescription opioids and is more prevalent than problematic use of cannabis among those receiving MC.”

Even Children Are Being Poisoned by Opioids

It’s not only adults that are affected by the opioid epidemic. A recent JAMA Pediatrics study analyzed more than 13,000 U.S. hospital discharge records and found that hospitalizations among children for opioid poisonings increased by nearly two-fold from 1997 to 2012.

While hospitalization rates were highest among older adolescents, the largest percent increase occurred among toddlers and preschoolers. Meanwhile, a synthetic opioid called U-47700 (also known as “pink” or “pinky”), has been linked to dozens of deaths across the U.S.

U-47700 is nearly eight times more potent than morphine and is legal to purchase in most states. It can also be legally purchased online in the form of powder, pills or nasal spray. U-47700 was originally created as an alternative to morphine, but it’s untested in humans and is toxic even in small doses.

The drug may cause sedation, slowed breathing and death, and it’s often mixed with other substances. Even one pill can be deadly but, to date, the DEA has yet to enact a ban.

DEA Denies Petitions to Reschedule Marijuana — Again

For decades, various groups have petitioned the DEA urging them to reschedule marijuana. In 1988, DEA administrative law judge Francis Young recommended unscheduling cannabis altogether in response to an activist-group petition. He ruled, “marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.”

The DEA denied the petition, along with a handful of others thereafter. Even when the Institute of Medicine acknowledged marijuana as a substance with medical uses and relatively low potential for abuse, the DEA again denied the resulting petitions, citing a lack of research — research that is being stymied by the nonsensical schedule I classification. In August 2016, the DEA again denied two more petitions.

On a brighter note, the DEA did state that it will end the current requirement that only the National Institute on Drug Abuse (NIDA) can grow marijuana for research purposes, which may make it easier for marijuana research to take place.

For the record, even the American Academy of Pediatrics (AAP) updated their policy statement on marijuana, acknowledging that cannabinoids from marijuana “may currently be an option for … children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate.”

While frowning on recreational use, the AAP gave their “strong” support for research and development as well as a “review of policies promoting research on the medical use of these compounds.” They recommended downgrading marijuana from a schedule I drug to a schedule II drug in order to facilitate increased research.

If every state legalized medical marijuana, the researchers estimated Medicare Part D savings of $400 million each year.

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