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According to 2016 data from the Centers for Disease Control, of U.S. counties with more than one million residents, Allegheny County had the highest drug-overdose death rate. In 2016, Allegheny County lost about 50 lives to drug overdoses per 100,000 residents. These deaths were primarily caused by residents overdosing on opioids like fentanyl and heroin. And in 2017, according to the Pennsylvania Opioid Overdose Reduction Technical Assistance Center, the amount of overdose deaths in Allegheny County only increased.
But 2017 is also the year that patients in Pennsylvania have legal access to medical marijuana to treat some types of chronic pain. And medical-marijuana proponents believe the drug can be a game-changer in the fight against the opioid epidemic. Doctors, advocates and medical-marijuana business owners feel marijuana should be recommended after patients complete their regiment of prescribed opioids. They believe it is a safer way to manage chronic pain and can keep many people from getting addicted to opioids.
Preliminary studies back up this case, as states that have allowed medical marijuana as a pain treatment have seen some drop-off in opioid-related deaths. However, getting the Pennsylvania medical community fully on board may be a struggle, as marijuana as medicine hasn’t been studied as much as other pain-relieving drugs. But Pennsylvania officials recently passed a small change to the state’s medical-marijuana statute, which could encourage more doctors to recommend medical cannabis and hopefully keep patients from forming an addiction to opioids. Dr. George Anastassov is the CEO of Axim Biotechnologies, a company focusing on the research and development of pharmaceutical products created from marijuana. Anastassov has a background in surgery and pain management, and is bullish on the idea that medical marijuana can be used to treat chronic pain.
Anastassov says opioids are still necessary to treat acute pain, or a short-term pain that resolves as patients heal. But, he says medicine derived from marijuana would be better suited to treat any longstanding pain that remains as a result of surgery or a traumatic event, also known as chronic pain.
“We are acutely aware of the opioid problem,” says Anastassov. “Opioids are here to stay, for acute pain, but not for chronic pain.”
Anastassov says historically many doctors prescribed opioids for chronic pain and were encouraged to do so by the large pharmaceutical companies that developed, studied and distributed opioids. He says this contributed to Pennsylvania’s growing opioid crisis, particularly in rural areas were medical options are limited. Anastassov recognizes other medicines can also replace opioids, but he believes medical marijuana is the best choice to help patients suffering from chronic pain. He says patients taking pharmaceutical cannabis products instead of opioids could play a role in keeping patients from developing addiction to opioids.
“I think pharmaceutical cannabis is the frontrunner,” says Anastassov. “We can dramatically reduce the number of opioids.”
Recent studies support that claim. A paper published April 2 in the medical journal JAMA Internal Medicine found a 14 percent reduction in opioid prescriptions among Medicare patients in states that allow easy access to medical marijuana. Another study also published in April in JAMA Internal Medicine found Medicaid enrollees filled nearly 40 fewer opioid prescriptions per 1,000 people in states that passed medical- or recreational-marijuana laws.
Patrick Nightingale is a lawyer who represents clients with drug addictions and is the director of marijuana-advocacy group Pittsburgh NORML. He says many of his clients enter the criminal-justice system due to interactions with opioid-related drugs and, over the years, he has seen an increase in clients whose first interaction with opioids was a prescription for legitimate pain.
Nightingale believes providing patients with medical marijuana to deal with chronic pain could be a better solution. “For someone new to pain treatment, these are the type of people to steer to medical cannabis, instead of giving them two to three months of opioids,” says Nightingale. “We are going to see less people with opioid addiction if they have access to medical cannabis in early stage treatment.”
Anastassov agrees, but also says a pharmaceutical-cannabis chewing gum he is developing at Axim can help those already suffering from substance-abuse issues. He says the physical exercise of chewing helps people who are addicted, like how nicotine gum has been shown to help people quit smoking cigarettes. Anastassov believes a medical-marijuana chewing gum can help wean people off opioid addiction. The product has yet to hit the market, but Anastassov is confident Pennsylvania officials will welcome it as a way to combat the opioid crisis.
Nightingale says the biggest obstacle in treating Pennsylvania patients who would normally use opioids with medical marijuana, is convincing prescribing physicians to recommend cannabis. Marijuana is still a Schedule I drug under federal law, and Nightingale says this has limited the amount of medical studies completed on marijuana, which has increased doctors’ skepticism of marijuana as medicine.
But there has been progress. On April 9, Pennsylvania’s medical-marijuana advisory board broadened the definition of chronic-pain patients who qualify for access to medical marijuana. The decision still needs to be cleared by the Department of Health, but marijuana-advocate Chris Goldstein, of Philly NORML, says Pennsylvania physicians will be able to recommend medical marijuana as the first option for chronic pain, if the change is approved.
Dr. Adam Rothschild is thrilled about this news. Rothschild practices family medicine in East Liberty and is a certified to recommend medical marijuana through Pennsylvania’s medical-marijuana law.
He says cannabis is much safer than opioids in treating chronic pain, and it should be much higher on our list of chronic-pain medications. According to Rothschild, the current rule about recommending medical marijuana for chronic pain has a caveat that states “in which conventional therapeutic intervention and opiate therapy is contraindicated or ineffective.” With that caveat likely to be removed soon, Rothschild believes more prescribing physicians in Pennsylvania will be open to recommending medical marijuana.
“For the people worried about legal aspects of recommending medical marijuana,” says Rothschild, “this will make them more comfortable.”
This article appears in Apr 11-17, 2018.
In regard to opioids, the use of cannabis in managing pain is one of its most important.
4 out of 5 heroin users begin with prescription opioids [Lankenau et al. 2012]. The reason is simple, heroin and opioids such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), are very similar drugs. When prescriptions run out, people turn to far less expensive, more available, more potent heroin from the street to support their habit.
Removing cannabis from our pharmacopeia 7 decades ago may have resulted in thousands of opioid deaths:
“From a pharmacological perspective, cannabinoids are considerably safer than opioids and have broad applicability in palliative care. Had cannabis not been removed from our pharmacopeia 7 decades ago and remained available to treat chronic pain, potentially thousands of lives that have been lost to opioid toxicity could have been prevented.”
“The medicinal cannabis user should not be considered a criminal in any state and the DEA and our legal system should be using science and logic as the basis of policy making rather than political or societal bias.” [Carter et al. 2011]
Legal medical cannabis has been shown to significantly reduce deaths from prescription opioid painkillers by reducing opioid use:
“States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.” [Bachhuber et al. 2014]
Two of the main reasons people switch to cannabis: less side-effects and less withdrawal:
“Over 41% state that they use cannabis as a substitute for alcohol, 36.1% use cannabis as a substitute for illicit substances, and 67.8% use cannabis as a substitute for prescription drugs. The three main reasons cited for cannabis-related substitution are ‘less withdrawal’ (67.7%), ‘fewer side-effects’ (60.4%), and ‘better symptom management’ suggesting that many patients may have already identified cannabis as an effective and potentially safer adjunct or alternative to their prescription drug regimen.” [Lucas et al. 2013]
Denying people medicine like this should be a criminal act, instead using it is. What a bizarre situation politicians have created.
SOURCES:
-Bachhuber et al. Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Intern Med. 2014
-Carter et al. Cannabis in palliative medicine: improving care and reducing opioid-related morbidity. Am J Hosp Palliat Care. 2011
-Lankenau et al. Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012
-Lucas et al. Cannabis as a substitute for alcohol and other drugs: A dispensary-based survey of substitution effect in Canadian medical cannabis patients. Addiction Research & Theory. 2013
-Gruber SA et al. The Grass Might Be Greener: Medical Marijuana Patients Exhibit Altered Brain Activity and Improved Executive Function after 3 Months of Treatment. Front Pharmacol. 2018
There are varying opinions about the extent to which previous opioid use contributes to Heroin addiction. Rather than pulling further sources to reference in this post, I would like to posit that something else is going on today with the medical care we are allowed to receive. Currently, there are very aggressive restrictions approved by our political representatives, (who have little to no medical knowledge, nor, it appears, any intimate experience with pain) and then pursued almost maniacally by the FDA and their enforcement agents. I believe it is time to examine how much government interference is contributing to the problems we are attempting to solve, by once again resorting to stringent restrictions.
When hospital employed surgeons are reluctant to send home new surgical post-op patients, even after major surgery, with enough pain medication to keep them comfortable until a family or referring doctor can see them for additional medicines, it is beyond frustrating; I contend that is abuse.
If the public were aware of the strength of drugs they had been needing to stay comfortable while in the hospital, versus what they were being sent home with, there would very possibly be more families contacting a malpractice attorney. Today someone can go home after back or heart surgery days after the procedure. That is not enough time to determine if the patient can tolerate being off intravenous pain medication, much less discover if the pain is even relieved with oral opioids, (the most common being Oxycontin). No wonder today’s families, especially those who have grown up anytime during or after the 60’s, will turn to contacts who can obtain street drugs for them!
It is especially sad to have witnessed the encroachment of inadequate pain management in other areas of medical care as well, but most apparent in hospital-owned practices. Today’s hospitals are in the profit making business and are especially sensitive to any fines or restrictions they might incur if found to be “non-compliant” with FDA regulations. They tend to be overly controlling with their “staff” physicians, and it is increasingly apparent hospitals are unwilling to defend or stand up for their staff if government agents question any. Their control extends to how they allow their Hospice teams provide in-home meds to dying patients. About 3 months ago a Hospice patient was discharged from a local hospital and referred to their own Hospice care unit for home care. Despite repeated phone calls, no one ordered pain medication, visited the patient to check for the necessity of in-home assistance nor was an effort made to set up a visit for almost 3 weeks.
Yes, I am glad we are finally allowing some forms of cannabis to be used medically in PA. How many years has it taken to roll back that draconian piece of misguided legislation? How many more years will it take for our representatives to allow those in the fields of medicine, science, psychology, chemistry etc. to study pain and all the drugs available to discover which are most effective and at what doses can they be administered? Who are we protecting by keeping certain drugs banned from even being studied? It definitely has NOT kept those compounds off the street. It is time for us to get our heads out of the sand and push our representatives to do the same.