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Questions raised about impact of medical marijuana on opioid use, deaths

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Medical marijuana vs. opioids

Medical marijuana and cannabinoid products are increasingly being touted as a pain management alternative for injured workers, but new studies have cast doubts on political arguments that access to the Schedule I drug will mitigate the effects of the opioid crisis, experts say.

Currently, all states except Idaho, Kansas, Nebraska and South Dakota have laws in place that allow some level of medical marijuana to treat specific ailments, according to the National Conference of State Legislatures. However, the drug remains illegal at the federal level.

But states with legalized medical marijuana had higher rates of deaths due to opioid usage, according to a study released in June by researchers at the Palo Alto, California-based Stanford University School of Medicine. And a report also released in June from the University of Texas medical branch at Galveston studied the number of prescriptions for opioids in states that allowed for medical marijuana and found that opioids were prescribed at lower rates in medical marijuana states among people aged 18 to 54.

While many state legislatures have passed opioid restrictions and approved medical marijuana as a way to reduce the risk of opioid deaths, “when we do see a decrease in opioid (use or death), it’s difficult to say that those are caused by the allowance of medical marijuana,” said Dr. Mitch Freeman, Jacksonville, Florida-based chief clinical officer at Mitchell Pharmacy Solutions. “This lack of clarity that is making it such a high-profile issue in workers compensation specifically.”

In the Stanford study, researchers replicated a 2014 study that cited a reduction in opioid deaths as a reason to legalize marijuana. However, Chelsea Leigh Shover, a post-doctoral research fellow at Stanford School of Medicine who worked on the recent study, said they found no connection between opioid deaths and the availability of medical marijuana. The researchers also found no correlation between opioid fatalities when comparing states that have more restrictive marijuana laws and those with recreational marijuana available.

While there may be a role for marijuana to replace opioids for some people, it can only be answered with individual data, according to Ms. Shover’s research.

“If you’re a policymaker looking at how you’re going to address the opioid crisis, making cannabis available isn’t going to do that,” she said. “As a drug, cannabis is pharmacologically safer than opioids … but it doesn’t mean it works to treat pain on in? a way that’s scalable for a population.”

The Texas study, while not examining opioid deaths, did demonstrate a positive correlation between the availability of medical marijuana and a reduction in opioid prescriptions among most adult age groups. The researchers initiated the study as a way to expand an earlier study that suggested a relationship between marijuana laws and lower opioid use among Medicaid and Medicare patients.

Mukaila Raji, professor and director of the university’s Division of Geriatric Medicine, said the Texas study may “suggest” a public health benefit and a potential alternative to mitigate the effects of opioid use, but cautioned that “unintended downsides” of marijuana legislation also needs to be considered.

Maren Schroeder, president and cofounder of Sensible Minnesota based in Stuartville, Minnesota, a nonprofit organization that works directly with individuals trying to navigate the state’s medical marijuana registry, said the contradictory research from Stanford could have an impact on future drug scheduling talks. But she believes the 2014 research showing the “significant decrease in prescribing (opioids) for Medicare and Medicaid patients” has a positive effect on legislatures such as Minnesota’s, which is “at a place where they are willing to go look at any and all options” to reduce opioids and improve accessibility to medical marijuana for patients who need it.

“We’re in a situation where policy has jumped way ahead of scientific evidence,” said Nikki Wilson, Omaha, Nebraska-based pharmacy product director for Coventry Workers Comp Services. While many tout medical marijuana or opioids as a way to treat pain in workers comp, she noted that there isn’t yet “clinical research backing these products” or their effect on pain reduction.

“Marijuana and some of its components may be effective in treating chronic pain, but they may not be effective in treating opioid dependence,” said Dr. Freeman. “Perhaps (medical marijuana) will reduce the use of opioids for newly injured patients. Over time, how would that impact the (workers comp) industry, or the amount of opioid use overall? Again, we don’t really know.”

Whitt Steineker, partner in the Birmingham, Alabama, office of Bradley Arant Boult & Cummings LLP, said “We’re certainly seeing instances where people both on the health care side and the patient side believe there’s a chance their treatment would be better off with something like medical marijuana than something like opioids … I think that information is coming,” he said. “But that’s where we don’t have the data yet.”

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