For Kathy Deschenes, marijuana is the only substance that can ease her pain. The Northern Massachusetts resident has a chronic illness, and she has discovered that by vaping marijuana each night, she can almost eliminate aches and soreness that once kept her up at night.
Deschenes lives in a state with some of the country’s most progressive marijuana laws. But she realizes that without such easy access to medical marijuana, she might have turned to other means of managing her pain – like addictive and dangerous opioid painkillers.
“I could see myself, if I hadn’t found this solution and I was living in the amount of pain that I’m living in every night, yeah I might’ve talked to my doctor about it,” Deschenes said about potentially using opioids as an alternative form of pain medication.
This interchangeable relationship is particularly appealing in Massachusetts, as the opioid crisis has become such a problem in the state and its residents have such easy access to cannabis. In theory, better access to marijuana, such as in Massachusetts, can lead to a decline in opioid overdose deaths, as marijuana can act as an alternative to pain killers and could decrease the amount to opioids prescribed.
“I have friends that do medical marijuana that, like me, chose not to do opioids,” Deschenes said. “So I know it has kept people from pursuing opioids.”
Though marijuana may have helped some to avoid opioids, it hasn’t appeared to have worked on most, as a decline in opioid overdose deaths is yet to be seen.
According to the Massachusetts Department of Public Health, the number of opioid-related overdose deaths per year in Massachusetts has been rising since as early as 2011. Even following the state-wide decriminalization of marijuana in 2008 and the legalization of medical marijuana use in 2012, the number of opioid-related deaths per year has in fact increased from 656 in 2011 to an estimated 2,032 in 2018. The data shows that the yearly number of opioid deaths have more than doubled since medical marijuana’s 2012 legalization, opposing the theory that marijuana would lead to a decline in these deaths.
The supposed relationship between access to medical marijuana and fewer opioid deaths has been discussed ever since a 2014 study published in the JAMA Internal Medicine first established the relationship. The study, led by Marcus Bachhuber, analyzed the medical marijuana legislation and opioid deaths in all 50 states from 1999 to 2010. Prior to 1999, three states had already enacted medial cannabis laws, and between 1999 and 2010, 10 more states implemented similar legislation. The study found that states with medical cannabis laws exhibited a 24.8% lower mean annual opioid overdose mortality rate than states without such legislation.
Since this study was published, its findings have been used by medical marijuana advocates across the country. Medical marijuana has been named a solution to the opioid problem by many, and that relationship has become both a talking point and a selling point for the implementation of medical marijuana laws.
To former Boston Globe deputy managing editor Ellen Clegg, research like this is paramount for the development of marijuana as an alternative to opioids.
“There’s great potential for new research and clinical trials into cannabis, controlled clinical trials, as a potential pain reliver,” Clegg said. “I think addiction is still poorly understood and poorly treated. So there’s room for new research and new approaches and treatment of addiction as well.”
After the Bachhuber study, others emerged with data to support a similar conclusion. One 2018 JAMA study found that between 2011 and 2016, states with medical marijuana laws exhibited a 5.88% decrease in opioid prescribing rates and states with adult-use marijuana laws exhibited a 6.38% decrease in opioid prescribing rates. Another study referenced by Dr. Peter Grinspoon of Massachusetts General Hospital found that when a state enacted new marijuana laws, opioid prescriptions fell by 2.21 million daily does per year, and when medical marijuana dispensaries opened, prescriptions fell by 3.74 million doses per year.
Yet, as with all scientific studies, all of these stressed that their findings are to be understood as a correlation rather than a causation relationship. They made clear their limitations, and insisted, as the Bachhuber study put it, that “although we found a lower mean annual rate of opioid analgesic mortality in states with medical cannabis laws, a direct causal link cannot be established.”
But marijuana advocates took the findings more seriously than researchers intended them to be taken, and now those findings may have been challenged. A 2019 Stanford study published in PNAS, the Proceedings of the National Academy of Sciences of the United States of America journal, took a closer look at the Bachhuber study. The researchers used the same methods as the Bachhuber study to extend the analysis through 2017, and they were met with similar results for 1999-2010 time period. However, when they examined the full analysis through 2017, they found that the relationship reversed – in states that had passed medical marijuana laws, the study found a 22.7% increase in opioid overdose deaths. Though this study also expressed caution when drawing conclusions from its findings, the vast difference in findings between the studies with nearly identical methods is well worth paying attention to. It certainly would explain the uptick in opioid overdose-related deaths that was recorded in Massachusetts during the same time period in which the Stanford study produced its findings.
Among all of these studies, health professionals differ in their opinion on whether or not marijuana as an opioid alternative can help the crisis. Some, like Caitlin McLaughlin, a spokeswoman for the Boston Public Health Commission, are neutral on the issue.
“The path to overcoming substance use disorder is different for each individual and is based on recommendations by their health care provider,” McLaughlin said.
But others, like author Judy Foreman, a former Boston Globe medical reporter, are more insistent on marijuana’s benefits for the opioid crisis. Foreman has written two books on what she identifies as a “global pain crisis,” and when asked if marijuana is a viable alternative to opioids, she answered frankly.
“It absolutely is,” she asserted.
Foreman points to scientific evidence, illustrating the comparability of marijuana’s pain managing effects to those of other pain killers. “Preliminary studies show that if you smoke marijuana, which seems to be the most quick-acting delivery system, there’s a synergistic effect with people who do marijuana and people who take lower doses of opioids,” she said.
Yet to Dr. Ken Finn, the evidence is not nearly as conclusive. Finn is a pain medication specialist in Colorado Springs, and has worked with the Colorado Pain Society and Colorado Medical Society to help manage Colorado’s own opioid crisis. Having written multiple articles on the subject, Finn actually believes that marijuana won’t help the opioid crisis at all.
“Colorado’s had a medical marijuana program since 2001,” Finn said in an interview. “More than 90% of the recommendations for the use of marijuana as a patient were for pain, and so you would think that there would be an impact on the opioid epidemic in Colorado if most people getting medical marijuana were using it for pain. Unfortunately, in 2017, we had a record number of opioid overdose deaths, and in 2018 was the second highest number of opioid overdose deaths.”
Finn takes issue with the lack of testing and scientific evidence to back up the relationship between marijuana and opioid deaths. Though there has been plenty of statistical studies, he feels that we are still missing many of the conclusions that would be drawn from more stringent drug testing.
“I think that there is something there, but we really need to put it through the rigors of drug development,” Finn insisted. “Despite the idea that substitution of opioids with marijuana is attractive… that just hasn’t shown to be true”
But beyond the debate over this relationship, there are other issues with the marijuana industry that need to be sorted out as well, according to Anne Hassel. Hassel began working as a bud tender in September of 2015 at one of Massachusetts’ NETA medical marijuana dispensaries. But she has since quit after she got a better glimpse into some of the company’s practices.
“I saw moldy marijuana in the bins,” Hassel admitted. “I don’t know if you know anything about marijuana but I shouldn’t have seen moldy marijuana in the bins.”
Hassel felt that while marijuana may have had health benefits for some people, the way it was handled throughout the marijuana industry may have caused more harm than help to users.
“I actually was diagnosed with heavy metal poisoning because I was consuming the high THC concentrate. Because I thought that the mold was being taken care of – they told us that,” she said.
But the relationship with the opioid crisis is still the most important aspect of the marijuana industry to many. As a Boston resident, Ellen Clegg understands that the opioid crisis is a pressing issue because she sees the real epidemic every day.
“There is indeed some crossover, as I’ve observed,” Clegg noted of the intertwined nature of marijuana and opioids in Boston. “If you’ve hung around Boston Common you know that the guy selling cannabis is also selling pills.”
Clegg is exposed to the damage that the opioid crisis has done to the Boston area, as she lives her life surrounded by it. The more she sees it, the more she realizes that time is running out to deal with the crisis.
“I think in the last year of taking the subway going downtown to The Globe, I saw two overdoses, one death, one person who was nodding out on the Red Line,” Clegg recalled. “It’s everywhere.”
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