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opioids

  • by Paul Armentano, NORML Deputy Director May 15, 2018

    In testimony before Congress last week, by DEA acting administrator Robert Patterson opined that the medicalization of cannabis is exacerbating opioid abuse. But when prompted to provide evidence in support of the agency’s position, he acknowledged that he could not. Further, he denied being aware of any evidence — including recent, well-publicized studies by the US National Academy of Sciences and others — indicating that cannabis mitigates pain or that its legal access is associated with reduced levels of opioid-related mortality.

    I summarize this mind-boggling exchange in my recent Hill op-ed, which is excerpted below

    Specifically, when asked by Florida Republican Matt Gaetz if the DEA was aware of the landmark 2017 National Academy of Sciences study finding, “There is conclusive or substantial evidence that cannabis [is] effective for the treatment for chronic pain,” Patterson answered that he was not.

    He further acknowledged that he was unfamiliar with several state-specific, longitudinal studies, such as those from Minnesota and New Mexico, finding that chronic pain patients who register to partake in cannabis therapy dramatically decrease their use of opioids and other pain-relieving drugs. (Separate assessments of state-authorized medical cannabis patients in Illinois, Michigan, New York, and elsewhere affirm these conclusions).

    He further claimed ignorance with regard to the findings of a highly publicized study in the Journal of the American Medical Association finding that medical cannabis regulation is associated with year-over-year declines in overall opioid-related mortality, including heroin overdose deaths.

    Moreover, when pressed to provide evidence — any evidence — in support of the DEA’s questionable position, Patterson readily admitted that he knew of none. In fact, upon further questioning, he acknowledged that the DEA has, to date, never even so much as reviewed the issue. He further suggested that those patients seeking an alternative to opioid analgesics may wish to try “Tylenol.”

    The testimony concluded:

    Rep. Gaetz: “You’re the acting administrator of the DEA. You cannot cite a single study that indicates that medical marijuana creates a greater challenge with opioids, and you’re unaware of the studies, including studies from the National Academies of Sciences, that demonstrate that medical marijuana can be an acceptable alternative to opioids. Is that what I’m understanding?”

    Robert Patterson: “Yes.”

    To read the entire op-ed, please click the link here.

    To watch a video of this exchange, as archived by MarijuanaMoment.net, please click here.

  • by Paul Armentano, NORML Deputy Director May 8, 2018

    Medical marijuanaPatients enrolled in New York state’s medical cannabis program reduce their use of opioids and spend less money on prescription medications, according to data published online in the journal Mental Health Clinician.

    Investigators from the GPI Clinical Research in Rochester and the University of Buffalo assessed trends in patients’ medical cannabis and prescription drug use following their enrollment into the state’s marijuana access program.

    On average, subjects’ monthly analgesic prescription costs declined by 32 percent following enrollment, primarily due to a reduction in the use of opioid pills and fentanyl patches. “After three months treatment, medical cannabis improved [subjects’] quality of life, reduced pain and opioid use, and lead to cost savings,” authors concluded.

    The study’s findings are similar to those reported among enrollees in other states medical cannabis programs, including the experiences of patients in Illinois, Michigan, Minnesota, New Mexico, and elsewhere.

    The full text of the study, “Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis,” appears online here. NORML’s fact-sheet highlighting the relevant, peer-reviewed research specific to the relationship between cannabis and opioids is available online here.

  • by Paul Armentano, NORML Deputy Director April 2, 2018

    The enactment of marijuana legalization laws is associated with a significant reduction in the number of opioids prescribed and filled, according to a pair of studies published online today in the journal JAMA Internal Medicine.

    In the first study, investigators from the University of Kentucky and Emory University assessed the association between medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees. They reported:

    “State implementation of medical marijuana laws was associated with a 5.88 percent lower rate of opioid prescribing. Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38 percent lower rate of opioid prescribing. … [T]he further reductions in opioid prescribing associated with the newly implemented adult-use marijuana laws suggest that there were individuals beyond the reach of medical marijuana laws who may also benefit from using marijuana in lieu of opioids. Our finding that the lower opioid prescribing rates associated with adult-use marijuana laws were pronounced in Schedule II opioids further suggest that reaching these individuals may have greater potential to reduce the adverse consequences, such as opioid use disorder and overdose.”

    The full text of the study, “Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees,” is available here.

    In the second study, University of Georgia researchers evaluated the association between the enactment of medical cannabis access laws and opioid prescribing patterns under Medicare Part D. They reported:

    “This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened. … Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.”

    The full text of the study, “Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population,” is available here.

    Both findings are consistent with those of numerous prior studies finding that cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, mortality, and overall prescription drug spending. A compilation of these studies is available in the NORML fact-sheet here.

  • by Paul Armentano, NORML Deputy Director March 5, 2018

    Pain reliefCannabis therapy mitigates symptoms of the chronic pain condition fibromyalgia and is associated with a reduction in the use of other prescription drugs, according to clinical data published online ahead of print in the Journal of Clinical Rheumatology. An estimated 3 to 6 million Americans are afflicted by fibromyalgia, which is often poorly controlled by standard pain medications.

    Israeli investigators assessed the safety and efficacy of inhaled cannabis in a cohort of 26 patients with fibromyalgia. They reported that medical cannabis treatment “was associated with significant favorable outcomes in every item evaluated,” such as reductions in pain and increases in energy.

    Most patients also reduced their use of conventional prescription drugs, such as opiates and benzodiazepines, during the trial period. Nearly half of the participants (46 percent) reduced their prescription drug intake by more than 50 percent during the study. Several patients were also able to return to work following the initiation of cannabis therapy.

    Researchers concluded, “Medical cannabis treatment had a significant favorable effect on patients with fibromyalgia, with few adverse effects.”

    Prior trials evaluating the use of either whole-plant cannabis or synthetic cannabinoids have similarly shown efficacy in patients with the disease. A summary of these prior studies is available here.

    The abstract of the study, “Medical cannabis for the treatment of fibromyalgia,” is online here.

  • by Paul Armentano, NORML Deputy Director March 1, 2018

    Patients routinely reduce or eliminate their use of prescription opiates following the use of medical cannabis; two recently published studies reaffirm this relationship.

    In the first study, published by the Minnesota Department of Health, investigators assessed the prescription drug use patterns of 2,245 intractable pain patients participating in the state’s medical cannabis access program. Among those patients known to be taking opiates for pain upon enrollment in the program, 63 percent “were able to reduce or eliminate opioid usage after six months.” The findings are similar to those of registered patients in other states’ medical cannabis programs, including Illinois, Michigan, and New Mexico, among others.

    In the second study, Israeli researchers assessed the safety and efficacy of cannabis in a cohort of over 1,200 cancer patients over a period of six months. Ninety-six percent of patients “reported an improvement in their condition.” Nearly half of respondents reported either decreasing or eliminating their use of opioids during the treatment period.

    A third recently published clinical trial provides insight into explaining this relationship. Investigators from the United States and Australia and assessed the efficacy of inhaled cannabis and sub-therapeutic doses of oxycodone on experimentally-induced pain in a double-blind, placebo-controlled model. Researchers assessed subjects’ pain tolerance after receiving both substances separately or in concert with one another. While neither the administration of cannabis nor oxycodone alone significantly mitigated subjects’ pain, the combined administration of both drugs did so effectively.

    Authors determined, “Both active cannabis and a low dose of oxycodone (2.5 mg) were sub-therapeutic, failing to elicit analgesia on their own; however, when administered together, pain responses … were significantly reduced, pointing to the opioid-sparing effects of cannabis.” They concluded, “Smoked cannabis combined with an ineffective analgesic dose of oxycodone produced analgesia comparable to an effective opioid analgesic dose without significantly increasing cannabis’s abuse liability.”

    The new studies add to the growing body of research finding that cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, opioid-related traffic fatalities, opioid-related drug treatment admissions, and opioid-related overdose deaths.

    Additional information regarding the association between cannabis and opioids is available from NORML’s fact-sheet here.

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