Marijuana eyed as opioid treatment

May 4, 2018 GMT

Doctors will gather in Hartford this summer to decide whether medical marijuana can be used legally as a treatment for opioid abuse and withdrawal.

The decision by the state Medical Marijuana Program Board of Physicians could be influenced by two studies published last month in the Journal of the American Medical Association, which reported that states permitting medicinal use of marijunana have seen a drop in opioid prescriptions.

“Cannabinoids have been a real breakthrough for us in terms of pain management, and we have to be open-minded about how we use it,” said Dr. Vincent Carlesi, a pain management specialist in Ridgefield and a member of the state board. “It doesn’t work for everyone, but for those who do, they use much less opioids and some have been able to completely wean themselves off.”

Angela D’Amico, a co-founder of the Compassionate Care Center in Bethel, a licensed medical marijuana dispensary, said she has seen patients who depended on prescription opioids stop using them all together with the help of medical marijuana.

“I had a patient with Crohn’s disease who was on a methadone treatment,” she said. “We got him off the methadone and now he is off the marijuana.”

Word is getting out that marijuana could help other patients as well, D’Amico said.

“On any given day I have parents reaching out to me for help whose children were recently released from rehab, but my hands are tied, there is nothing I can do,” she said.

Most experts agree that the use of cannabinoids has shown positive effects in pain management, and some argue that instead of starting patients on opioids and risking the potential for abuse, medical marijuana could be prescribed instead. Unlike opioids, marijuana does not present an overdose risk, and it also been shown to be less addictive.

“It could stop the opioid abuse before it even starts,” said D’Amico. “If a doctor feels it’s necessary to prescribe a patient opioids, then I think they should also be certified for medical marijuana.”

One of the JAMA studies released last month, analyzing data from Medicare Part D prescriptions, found a significant decline in opioid prescriptions in states that allow medical marijuana. Connecticut alone has seen a decline of nearly 28 percent in opioid prescription rates since medical marijuana was approved four years ago.

Despite the decrease in prescriptions, the state has still seen an increase in opioid-related deaths, owing in large part to the spread of synthetic opioids such as fentanyl, which is far stronger and much cheaper for dealers to produce — and often more fatal.

“In this time when we are so concerned — rightly so — about opiate misuse and abuse, and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies,” said W. David Bradford, one of the study’s authors.

“If you’re interested in giving people options for pain management that don’t bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies,” Bradford said.

Some experts, however, note that while cannabinoids could be a good alternative to opioid prescriptions for pain management, there is little evidence that they can treat opioid addiction itself.

“There is certainly evidence about using cannabinoids to treat chronic pain, but it’s a huge leap to say it can be used to treat a full-blown opioid addiction,” said Dr. J. Craig Allen, a child psychiatrist and president of the American Society of Addiction Medicine’s state chapter.

He added that some of his patients with opioid addictions have relapsed after using marijuana.

“We may find someday that certain cannabinoid products are helpful to treat addiction, but we don’t have that evidence right now,” he added. “I wouldn’t push a patient out of a plane with a parachute unless I’ve tested it first.”

Allen said he also has concerns about the follow-up care received by patients who are prescribed medical marijuana.

“In my experience — and this may change — but in Connecticut the people who are writing the medical marijuana certificates aren’t all that knowledgeable about the (underlying) disorder,” he said. “If someone does develop an addiction, how would we know and how do we help the patient if there isn’t any screening?”

Medical professionals writing certificates for medical marijuana, as well as the pharmacists at dispensaries who provide the marijuana, should receive mandatory training in addiction disorders and mental health, he said.

Carlesi agreed that more research is necessary.

“We have to be cautious about about why we are approving cannabinoids for certain diagnoses,” he said. “There has to be more research, and unfortunately there is a lot of difficulty with that right now.”

He said the board will likely meet in June or July to discuss and vote on the issue.

“We will listen to both sides of and look at the pros and cons of the decision,” Carlesi said. “No drug is perfect but we have to look at the worst of the evils and weigh the risks.”