More than 72,000 Americans died from drug overdoses in 2017 – 30,000 of these specifically from opioid overdoses. To put these numbers in perspective, between 2002 and 2017, drug overdose deaths increased by a factor of 22. The general overdose data alone is frightening, but even more worrisome is the fact that the last two decades in the U.S. have seen such a sharp increase in deaths due to opioid overdoses. More importantly, these deaths demand a solution. Amid this crisis, it is possible that medical marijuana may be the controversial solution to the current opioid epidemic. However, there are drawbacks to the data promoting medical cannabis prescription as a response to opioid addiction. While it may seem to be a promising solution, other opioid-reduction policies that have more reliable evidence of being effective should not be overlooked. But first, how did we get here?
It is no surprise that the U.S. is in the midst of a severe opioid crisis. As early as the 1970s, many American soldiers involved in the Vietnam War were victims of heroin addiction. However, recent years have seen an unprecedented increase in drug related deaths. What is the source of the seemingly sudden modern epidemic? The short answer: there is no such thing as a free lunch.
The late 1990s saw a sharp increase in the aggressive advertisement of painkillers to physicians. At the time, the drug market was composed of many competitive products and merchants. However, one company left the competition behind with the advent of their painkiller, OxyContin. In a 1996 press release, Purdue Pharma advertised that their novel drug was capable of pain relief for up to 12 hours and came with less addictive side effects than its competitors. Not only were their claims attractive, but so were their marketing methods. Over the next 5 years Purdue Pharma invited more than 5,000 healthcare professionals to resorts to participate in pain-management and speaking conferences. From free meals to educational programs, Purdue Pharma made certain that all attendees left their symposiums with one thing on their mind: prescribe OxyContin. Perks for physicians resulted in more prescriptions for patients and by 2014, opioid sales had increased almost four-fold since 1999, according to data from the CDC. Over-prescription of opioids inevitably led to abuse, in part causing the modern opioid crisis.
Despite a shady history and shocking numbers, a controversial solution has provided at least some hope for remediating opioid addiction. A recent study released by Dr. David Bradford and his student Ashley Bradford at the University of Georgia claims that medical marijuana legislation led to a significant decrease in opioid prescriptions. Another study extended the timeline and found that between 2011 and 2016, doctors in states that implemented medical cannabis laws prescribed opioids nearly 6% less often.
These results can be misleading, however. Even though the reduction in opioid prescription was indeed correlated with the implementation of medical cannabis legislation, this does not prove that the solution simply lies with nationwide medical legalization. According to Dr. Rosalie Pacula of the RAND Drug Policy Research Center, the correlation between medical marijuana laws and fewer opioid related deaths weakens in states where marijuana dispensaries are more tightly regulated. In other words, the benefit of passing such legislation is largely contingent upon if the state has fully permitted dispensaries as opposed to simply allowing home cultivation. As long as states have restrictive marijuana laws, the potentially positive effects of cannabis on opioid addiction cannot take effect. 2012 was the first time the U.S. had seen recreational legalization and between then and now, only 9 total states allow open dispensaries and recreational marijuana use.. Given this trajectory, it may take more time to see broad and liberal allowance of marijuana use in the 41 other states. The opioid crisis is a national issue; therefore, the solution should not be dependent on unpredictable future state laws.
Until the evidence is clearer for medical marijuana as a solution, other promising methods include medication designed specifically for treating addiction. Methadone, for example, is a synthetic narcotic that has been used for pain relief as early as 1947 and for successful addiction treatment in the 1970’s. Methadone is not without its flaws either. Firstly, it is itself an opioid and is accompanied by its own withdrawal symptoms. It also has caused deaths from overuse, albeit from use as a painkiller and not addiction treatment. However, while methadone is certainly not a panacea for the opioid crisis, it does have a more proven history of effectiveness compared to marijuana. In a 2017 study from the British Medical Journal, opioid-dependent cohorts that were in and out of methadone and buprenorphine substitution treatment were selected for research. The study found that methadone treatment for a population of 122,885 people caused a steep decline in the all-cause mortality rate within just the first four weeks. This decreased mortality rate showed long-term stabilization in patients undergoing further treatment with buprenorphine. Despite these results, a vast majority of the U.S. still lacks programs that provides such treatment.
While not completely out of the question, looking to medical marijuana as the immediate answer to the opioid crisis may be unwise. Initiatives that have a promising track record, such as treatment with methadone and buprenorphine, should first be expanded before relying on state marijuana policies. In an analysis done in February of this year, researchers warned against having high hopes for the data published by Dr. Bradford of the University of Georgia ̶ correlation between two factors does not constitute a causal relationship. Therefore, expansion of trusted initiatives should precede any further policy experimentation. A sudden crisis such as the recent opioid epidemic demands an equally prompt and reliable solution. Therefore, the resources we potentially spend on the expansion of medical marijuana may first be better spent on the expansion of medications proven to reduce opioid addiction nationwide.