CDC Pressured to Study Medical Marijuana as an Opioid Substitute

CDC Pressured to Study Medical Marijuana as an Opioid Substitute

By Ed Coghlan

One of the nation’s most influential U.S. Senators thinks medical marijuana should be studied as a way to address the nation’s opioid issue.

Sen. Elizabeth Warren (D-MA) asked the Centers for Disease Control to work with other federal agencies “to fill the gap in our knowledge about” medical marijuana’s ability to help combat the opioid epidemic.

Warren asked the federal agency to consider and study “the use, uptake, and effectiveness of medical marijuana as an alternative to opioids for pain treatment in states where it is legal.”

Here’s her letter to the CDC.

While recreational marijuana is legal in four states, and medical marijuana is legal in 23 states, the drug remains illegal under federal laws. That has held back any serious research.

Marijuana is a “Schedule I” substance. Researchers who want to study the drug need a license from the Drug Enforcement Administration, and the approval of the FDA.

There are some data that medical marijuana might help reduce opioid abuse.

“Our findings suggest that providing broader access to medical marijuana may have the potential benefit of reducing abuse of highly addictive painkillers.”

That’s a conclusion from a working paper from David Powell and Rosalie Pacula of the RAND Corporation and Mireille Jacobson of the University of California, Irvine.

The researchers compared treatment admissions for opioid pain reliever misuse and state-level opioid overdose deaths. They found decreases in misuse and deaths in states with medical marijuana dispensaries, but they didn’t find decreases in states that allow medical marijuana without dispensaries.

It appears it isn’t whether medical marijuana is legalized as much whether there is access to medicinal marijuana through dispensaries.

Presidential candidates are timid on the issue, most of them either against it or asking for more research.

There should be more studies and large-scale clinical trials, especially if they can prove good ways to separate pot’s psychoactive effects while keeping its maximum medical benefits — as low-THC, high-CBD strains of marijuana purport to do.

Here’s a review of the research to date on medical marijuana, published in the Journal of the American Medical Association, that looked at 79 studies that tested cannabis’s medicinal effectiveness among nearly 6,500 patients.

For more on this story on MSN, click here.

The National Pain Report has written extensively on medical marijuana. For some previous reporting, click here.

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Authored by: Ed Coghlan

There are 12 comments for this article
  1. brian at 5:28 pm

    The details of the study will matter. There are people in all branches of government who have made a living demonizing marijuana. In the 1980’s I worked at a University medical center with a bone marrow transplant program. They had a study comparing a THC derivative with the common anti-emetic medications (nausea preventers) but the study was set up so the patients randomized to marijuana were not able to receive the THC until after nausea set in while the non-THC patients could be premedicated before they started chemo. The marijuana side was quickly destined to fail. The study schema was forced on the physicians by the FDA.

    So it really will depend on who decides the parameters for the study and if they give pot a chance.

  2. Mona Twocats-Romero at 5:40 pm

    J Psychoactive Drugs. 2012 Apr-Jun;44(2):125-33.
    Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain.
    Lucas P1.
    Author information
    Abstract
    There is a growing body of evidence to support the use of medical cannabis as an adjunct to or substitute for prescription opiates in the treatment of chronic pain. When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective. Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates. Despite a lack of regulatory oversight by federal governments in North America, community-based medical cannabis dispensaries have proven successful at supplying patients with a safe source of cannabis within an environment conducive to healing, and may be reducing the problematic use of pharmaceutical opiates and other potentially harmful substances in their communities.
    PMID: 22880540 [PubMed – indexed for MEDLINE]

  3. Mona Twocats-Romero at 4:52 pm

    First of all, there are currently thousands of studies on cannabis and its active compounds. The DEA just doesn’t want anyone to know about them. http://beyondchronic.com/wp-content/uploads/2012/08/Grannys-List-July-2012.pdf is an older list and there have been many more studies done in Canada, Israel, and other countries that show medicinal value and significantly positive effects from cannabis. One of them just happens to be about how cannabis acts as a catalyst for opioids, enhancing their pain killing effect without increasing the dose. The evidence is already out there, in spades.

    Second, this is just another “created” epidemic being sold by the DEA to keep the for-profit prisons full and functioning. If you look at the number of chronic pain patients out there, only a very small number of them ever become addicted. It is street use of opiates that is the problem. The DEA wants to be able to increase sentences for possession and use of opiates,, so they can keep the prison industrial complex satisfied. There really is no epidemic of opiate use that leads to heroin. It is a completely different population than chronic pain patients and that needs to be made clear, period.

  4. Scott D. Mendelson, M.D., Ph.D at 9:20 am

    First of all, the very title is loaded. The word “pressured” suggests coercion and thumbscrews. Let’s begin by replacing “pressured” with “advised” or “requested”, shall we?

    Next, as a psychiatrist, I regularly prescribe lithium, clozapine, and tricyclic antridepressants, all of which are extremely deadly and have killed many people. Similarly, dozens of people die every day in the US from opiate overdose. I believe that any medication strong enough to help is also strong to hurt you. However, to the very best of my knowledge, there are no clear cases of death by marijuana overdose, and when there are even indications of adverse of marijuana, a case study is warranted. Those are few and far between. I see many references to “more study is needed” to guarantee safety of marijuana for each and every apparent application before any recommendations can be made to offer patients marijuana as treatment. However, the relative safety is very well known and has been ever since the widespread use of marijuana that began in this country in the 60’s. Indeed, whereas formal studies are lacking due to illegality, natural studies have long existed. If one is willing to suggest that the use of marijuana to treat neuropathic pain, for example, creates unique risk beyond the use of marijuana simply to get stoned every day, then I suppose they are welcome to do so. Lunacy abounds. However, the risk to benefit ration is really far better than many if not most medications we physicians prescribe. The fact also remains that many good, solid studies show efficacy of marijuana for pain, and studies also show synergism between marijuana and opiates such that the dangers of opiates can be reduced by combined use. There is much suffering in this world, and doctors are withdrawing opiates out of an irrational hypervigilence. Nonetheless, it is only reasonable to pursue the use of marijuana with or in place of opiates to both relieve pain and reduce the dangers of its treatment.

  5. Jeremy Goodwin, MS, MD at 4:27 pm

    The naïveté of the political and medical establishment amazes me. The pharmacology of cannabinoids and opioids are very different. Both have naturally occurring endogenous versions within the body that work alone or together depending on the system involved. To expect one to substitute for the other is not rational. To force patients to choose one or the other is just as irrational. The methods used to date to accrue and analyse clinical and social data under the intention of developing evidence-based guidelines for the use of and avoidance of abuse of such agents are sadly lacking in scientific rigor. It is nowt but a political nightmare. There is also a strong racism-laced influence on why the debate has taken the turn that it has these past few years. Blacks have been targeted for prison and their drug related deaths dismissed as inconsequential for years. Now that the drugs on the street are affecting large numbers of whites, we are suddenly in a crisis! Why not so before ?

    I am surprised that Elizabeth Warren is apparently so misinformed.

    We need protection from the medical boards so that this debate concerning opioiphobia and the potential role of cannabinoids for the treatment of pain can be addressed in a more honest manner dropping the political motivation that is ruining medical careers while simultaneously leaving previously highly functioning patients on these agents in intolerable levels of pain.

  6. HOWARD H HEROLD at 2:15 pm

    Medical Marijuana is a joke !!! It”s all in there heads!!!! Ive taken opiods for the past ten years. Im not ADDICTED to it !!! I was told by my Internist that she will not be able to prescribe opiods to according to the NIH, So i have two failed back surgeries and one of them is a Fusion, so i suppose i will have to suffer with Chronic-Pain, the rest of my life, because of these addicts and crooks out here selling there own Pain Meds, So people like me have to suffer because of these addicts and crooks.
    RESPECTFULLY

  7. HJ at 2:01 pm

    This is what I feared. It will not be an “option” but a forced substitute. In pain? Opiods helping… well, too bad – Marijuana is your only option.

    My employer would not be pleased with my using marijuana, legal or not. If I were to use it, would I be using it during working hours when I most need the pain relief? Could I still function at my work?

    I’ve not used marijuana, but from what I understand, it’s NOT likely to keep you feeling wakeful. Fatigue is a tremendous issue for me and I don’t need anything to add to my fatigue.

    Opiods help. I’m not addicted, but I need them to continue to work. I take one tablet in the morning to ease the stiffness and aches so that I can rally myself to get dressed and leave the house. I take one at night to help me sleep without the disruption of pain. On weekends, that may be all I take unless my activities (housework, shopping outside my home) have increased my pain to the point that rest or heating pads won’t help. During the week, I most need my pain relief to allow me to focus and concentrate at the office.

    This attack on opiods is foolish. Chronic pain patients deserve to have access to the medications to treat their pain. We need access to OPTIONS as well. I fear that we’ll lose our access to opiods and be told we have to treat with marijuana.

    Forgive me, I’d write more but it’s been a long week and I’m too fatigued to gather my thoughts further. I’m just so frustrated that I wanted to respond as I saw the article rather than waiting until I was truly up for writing well.

  8. Christina at 1:46 pm

    Government in each state do what they get by their citizens. Passing bills changing bills.. I dont understand why someone needs to be a politician for a career. These seats should change ever four years max. It should be made up with different professions in all walks of life. Meet two times a year and save money for what the state needs. Not Monday thru Friday jobs…
    WHAT YOU DONT KNOW IS HURTING YOUR ACCESS TO TREATMENTS. They will keep taking your rights away if you dont pay attention. There is no one fits all approach to pain. I think more research is need on the plant. The sad part of it all is how many years of repeated History do we have to endure before change? We should be learning not repeating and genetics is another department that needs further research. If a couple could have there DNA checked before having a child and prevent Horrible dieases why the hell not?
    Untill every state has it passed it is unhumane to block patients from access to opioid treatment. The diverson risk is so low. All this is doing is creating more jobs and torturing citizens with their own body.

  9. Clifford Schaffer at 1:44 pm

    The question of what to do about drugs is not a new one. Over the last 100 years there have been numerous major government commissions around the world that have studied the drug laws and made recommendations for changes. You can find the full text of all of them at http://druglibrary.org/schaffer under Major Studies of Drugs and Drug Policy.

    They all reached remarkably similar conclusions, no matter who did them, or where, or when, or why. They all agreed that the current laws were based on ignorance and nonsense, and that the current policy does more harm than good, no matter what you assume about the dangers of drugs. You don’t have to take my word for that. Read them yourself.

    If you are new to the collection, start with Licit and Illicit Drugs at http://druglibrary.org/schaffer/Library/studies/cu/cumenu.htm That is the best overall review of the drug problem ever written. If you only read one book on the subject, make it that one. It will give you a good summary of what you would learn if you read all the other major reports.

    In 1973, President Nixon’s US National Commission on Marihuana and Drug Abuse completed the largest study of the drug laws ever done. At the end of their study, they said the real drug problem was not marijuana, or heroin, or cocaine. The real drug problem, they said, was the ignorance of our public officials who keep spouting off with solutions but have never read the most basic research on the subject.

    In a perfect illustration of their point, Nixon refused to read his own commission’s report. The full text can be found at http://druglibrary.org/schaffer/Library/studies/nc/ncmenu.htm

  10. Clifford Schaffer at 1:43 pm

    Marijuana was outlawed for two major reasons. The first was because “All Mexicans are crazy and marijuana is what makes them crazy.” The second was the fear that heroin addiction would lead to the use of marijuana – exactly the opposite of the modern “gateway” nonsense.

    Only one MD testified at the hearings for the Marihuana Tax Act of 1937. The representative of the American Medical Association said there was no evidence that marijuana was a dangerous drug and no reason for the law. He pointed out that it was used in hundreds of common medicines at the time, with no significant problems. In response, the committee told him that, if he wasn’t going to cooperate, he should shut up and leave.

    The only other “expert” to testify was James C. Munch, a pharmacologist. His sole claim to fame was that he had injected marijuana directly into the brains of 300 dogs and two of them died. When they asked him what he concluded from this, he said he didn’t know what to conclude because he wasn’t a dog psychologist. Mr. Munch also testified in court, under oath, that marijuana could make your fangs grow six inches long and drip with blood. He also said that, when he tried it, it turned him into a bat. He then described how he flew around the room for two hours.

    Mr. Munch was the only “expert” in the US who thought marijuana should be illegal, so they appointed him US Official Expert on marijuana, where he served and guided policy for 25 years.

    If you read the transcripts of the hearings, one question is asked more than any other: “What is this stuff?” It is quite apparent that Congress didn’t even know what they were voting on. The law was shoved through by a small group of lunatics with no real awareness by anyone else of what was happening.

    See http://druglibrary.org/schaffer/History/whiteb1.htm for an entertaining short history of the marijuana laws.
    See http://druglibrary.org/schaffer/hemp/taxact/taxact.htm for the complete transcripts of the hearings for the Marihuana Tax Act of 1937.

  11. Cary at 12:23 pm

    Please help the cronic pain patients we shouldn’t have to die from pain drugs this is not the Stone Age were they left people to die this will help all of us !

  12. Dave at 11:01 am

    Marijuana is a threat to the opioid manufacturers- as they missed the ball for too long on that. And don’t we know studies have shown that marijuana can be “opioid sparing”.
    But the problem with Senator Warrens call for marijuana- is it is too limited- there are many botanicals that could benefit people in pain. It is unfortunate government and the health care industry always chose the narrow path of approach. And so it is no wonder why too many people in pain believe their choices are limited- there are too many people in government trying (and succeeding) in limiting their choices.
    Like I say- pain care is not “free”- in more ways then one. Its time to free pain care from the mind forged manacles of petty politicians and from the greed of the health care industry.