Could marijuana become a treatment for heroin addicts?

Some think it offers a gateway out of opioid use
Could marijuana become a treatment for heroin addicts?
Posted at 7:00 AM, Sep 25, 2016
and last updated 2016-09-25 07:00:50-04

Is marijuana a gateway drug? Carrie Roberts sure hopes so.

%page_break%Roberts, a consultant with Colorado-based Medicine Man Technologies, doesn't believe that marijuana use leads to abuse of harder drugs, though. Instead, she thinks it might present a gateway out of risky drug use for people struggling with opioid dependency.

"I think we could save a lot of lives," Roberts said. "Right now, it's really about needing to focus on harm reduction. That's so much of what we're seeing in other states."

Roberts points to a 2014 study published by the Journal of the American Medical Association (JAMA) that concludes "medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates." States with medical marijuana laws saw about 25 percent fewer overdose-related deaths than states without, according to the study.

Roberts argues that this could be the case in Ohio, a state in the throes of an opioid epidemic that saw fentanyl-related overdoses spike in 2015. Fentanyl continues to cause heroin users to overdose, and the more recent introduction of carfentanil into the drug ecosystem has provided cause for further alarm.

"There is a lot of anecdotal evidence regarding being able to use cannabis as a treatment, either for people coming off of opioid pain medication to help them through the withdrawal phase of it, or just to keep people from having to use it in the first place," Roberts said.

Because the federal Drug Enforcement Agency still classifies marijuana as a Schedule 1 controlled substance, there's no hard science to back up the idea. And the JAMA study cited by Roberts notes 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 for many experts, there's no question that overprescribing opioid painkillers is what led to today's opioid crisis.

"Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly -- almost enough for every adult in America to have a bottle of pills," U.S. Surgeon General Dr. Vivek Murthy wrote in a letter sent last month to every doctor in the country. "Yet the amount of pain reported by Americans has not changed. Now, nearly two million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C."

Though it doesn't explicitly allow marijuana to be prescribed for the purpose of overcoming opioid addiction, Ohio's new medical marijuana does allow it to be used to treat chronic, severe or intractable pain.

"I can understand why people would be supportive of the idea that people should have enhanced access to marijuana in light of all the deaths that we're seeing from opiates," said Dr. Jeffrey Bill, founder and CEO of Sunrise Treatment Center in Forest Park. "I'm not so sure that we won't see more significant issues impacting our country, though, if the use of marijuana increases even further, as there are definitely concerns related to its physical and mental health complications and negative impact on brain development and intelligence in more regular users that start at younger ages."

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Don't count on places like Sunrise, which administers a Suboxone-based treatment program for opioid addicts, to start prescribing marijuana to patients. According to Bill, "marijuana definitely keeps the brain primed to experience the effects of opiates even more positively should (the patients) have a relapse, and it also interferes with the metabolism of the medication that we use in a way that makes them feel less stable."

Suboxone is a drug used to help treat opiod addiction.

Medical marijuana became the law of the land in Ohio on Sept. 8. However, regulations governing the various aspects of how medical marijuana will work are not required by the law to be finalized until this time next year, and it could be another year after that before it becomes possible for a patient to get a prescription, much less get it filled.

That's a source of frustration for some of the legislators who co-sponsored the bill in the Ohio Legislature.

"People can't die from marijuana," said Cindy Peters, senior legislative aide to bill co-sponsor State Sen. Cecil Thomas (D-Cincinnati). "I think it definitely is a step in the right direction that we have legalized it. Unfortunately, we're just going to have to let time pass until we see the actual effects of it."

When asked if the opioid epidemic and ongoing problems with overdose deaths created a new sense of urgency to get regulations ironed out, Peters said the governor's office will make that call.

Judging by the responses given by officials in Gov. John Kasich's administration, the answer seems to be "no." Department of Commerce representative Kerry Francis said in an email to WCPO that the department will "take the time necessary to develop rules that ensure the safety of the public and access to a safe product." Francis wrote that September 2018 remains the target date to get the program fully operational.

"Fighting drugs has been a key priority for Gov. Kasich, and he is fully committed to working with locals to fight this battle, and that means working together on proven solutions and proven tools," wrote Emmalee Kalmbach, Kasich's press secretary, in an email response to a WCPO inquiry. "It also means focusing on tools that actually exist instead of hoping for the equivalent of magic spells that (don't) exist. That's just a distraction that hurts those in need."

Kasich has remained silent on the reasoning behind his decision to sign the medical marijuana bill into law in June.

Kalmbach touted Kasich's efforts to curb opioid overdoses, including expanded access to Medicaid and other treatment options, public relations campaigns to connect addicts to treatment resources, funding for local-level treatment and interdiction programs, and increased regulatory requirements for opioid prescribers.

"In addition, the governor's 2016 Mid-Biennium Review proposes additional reforms to further prevent the diversion of addictive prescription medications, expand access to naloxone to reduce drug overdose deaths and ensure access to safe and effective treatment for those suffering from addiction -- this bill has passed the Senate and will resume in the House this November," Kalmbach wrote.