Legalization of Opioids and Marijuana

There is a significant public health problem in America that is causing mass devastation. Ironically, it is administered by your healthcare providers. The culprit is opioid addiction. There have been some efforts to curb this epidemic. Andrew Yang has offered many solutions in his presidential campaign. But despite the attempts to stop this epidemic, Andrew Rogers, who is a doctoral student in clinical psychology who works in the UH Anxiety and Health Research Laboratory and its Substance Use Treatment Clinic says that opioids are still the most widely prescribed class of medications. Opioids help treat chronic pain and contain chemicals that relax the body and treat moderate to severe pain. The effects of opioids are an important factor in understanding this epidemic. The opioid epidemic has resulted in over 7,200 deaths in 2017 according to the National Institute on Drug Abuse. Many believe that legalizing Marijuana could help with this epidemic and reduce the use of opioids due to Marijuana being able to help with chronic pain. States like Illinois and New York passed the legalization of medical marijuana so that it would be more accessible to those who have opioid prescriptions. However, Marijuana should not be the sole candidate to solve the opioid crisis. Co-occurring marijuana and opioids could be detrimental to society and we should not rely on a drug to solve another drug problem.

Marijuana has been celebrated for its relaxing effects and is currently being pushed in many states to be legalized not only medically but also recreationally. It has garnered a lot of attention in the chronic pain area of medicine. Andrew Rogers, who is clinical psychologist said that more individuals have been using marijuana to manage pain. “Increasing numbers of individuals use marijuana to manage chronic pain. Co-use of substances generally is associated with poorer outcomes than single substance use.” (Rogers). Replacing evidence-based opioid addiction treatments like methadone and buprenorphine with Marijuana could be lethal to the recovery of the addiction. Jonathan Stea who is a practicing clinical psychologist who specializes in treatments for coexisting addictive and psychiatric disorders says from a medical standpoint, it would be unethical to replace the treatment with Marijuana due to the inconsistent data compared to treatments that have been tested before.

The main reason for making medical marijuana an option to get rid of opioid addiction in America is that marijuana can help with chronic pain. “While less than 8 percent of chronic pain patients become addicted to opioids, people who experience opioid addiction have higher rates of chronic pain compared to the general population.” (Stea). Despite many people's belief, marijuana is almost ineffective and weak for severe chronic pain (National Drug and Alcohol Research Centre). This research implies that people who experience chronic pain and opioid addiction would most likely not be saved by marijuana and would need to rely on other methods and treatments for chronic pain management.

Not only is marijuana ineffective for severe chronic pain management but also a researcher from the University of Houston has found that adults who take prescribed opioids for their chronic pain are more likely to have increased depression, anxiety, and substance abuse issues if they use marijuana as well. Andrew Rodgers surveyed 450 adults who experienced chronic pain for more than three months. His study showed that not only were there elevated anxiety and depression symptoms, but more common use with tobacco, alcohol, cocaine, and sedative who used Marijuana with their opioids compared to those who only used opioids. There was no increased pain reduction reported in his research. He also claims that co-using opioids and marijuana is generally associated with poorer outcomes than single-use and little work has been done to examine the impact of mixing opioids and marijuana.

There have been claims coming to surface that there is a link between the usage of marijuana and lower rates of fatal opioid overdoses from 1999 to 2010 in states that legalized medical marijuana. A new study found similar results in 2014 that there was a 21% decrease in opioid mortality for every 100,000 people in the population where medical marijuana is legalized (Rapaport). Researchers found that deaths from opioids are decreased by 33% in 13 states in the six years after medical marijuana was legalized. They determined this by looking at death certificate data across all 50 states between 1999 and 2010. Only 13 states had medical marijuana legalized. Researchers claim to see that the rates of overdoses were significantly lower that has legalized marijuana laws in place. The researchers say that there have been 1,700 fewer opiate-related overdose deaths. 60% of fatal overdoses happen with patients who have an authorized prescription for their medication. Authorized opiate users can significantly decrease his or her dosage in states where medical marijuana is legalized, making overdosing less likely to occur (American Addiction Centers Editorial Staff).

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Nathan Chan, an assistant professor in the resource economics department at the University of Massachusetts claims to have found that the mortality rates of opioid users have decreased. They estimated that recreational marijuana laws would reduce opioid mortality in the range of 20%-35%. However, if their research they stated that their study does not allow them to pinpoint the precise mechanism for the reduction in mortality (Chan). Lisa Rapaport who is a freelance journalist on health science claims that a new study looked from 1999 to 2017 they found that there was a 23% increase in opioid overdoses that were states that passed medical marijuana laws. Like the 2014 study that I stated earlier, new analysis cannot show whether people are using marijuana as an alternative for pain relief or recreational. Those studies were not designed to determine the effectiveness or safety of medical marijuana for any specific health issues. Chelsea Shover who is the lead study author of Stanford University School of Medicine in California stated, “With the benefit of a longer time span we conclude that medical cannabis laws do not seem to have reduced opioid overdose mortality at the population level,” (Rapaport). Shover goes on to say that there are shared characteristics between those 13 states like incarceration of drug users, more availability of treatment for opioid addiction, and availability of the overdose reversal drug naloxone explain the data they found. We must also consider that expanding access to naloxone is a short term solution and we instead need to provide treatment services to individuals with all forms of addiction to prevent future overdose cases. But since almost every state has passed a version of medical marijuana law, we can see how it plays out in a more representative group (Rapaport).

Another study that was conducted wanted to compare the sociodemographic and clinical characteristics of patients that had the opioid drug disorder. However, they concluded that they need to further investigate whether the effects of marijuana used on patients that have an opioid addiction are counterbalanced by the potential benefits of reduced opioid prescribing (Aquino). This furthers the argument that it is too soon to tell if marijuana is really helping or if it negatively impacting the progress.

Lastly, using marijuana as treatment has not reduced the use of opioids. Marijuana should not be treated as the only solution to the opioid crisis. Using marijuana and opioids simultaneously would have detrimental effects on the progression of figuring out this crisis. The point of co-using Marijuana and opioids was to decrease the need for opioids. Though it did prevent people from overdosing, the users are still addicted and overprescribed. Once they run out of Marijuana or cannot afford to get more, the likelihood of them overdosing increases dramatically. However, Marijuana could help with opioid addiction symptoms like withdrawals and cravings.

As stated earlier, states including New York and Illinois have legalized medical marijuana to make it more accessible to people who have prescribed opioids as a treatment option for addiction. Critics like the American Society of Addiction Medication argue that there has not been enough evidence gathered yet to support or promote cannabis as a treatment option. There have not been randomized controlled trials or rigorous research methodologies that evaluate Marijuana as a treatment option (Marijuana Is Not a Public Health Solution to the Opioid Crisis). Studies that are done at a state level cannot conclude individual behaviors. We must watch out for the ecological fallacy.

We still need more resources and solutions to the opioid problem instead of making Marijuana the sole solution to this crisis. The notion that having better access to Marijuana will help America shed its current opioid crisis does not have any scientific merit. It distracts from implementing a long term solution that has evidence-based strategies. It is a multilayered and multi-causal problem that demands an equally multi-pronged solution instead of a duct tape solution. The cause of opioid addiction is not just from one source but multiple like biological, psychological and social factors. Therefore, we need effective and innovative treatments that are evidence-based psychological and pharmacological treatments. It also has to be easily accessible to everyone for it to reach its full potential. We should look more into finding more solutions to this epidemic and establish more restrictions on the drugs. Instead of ignoring and downplaying the problem we need to remove the stigma of opioid misuses and addictions to be able to correctly fix our future healthcare system. The annual number of opioid overdose deaths is expected to increase by 150% between 2015 and 2025 (Marijuana Is Not a Public Health Solution to the Opioid Crisis). This data shows how urgent this crisis is and to be able to move forward we must let go of what we want and instead take into account what research shows. “We need to help our neighbors, friends, and colleagues get judgment-free treatment and overcome the stigma associated with it,” John Gale says, who is Rural Health Research r senior research associate. “These folks deserve a second chance to get their lives back.” (Rural Horizons).