Could medical marijuana help fight opioid abuse? It’s complicated
By Dean Olsen
Posted May 26, 2018 at 3:52 PM
Updated May 27, 2018 at 3:02 PM
Tom Utley says medical marijuana allowed him to reduce his use of prescription painkillers by 98 percent over the past year and a half.
“It has given me control of my life,” said Utley, 42, a Mason County resident whose chronic pain after a car crash 27 years ago used to require him to swallow Vicodin and OxyContin pills four times a day. Now he takes prescription opioids only a few times each month.
Utley, who works part time running a gymnastics tumbling program, has found relief in marijuana-infused topical lotions and patches, as well as smokable cannabis, from Springfield’s HCI Alternatives dispensary. Unlike prescription opioids, marijuana doesn’t come with the unwanted side-effects of constipation, cravings and cloudy thinking, he said.
“I take it till I feel better,” said Utley, who lives in Kilbourne. “I don’t take it to get messed up.”
Utley is among those who see expanded access to medical marijuana for people in pain as one solution for the nationwide epidemic of addiction to legal opioid painkillers and illegal opioids such as heroin and fentanyl. There were about 2,000 fatal and 14,000 nonfatal opioid overdoses in Illinois last year.
“I think it would be a way-better alternative,” Utley said of medical cannabis. “There is so much knowledge and science behind it now.”
The Illinois General Assembly is considering a bill that could vastly expand the number of people qualifying for the state’s medical marijuana pilot program. Senate Bill 336 would allow people who have been or could be prescribed opioids to apply for acceptance into the program.
The science surrounding the therapeutic benefits of marijuana is far from conclusive. But those shades of gray are missing from descriptions of both the benefits of cannabis from supporters of SB 336, and the drawbacks cited by opponents.
“Public policy is light years ahead of the science right now,” said Ziva Cooper, a research scientist who is associate professor of clinical neurobiology in psychiatry at Columbia University in New York. “There seems to be this nationwide experiment on the effects of cannabis that is happening in the absence of rigorous studies.”
SB 336 passed the Illinois Senate on a 44-6 vote April 26. The bill is expected to receive a vote from the full House by the end of the week.
The legislation has received bipartisan support. In the Senate, Democrat Andy Manar of Bunker Hill voted “yes,” while Sam McCann, a Plainview resident who was elected as a Republican, voted “no.” Among the bill’s co-sponsors in the House is Rep. Tim Butler, R-Springfield.
A spokeswoman for Gov. Bruce Rauner, a Republican, didn’t respond when asked the likelihood that Rauner would sign the bill into law if it reaches his desk.
Supporters of the legislation cite studies that have documented a correlation between a reduction in opioid-related fatalities and opioid prescriptions in states that allow the use of marijuana for medical or recreational purposes.
“The science is generally supportive of the concept,” said state Sen. Don Harmon, D-Oak Park, the bill’s chief Senate sponsor. “People don’t die from cannabis. I don’t feel like we’re doing much harm.”
But those studies, as well as numerous anecdotal reports from patients, don’t necessarily prove that expanding medical marijuana use leads to positive outcomes for the general population, Cooper said.
Results also aren’t conclusive when it comes to the negative implications of cannabis use reported in other legitimate but non-definitive studies, she said.
Those studies, publicized by Springfield-based Illinois Church Action on Alcohol and Addiction Problems, suggest marijuana is associated with an increased risk of prescription opioid misuse and addiction, and actually may contribute to the opioid epidemic.
Rep. Kelly Cassidy, D-Chicago, House sponsor of SB 336, said she wasn’t familiar with studies cited by the bill’s opponents, though she was skeptical about the research because many opponents of the bill are “prohibitionists. They’re against alcohol, tobacco, gambling. I will say that most of the studies I’ve seen show the benefit of cannabis as … an alternative for pain treatment that is non-addictive or less addictive.”
Cooper said, “There is correlational evidence on both sides of the argument.”
For example, the reported quadrupling of opioid-related deaths in Colorado since 2002 may be a reason to think that cannabis legalization in that state in January 2014 “is not helping with opioid-induced fatalities,” she said. “But we don’t know what the rates have been like in other states over that time range.”
The studies do make a compelling argument that more and more-rigorous follow-up studies are needed, she said while declining to comment on SB 336.
“It’s just going to take time for us to do the studies that will yield the actual data that support some of these things we’re hearing about in the media,” she said.
Cooper was a member of a committee convened by the National Academies of Sciences, Engineering and Medicine that issued a report in January 2017 on the current state of evidence surrounding the health effects from cannabis and chemicals in cannabis known as cannabinoids.
The report said there is “conclusive” or “substantial” evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults. “But there are a couple of caveats,” she said.
For example, she said, the report didn’t say there’s conclusive evidence that cannabis is more effective than opioids in helping patients deal with pain.
“We did not make that conclusion because right now, there is not data supporting that point,” Cooper said.
She and her colleagues recently published what she described as the first rigorous study in humans — a “placebo-controlled, double-blind study” — that demonstrated “robust pain relief” when cannabis is combined with an extremely low dose of an opioid.
“There are strong indications that cannabis might be an effective treatment adjunct to help with chronic pain,” Cooper said. But she said more study is needed because, among other things, her study didn’t focus on people with chronic pain.
Data from the state indicate that 3 million Illinoisans obtained an opioid prescription in 2016, according to Chris Stone, chief executive officer of HCI Alternatives.
Even if just 10 percent of those patients sought temporary access to the state’s medical marijuana program under the provisions of SB 336, up to 300,000 people would join a program currently serving 36,800 people, he said.
Expanding the program would help more patients and increase employment in the legal cannabis industry, Stone said. HCI employs 37 people at its dispensaries in Springfield and Collinsville and serves 2,400 patients — 1,100 of them in the Springfield area, he said.
A “large majority” of HCI’s patients taking prescription opioids for pain have been able to reduce their opioid use with cannabis, Stone said.
Such anecdotal reports are being reported across the state, according to John Sullivan, a member of the Medical Cannabis Alliance of Illinois who is part-owner and operator of marijuana dispensaries in Chicago and Rockford.
“It’s really remarkable,” he said. “I don’t think we can afford to wait any longer.”
Illinois, unlike most states with medical marijuana programs, doesn’t allow a general diagnosis of pain to qualify patients for the program, Cassidy said.
The Illinois Department of Public Health is appealing a Cook County judge’s January ruling ordering the department to add “intractable pain” to the list of qualifying conditions for medical marijuana.
IDPH director Dr. Nirav Shah has said there was a lack of “high-quality data” to justify adding pain to the list of more than 30 conditions, which include cancer, AIDS, spinal cord injury, seizures and fibromyalgia.
SB 336 isn’t designed to add pain patients to the program for the rest of their lives.
“This is really about folks who are looking at a six-month period of time of needing these medications or a three-month time period — for those folks who are very much at risk of addiction,” Cassidy said.
Some pain patients could qualify for the program for a longer period, she said.
Anita Bedell, executive director of Illinois Church Action, said the bill “will greatly expand the use of marijuana. Rather than help the problem, it could make drug problems worse in Illinois.”
The Sangamon County Opioid Task Force Coalition has discussed the over-reliance on opioids in treating pain, according to Jim Lewis, a retired federal prosecutor. The group hasn’t focused on any particular alternatives to legal opioids, such as medical marijuana, he said.
There are diverse views among substance-abuse treatment providers when it comes to medical marijuana, said Eric Foster, chief operating officer of the Illinois Association for Behavioral Health. The association has taken a neutral stance on SB 336.
“If there are alternatives to prescription opiates, they should be considered,” he said.
Dr. Eli Goodman, a Springfield physician who is medical director of a Chicago-area drug-treatment program, said using marijuana to reduce opioid use is illogical.
At his employer’s program, “Footprints to Recovery,” almost all clients with an opioid-abuse problem have been using marijuana, he said.
“So if marijuana were an effective treatment, they wouldn’t be using opiates,” he said. “It’s a real leap to say using marijuana prospectively would reduce their opioid use. It might make it worse.”
Ronald Vlasaty, executive vice president of Family Guidance Centers, which operates a site in Springfield, said some people could use medical marijuana to avoid opioid addictions. But he said his organization is “very cautious” in considering the legislation because most of its clients have used marijuana in the past.
Even if SB 336 becomes law, patients wanting to be added to the medical marijuana program will have to find doctors willing to sign paperwork certifying that they are receiving opioid prescriptions or have pain that would qualify them for prescriptions.
The Illinois State Medical Society and the Sangamon County Medical Society haven’t taken stances on the bill.
“I’m just not sure there’s enough science to point one way or the other,” said Dr. Andrew Bland, president of the county medical society.
Andrew Dewey, 51, a Chatham resident and recovering heroin addict, said he might have avoided excessive use of prescription painkillers and eventual addiction to those drugs and illegal drugs if he had access to medical marijuana for pain a decade ago.
Larry Lenkart said he has been able to reduce his use of prescription opioids by one-third and feel less anxiety because of marijuana-infused “gummies” candy and marijuana vaping.
Lenkart, 60, of Springfield, said he has dealt with chronic pain related to diverticulitis for 18 years and had to use significant amounts of hydrocodone and other prescription opioids to function at his previous office and retail jobs.
He said he wished he could have qualified for medical marijuana before he was diagnosed in September with pancreatic cancer.
“If I had access to it years ago, I think I would be using a minimal amount of opioids now,” he said. “Anytime I can take less opioids, it’s good.”
Contact Dean Olsen: firstname.lastname@example.org, 788-1543, twitter.com/DeanOlsenSJR.