Cannabis doesn’t replace opioids the way methadone or buprenorphine do. There’s no antagonist effect as with naloxone or naltrexone.

A cautionary tale about medical marijuana and opioid deaths

Just the other day, our state decided to include opioid disorders among qualifying conditions for its medical marijuana program. One of the strongest arguments for the move was a study that compared rates of opioid fatalities in states with medical cannabis programs versus those without, during the first decade of the new century. The findings were nothing short of remarkable: The presence of a medical cannabis program in a state appeared to lower the rate of death from opioids by 25%, on average.

Should we now anticipate a comparable drop in opioid fatalities in our state? Not so fast. A second study that used the same methods but with an expanded sample (more years of data) has arrived at a different conclusion. In fact, they found a 25% increase in fatality rate. Essentially a complete reversal of the first study’s findings.

Looking back, the research team on the initial study went to considerable lengths to caution against making too much of their results. More research was needed. That wasn’t enough to discourage cannabis advocates and an enthusiastic media from trumpeting those early results at every opportunity. It surely influenced the thinking of state legislators.

I expect we’ll soon begin hearing from some disappointed politicians. Back to the drawing board.

For me, the notion of relying on medical marijuana to substantially curtail opioid OD fatalities never did quite add up. In the first place, only a relatively small percentage of opioid users were enrolled in cannabis treatment, so how could it have such an impact on the larger population? I’d wonder what other factors were involved. Second, cannabis and the opioids are quite different, biochemically speaking. Cannabis can’t replace opioids the way methadone and buprenorphine do. There’s no antagonist effect, as with naloxone or naltrexone. In sum, it’s just another drug — like alcohol, or a tranquilizer. And we already have plenty of access to those.

Third, from experience, I’ve found that many (perhaps most) opioid patients presenting for treatment are already longtime users of marijuana — often long before they were exposed to opioids. It certainly hasn’t discouraged their opioid use up to this point. Why would we expect that to change with the introduction of more marijuana into their daily lives?

None of this seems to make a difference to advocacy groups or the physicians who support them. They’ve pressed ahead, sometimes out of conviction, other times with the hope of financial reward.

Of course, opioid users will sign up for medical marijuana. It’s part of the conditioning that occurs during addiction.

As one patient put it, when a practitioner asked him if he felt the need for pain medication: “What are you offering?” He explained that he rarely if ever turned down a medication, on the grounds that it might come in handy someday. After all, he said: “You never know, do you?”

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