Medical Cannabis & Opioids in Kentucky


Could Medical Cannabis Help Kentucky’s Opioid Addiction and Overdose Crisis?

By Jason L. Maynard  –  August 24, 2018

You may have heard claims that marijuana can help the areas that have been suffering from high rates of addiction to opioids, and the consequential high rates of overdoses in those areas. What are the basis for those claims, and could they apply here in Kentucky?


1,565 Kentuckians died from a drug overdose last year (2017). According to statistics released by the Kentucky Office of Drug Control Policy (ODCP) in July, this was an 11.5% increase over 2016 numbers. This is continuing a trend that has seen an increase of 40% over the last five years [1]. The news comes on the heels of a slew of legislation passed that was meant to stem the tide of ever-rising numbers like these. Lawmakers have restricted medical professionals’ ability to prescribe painkillers to their patients, further expanded the state’s prescription drug monitoring program (PDMP), and even increased criminal penalties for anyone caught selling opioids [1a]. These have been the traditional responses, copied in jurisdictions across the nation. But they have also proven ineffective, and possibly even made the problem worse.

KY opioid OD death rate

Unfortunately, Kentucky is not alone in our fight against opiate addiction. At least two of our neighboring states, West Virginia and Ohio, have seen similar increases in recent years. In Ohio, overdose deaths increased from 3,050 in 2015 to 4,050 in 2016, an alarming rise of 32.8%. But according to the Ohio Board of Pharmacy, by 2016 opioid prescriptions in that state had fallen for a fourth consecutive year. Between 2012 and 2016, the total number of opioids dispensed to Ohio patients decreased by 162 million doses, or 20.4 percent [2]. In 2017, the total number of doses of prescribed controlled substances dispensed in West Virginia decreased by 31.3 million compared with 2016 [3]. Yet the number of fatal drug overdoses in that state continued to rise as well [4].

Taken together, these numbers indicate that the laws meant to help stop this epidemic have succeeded within their narrow scope, yet that success has not translated into their intended consequences: improved addiction rates and overdose-related statistics. This same phenomenon is happening here in Kentucky, resulting in reports of chronic pain patients in legitimate need of opioid painkillers unable to get them from their doctor, some even being driven to the black market seeking relief. Physicians do not want to be flagged by the state for their controlled substances prescribing rates.

KY opioid Rx, per person


We in Kentucky are, however, in a growing minority of Americans that still cannot legally use medical cannabis. California has now allowed it for 22 years. Our neighbors in Ohio are in the process of starting their program, and lawmakers in West Virginia have agreed to allow medical cannabis be recommended by doctors there beginning July of next year (2019). Patients in both states now stand to benefit from a more natural form of medicine, one that could possibly replace others bought over-the-counter, or even prescribed by their doctor.

This simple idea is what is believed to be behind the results of recent studies showing links between medical cannabis and lower opioid prescriptions, including one that looked at opioid prescribing rates in states with and without medical cannabis programs. They found that within the Medicare population in their study, medical cannabis programs were associated with significant reductions in opioid prescribing. The authors said that their findings “further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.” [5] This study, and several others, suggests that patients may utilize their state’s medical cannabis program as a substitute for the traditional prescribed painkillers.

According to data published in The Journal of Headache and Pain, more than two-thirds of chronic pain patients registered to legally access medical cannabis products do substitute marijuana for prescription opioids [6]. This “substitution effect” could prove to be a critical link between the availability of medical cannabis and the lower rates of overdose deaths that have been reported in medical-legal states. One of these studies found that, on average, states with medical cannabis laws had overdose death rates that were 24.8% lower than states without them [7]. Another 2017 study looking at state’s prescription drug monitoring programs concluded, “When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality” [8].

 

In Kentucky, most of the overdose victims of heroin and fentanyl had “histories of substantial exposures to legally acquired prescription opioids.” [1] Data from West Virginia indicates similar histories for overdose victims in that state. 91% of all decedents there had a documented history with the West Virginia Controlled Substances Monitoring Program (CSMP) [4]. Reducing the rates of opioid prescribing by instead utilizing the well-known painkilling effects of cannabis could interrupt this cycle near its beginning. A study published in the journal Nature found medical cannabis can also work in conjunction with low doses of opioids to provide greater pain relief than opioids alone [9]. This suggests that when used in addition to prescription opioids, cannabis may allow patients to need less of them.

Several state’s medical cannabis programs have recognized the important role the drug can play in a multi-faceted approach to this deadly problem. Most now allow its use for different chronic pain conditions [10]. Some are now beginning to allow it for other types of pain as well. New York and Illinois have passed legislation allowing medical cannabis to be recommended by a physician for any patient who has been prescribed an opioid painkiller, or is suffering from pain that otherwise may be treated by an opioid [11,12]. These laws put patients back in charge of their care, enabling them to decide what treatment works best for their condition, while minimizing risk.

Separate research has been done showing correlations between medical cannabis programs and other lower opioid-related figures, including hospitalizations [13], traffic fatalities [14], and drug treatment admissions [15]. But there are even more ways that cannabis could assist in fighting opioid addiction.

 

The medical standard for addiction treatment is MAT, or Medication Assisted Treatment. This usually involves administering another form of opioid that is considered safer, slower- and longer-acting. Methadone and buprenorphine (Suboxone) are now widely used all across the state to help stabilize patients with substance use disorder (SUD) or opiate use disorder (OUD). The medications prevent symptoms of withdrawal and allow patients to lead a normal life, free from the daily struggle of their disease.

Suboxone film

Thousands have been successfully treated this way, and many credit MAT with saving their life. But many addicts considering treatment (and some currently in MAT programs) feel that substituting their illicit use of an opiate with a doctor-prescribed one only delays the inevitable – one day they will want to stop the MAT. And opiate withdrawal is an unbearable thought, regardless of which opiate you are quitting.

A growing community has sprouted up within states with medical cannabis programs that tout the use of cannabis as a substitute instead. Some credit its analgesic and mood-altering effects for helping them through the withdrawal, and that it allows them to maintain an opiate-free life. New York, New Jersey and Pennsylvania now allow opioid use disorder to be treated with medical cannabis [11,16,17]. Serious attention is being given to this treatment concept by researchers and academics [18], and other states are considering adding the condition to their lists of qualifying ailments.

Cannabis could also be used as a part of other, more traditional therapies such as buprenorphine MAT. In fact, it already is being used, even by some here in Kentucky who claim the key to their success in treatment is their illicit use of cannabis. Physicians who oversee MAT programs often choose to not drug test for cannabis, or may ignore any positive results, feeling that a positive result for cannabis is not an indicator of progress, or lack thereof.

A recent study published in the Journal of Addiction Medicine lends some validity to these claims when researchers found that, in fact “participants [in buprenorphine MAT] using cannabis currently were on lower doses of buprenorphine”. They concluded that patient’s cannabis use did not negatively affect treatment outcomes [19]. While any use by Kentuckians for any purpose remains illegal, in Pennsylvania the Secretary of Health said that medical cannabis will be available there for OUD patients “if a physician recommends that it be used in conjunction with traditional therapies.”[17]

 

Epidemiologists have predicted that the peak of the opioid addiction epidemic has yet to be reached. They have estimated the annual death toll will increase by at least 35 percent by 2027.  In their worst-case scenarios, it could triple — to more than 93,000 deaths a year [20]. The most potent synthetic opioids have yet to even fully reach all the markets in the U.S.  As fentanyl and carfentanyl spread further across America, including into the rural areas of Kentucky’s Appalachia, the numbers of devastated lives and families will surely rise. We will be fighting this health crisis for many years to come.

The people of Kentucky are on the front lines of this epidemic, as demonstrated by consistently having some of the highest rates of overdose deaths in the nation. We should also be on the forefront of new strategies and ideas for solving this crisis. Our lawmakers have passed many new bills in Frankfort to try to reign in these bleak statistics. They should remember that these numbers are only a cold, hard reflection of the many more thousands of people whose lives are devastated and who are desperately needing a way out. However, they have mostly focused on old ideas such as punishment and regulation. Perhaps it is the deregulation of a natural medicine that is needed.

 

If you or someone you know are suffering from addiction and want help, you can call 1-833-8KY-HELP (1-833-859-4357) toll-free to speak with a live specialist about treatment options and available resources. You can also visit www.findhelpnowky.org, a state-run site that offers real-time information about available space in treatment programs, and guides users to the right type of treatment for their needs.


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Sources

[1]
2017 Kentucky Overdose Fatality Report
Kentucky Office of Drug Control Policy
https://odcp.ky.gov/Pages/Overdose-Fatality-Report.aspx

[1a]
Legislative Initiatives
Kentucky Office of Drug Control Policy
https://odcp.ky.gov/Pages/Legislative-Initiatives.aspx

[2]
2016 Ohio Overdose Report
Ohio Department of Health
https://www.odh.ohio.gov/health/vipp/drug/dpoison.aspx

[3]
2017 West Virginia Board of Pharmacy Annual Report
http://www.wvlegislature.gov/legisdocs/reports/agency/P17_FY_2017_13841.pdf

See also,
WV pharmacies dispensed 31M fewer painkillers and other powerful drugs last year
Charleston Gazette Mail, By Eric Eyre, Jan. 20, 2018
https://www.wvgazettemail.com/news/health/wv-pharmacies-dispensed-m-fewer-painkillers-and-other-powerful-drugs/article_c8756a55-8cac-5618-9f86-2e0e990d0e72.html

[4]
2016 West Virginia Overdose Fatality Analysis – Press Release
West Virginia Department of Health & Human Resources, Jan. 23, 2018
https://dhhr.wv.gov/News/2018/Pages/DHHR-Releases-2016-West-Virginia-Overdose-Fatality-Analysis-.aspx

Full Report:
https://dhhr.wv.gov/bph/Documents/ODCP%20Reports%202017/2016%20West%20Virginia%20Overdose%20Fatality%20Analysis_004302018.pdf

[5]
Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population
JAMA Internal Medicine, 2016
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2676999

[6]
Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort
The Journal of Headache and Pain, 2018
https://thejournalofheadacheandpain.springeropen.com/articles/10.1186/s10194-018-0862-2
See also,
http://norml.org/news/2018/06/07/study-majority-of-chronic-pain-patients-replace-opioids-with-cannabis

[7]
Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010
JAMA Internal Medicine, 2014
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392651/

[8]
Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality
Journal of Opioid Management, 2018
https://www.ncbi.nlm.nih.gov/pubmed/28953315

[9]
Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability
Neuropsychopharmacology, 2018
https://www.nature.com/articles/s41386-018-0011-2

[10]
Medical Marijuana Laws by State, multiple sources:
https://healthcare.findlaw.com/patient-rights/medical-marijuana-laws-by-state.html
https://www.safeaccessnow.org/state_and_federal_law

https://www.leafly.com/news/health/qualifying-conditions-for-medical-marijuana-by-state

[11]
“New York State Department of Health Announces Opioid Use to be Added as a Qualifying Condition for Medical Marijuana” – Press Release
New York Department of Health, July 18, 2018
https://www.health.ny.gov/press/releases/2018/2018-06-18_opioid_use.htm

[12]
Illinois General Assembly
Bill Status of SB0336, 99th General Assembly
http://www.ilga.gov/legislation/BillStatus.asp?GA=99&DocTypeID=SB&DocNum=336&GAID=14&SessionID=91&LegID=100276

[13]
Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever
Drug and Alcohol Dependence, 2017
https://www.ncbi.nlm.nih.gov/pubmed/28259087

[14]
State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers
American Journal of Public Health, 2016
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303426

[15]
Do medical marijuana laws reduce addictions and deaths related to pain killers?
Journal of Health Economics, 2018
https://www.sciencedirect.com/science/article/abs/pii/S0167629617311852

[16]
Frequently Asked Questions
New Jersey Department of Health
Medicinal Marijuana Program
https://nj.gov/health/medicalmarijuana/pat_faqs.shtml

[17]
Wolf Administration Approves Eight Universities as Certified Medical Marijuana Academic Clinical Research Centers
Pennsylvania Governor’s Office Press Release, May 14, 2018
https://www.governor.pa.gov/wolf-administration-approves-eight-universities-certified-medical-marijuana-academic-clinical-research-centers/

[18]
Rationale for cannabis-based interventions in the opioid overdose crisis
Harm Reduction Journal, 2017
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563007/

[19]
Does Cannabis Use Influence Opioid Outcomes and Quality of Life Among Buprenorphine Maintained Patients? A Cross-sectional, Comparative Study
Journal of Addiction Medicine, 2018
https://journals.lww.com/journaladdictionmedicine/abstract/2018/08000/does_cannabis_use_influence_opioid_outcomes_and.11.aspx

[20]
STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade
https://www.statnews.com/2017/06/27/opioid-deaths-forecast/

 

Further Reading: There is an enormous amount of information and research on this and other cannabis-related topics on the web. You are encouraged to research further, however choose your sources from among trusted sites and organizations. Here are some to help get you started, in addition to the references above.

National Academy of Sciences, Engineering and Medicine (NASEM)
http://nationalacademies.org/hmd/Reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx

Cannabis for Chronic Pain
Americans for Safe Access
https://www.safeaccessnow.org/chronic-pain

Also see the ASA’s End Pain Not Lives project for more information, including model legislation and other resources, at http://www.endpainnotlives.org

Where Marijuana Is Legal, Opioid Prescriptions Fall
Scientific American
https://www.scientificamerican.com/article/where-marijuana-is-legal-opioid-prescriptions-fall/

Cannabis and the opioid crisis: a multidisciplinary view
Center for the Study of Cannabis at the University of California, Irvine
Hosted by the Beckmann Center of the National Academy of Science
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5931647/#__ffn_sectitle

Relationship Between Marijuana and Opioids
NORML
http://norml.org/marijuana/fact-sheets/item/relationship-between-marijuana-and-opioids

Tilray® Shares Preliminary Data from the Largest National Longitudinal Medical Cannabis Patient Study in Canada
Study finds significant reduction in opioid use and improvements in quality of life within first 6 months
https://www.businesswire.com/news/home/20180501005497/en/