Marijuana will not curb the opioid epidemic: (“Can Cannabis Cure the Opioid Epidemic?” EMN Enews. 2020;42[10A]; https://bit.ly/3nQgeMk.) California, for instance, has had medical marijuana since 1996, yet the number of opioid deaths continues to rise. (California Department of Health. https://bit.ly/2T8sJ7L.) This is despite doctors doing the right thing, such as reducing the number of prescriptions, giving lower morphine equivalents, co-prescribing fewer opioids and benzodiazepines, and prescribing more buprenorphine for opioid use disorder.
The most current data based on a meta-analysis of the studies to date, including randomized controlled studies, simply do not support the use of marijuana for pain. (Eur Neuropsychopharmacol. 2020;36:206.) In fact, data show that states with medical marijuana have a 23 percent increase in opioid overdose deaths. (Proc Natl Acad Sci U S A. 2019;116:12624; https://bit.ly/3m3nDGo.) Additional studies show there is not evidence to support using marijuana as an opioid substitute. (JAMA Netw Open. 2019;2:e197216; https://bit.ly/3kbPJi6.)
Colorado has had medical marijuana for nearly 20 years, with more than 90 percent of recommendations for pain. (Medical Marijuana Registry Program Monthly Report. September 2020; https://bit.ly/3dIkQ2p.) But in 2019, it had a record number of opioid deaths, and preliminary 2020 data are pointing to yet another record year in drug deaths. (Colorado Drug Overdose Dashboard. https://bit.ly/3m8iaOK.) Adolescent presentations to the emergency department related to marijuana have also continued to rise, with more than 70 percent with psychiatric illness. (J Adolesc Health. 2018;63:239; https://bit.ly/37qiSm4.)
Recall that we were in the middle of a vaping epidemic when COVID-19 hit, with vitamin E acetate and THC centerstage related to those deaths. There are significant conflict-of-interest concerns with the magazine promoting the use of marijuana by a physician simultaneously promoting her Cannabis business and self-interests.
Ken Finn, MD
Colorado Springs, CO
The author is the editor of Cannabis in Medicine: An Evidence-Based Approach and the owner of Springs Rehabilitation, a group practice in physical medicine and rehabilitation.
Dr. Yafai responds: Thank you so much for the thoughtful and thought-provoking reply. Legalizing a product, meaning not imprisoning individuals for the use of a product, which is what was done in 1996 in California, is completely different from implementing, prescribing, advising, and educating medical patients on a product for the sole purpose of removing an opioid. We, the medical community, have never recommended Cannabis use for the isolated issue of removing opioids until very recently. (See Dr. Yasmin Hurd's research on CBD and heroin withdrawal.)
The use of Cannabis for the reduction and removal of opioids is only being done by a handful of doctors, nurses, and medical care providers across the entire country. The assumption that simply legalizing a product should equate with an automatic down trend in opioid use, abuse, and death is far-fetched. We need stable medications, good education, and good dosing strategies to be able to see if there is an actual value on a larger scale. These issues are never to be ignored and the point of my column is to question our pre-existing ideas about Cannabis.
The medical equivalent of your analogy would be to allow anyone to purchase methadone or buprenorphine for any reason and then assume that these medications are poor strategies for treatment when the deaths multiply.
The vaping “epidemic” resulted from additives of vitamin E acetate, and had nothing to do with THC itself except that individual manufacturers of all types of vape oils were trying to dilute the product to make more money. This applied to nicotine, THC, and CBD products. That said, the total number of deaths in the United States was 68 in total, according to the CDC. (Feb. 18, 2020; https://bit.ly/2TqgvHZ.) That doesn't even come close to opioids.
As for the idea that I am trying to promote my Cannabis “business,” please note that I do not produce, distribute, manufacture, or in any way benefit financially from Cannabis products. My “business” is that I am a physician who can provide advice and education from a medical perspective on Cannabis to patients and other physicians. I don't do injections or costly procedures for patients. As for conflict of interest, do you benefit financially from your facility that profits on providing patients with buprenorphine, urine tox screens, costly injections, and a continued circle of addiction?