Wednesday 8 June 2016

Commentary: Medical marijuana cuts use of deadly opioid painkillers

By Marcus Bachhuber,

The harms from long-term use of opioid painkillers are clear. In 2014 alone, there were almost 19,000 overdose deaths involving these medications. The New York Legislature, like legislatures around the country, is struggling to find ways to help stem the opioid overdose crisis. They don't have to look far.

In 2014, I authored a study in JAMA Internal Medicine that found the average yearly rate of opioid painkiller overdose deaths in states with medical marijuana laws was about 25 percent lower than the average rate in states without these laws.

In other words, our findings suggested that the availability of medical marijuana may have led to a decrease in fatal opioid pain reliever overdoses. While no one would argue that access to medical marijuana will completely fix the problem, it may represent a small step in the right direction.

The good news is that, as of January this year, many patients in New York have access to medical marijuana as a treatment option. The bad news is that many people who could potentially benefit — including many with severe, chronic pain—don't qualify under the current statute.

Recently, I saw a patient in my clinic who, because of a brain injury as a child, walks with a pronounced limp, which puts severe stress on her right hip, knee, and ankle. Despite intensive physical therapy, over the years these joints have broken down, causing severe pain. Betty has tried many medications and therapies, and opioid painkillers are one of her last options.

Looking for relief, she recently tried marijuana offered to her by a family member. Much to her surprise, it helped. She was able to get up and go buy groceries "like a normal person."

But she doesn't qualify for medical marijuana in New York right now because her pain isn't from "neuropathy" (nerve pain). While medical marijuana has most commonly been studied in patients with neuropathy, it has also been studied in other types of severe chronic pain, like what my patient has.

These studies are small, but they have found that medical marijuana can provide relief for some patients. But the current program in New York cuts off access to medical marijuana for any patient with chronic pain who doesn't specifically have neuropathy.

Medical marijuana is an alternative to opioid painkillers for many patients like her. Research from other states has found that patients taking medical marijuana often substitute it for other medications and that they are interested in safer alternatives to opioids.

A study of patients with chronic pain already taking opioid painkillers found that adding medical marijuana improved pain relief, suggesting that medical marijuana may allow patients to decrease their doses of opioid painkillers. I've even heard from patients who traveled to Colorado to buy legal marijuana to wean themselves off of their opioid medications.

While experts continue to debate marijuana's effectiveness in treating pain, even the harshest critics will admit that it is safer than long-term opioid painkiller use.

No one would argue that medical marijuana is the right choice for everyone with severe chronic pain. But this decision should be left to patients and their health care providers. Patients like the one I described should have access to this treatment option, especially if it means providing relief, avoiding the long-term use of opioid painkillers, and potentially reducing overdose deaths from these medications.

If the New York Legislature wants to help patients like her while decreasing our reliance on opioid pain medications, it should pass the bill (A9514A/S724A) adding severe chronic pain to New York's medical marijuana program. It's the smart and humane thing to do.

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