Michael D. Cutler: Marijuana's value as opioid 'exit drug'

By Michael D. Cutler

NORTHAMPTON >> The opioid epidemic in Massachusetts has raged into full-blown crisis that state leaders have pledged to combat. They now recognize the failure of government-enforced abstinence to reduce access or addiction, and they promise more emphasis on treatment. Overdose deaths swelled in secrecy, and part of the relief has been public recognition of the epidemic and that existing policy must change.

Amid the publicity about the epidemic and expanded treatment, an evidence-based tool for reducing overdose deaths remains unmentioned by our leaders: Marijuana. Marijuana's success in saving the lives of opioid abusers, supporting their opioid abstinence and combatting the effects of withdrawal, is well-documented.

Our leaders' silence — ignoring the evidence that marijuana helps addicts, while marijuana prohibition harms the public health more than marijuana use — is costing lives.

Marijuana did not cause the opioid epidemic. The U.S. Centers for Disease Control places blame for the epidemic squarely on the proliferation of opioid prescriptions. Marijuana, according to mounting evidence, may serve a valuable role in the epidemic's solution.

Federal research indisputably establishes that marijuana is not a "gateway drug." To the contrary, multiple studies show marijuana's value as an "exit drug," enabling addicts to better withstand the rigors of abstinence and withdrawal.

The Journal of the American Medical Association in Internal Medicine published research in 2014 — tracking 13 states with medical marijuana laws over an 11-year period — showing that states with medical marijuana access experienced 25 percent fewer opioid overdose deaths, than states without such laws.

Research also shows that underage use rates are no higher in medical states than in full-prohibition states.

Marijuana prohibition, however, is a proven gateway to dangerous drug use. Prohibition drives marijuana users to black market dealers motivated to provide more dangerous drugs at higher profit margins.

Undercutting the black market by ending prohibition will divert lawful marijuana customers away from toxic addictive drugs.

Evidence from Holland's 40 years of adult marijuana access reveals an aging population of opioid users.

Fewer youth have tried heroin since the Dutch disconnected heroin sellers from legal marijuana stores.

Moreover, Holland's underage marijuana use rate is half the American rate. The evidence proves that adult-use legalization protects the public health far better than prohibition.

Sadly, many addicts report difficulty in obtaining medical marijuana under the state's Department of Public Health-run program, despite the agency's 2013 statewide listening sessions' hearing courageous reports of marijuana's unique help in fighting addiction. Governor Baker and Attorney General Healey trumpet 'comprehensive' remedies for the overdose crisis, but their proposals glaringly omit any reference to marijuana as a tool to combat the epidemic, despite the evidence of its value.

The failure of state officials to recognize marijuana as a opioid-abuse treatment further demonstrates marijuana prohibition's inability to improve public health and reduce addiction rates. It is time to legalize adult marijuana use, as proposed by the initiative headed for this November's ballot, to curb our epidemic and save lives. It is past time for our elected leaders to adopt evidence-based policies and reconsider their unfounded support for maintaining prohibition.

The initiative will ease adult access to marijuana and — as experienced in 13 states — may save 300 Massachusetts lives from overdose next year. The initiative will decimate the black market, reduce underage access and create new revenue streams for state and municipal governments. Saving lives, however, is the initiative's greatest asset to addicts, their families, and the state's public health.

Michael D. Cutler is a Northampton attorney who has provided continuing legal and medical education programs on marijuana policy and on mental health law.