NIDA statement on Medical Marijuana and Opioid Use Outcomes

The U.S. Government National Institure of Health NIDA, the National Instiute of Drug Abuse released a update concerning medical marijuana and dispensaries related to the decrease of opioid use and overdoses.  Ohio Patient Network applauds the NIDA for recognizing and making this statement. 

"NIDA funded two recent studies that explored the relationship between marijuana legalization and adverse outcomes associated with prescription opioids. The first found an association between medical marijuana legalization and a reduction in overdose deaths from opioid pain relievers, an effect that strengthened in each year following the implementation of legislation.⁷⁸ The population-based nature of this study does not establish a causal relationship or give evidence for changes in pain patient behavior.^79,80

The second NIDA-funded study, a more detailed analysis by the RAND Corporation, showed that legally protected access to medical marijuana dispensaries is associated with lower levels of opioid prescribing, lower self-report of nonmedical prescription opioid use, lower treatment admissions for prescription opioid use disorders, and reduction in prescription opioid overdose deaths.⁸¹ Notably, the reduction in deaths was present only in states with dispensaries (not just medical marijuana laws) and was greater in states with active dispensaries.

Research into the effects of cannabis on opioid use in pain patients is limited, but data suggest that medical cannabis treatment may reduce the dose of opioids required for pain relief.^82,83 In addition to its research portfolio on the roles of the cannabinoid and opioid systems in pain, NIDA is funding additional studies that will provide data relating to medical marijuana and opioids: 

Another recent study analyzed Medicare prescription drug coverage data and found that availability of medical marijuana significantly reduced prescribing of medications used for conditions that medical marijuana can treat, including opioids for pain.⁸⁴Overall savings for all prescription drugs were estimated to be $165.2 million in 2013."

Source NIH- National Institute on Drug Abuse  (NIDA)

https://www.drugabuse.gov/publications/marijuana/marijuana-safe-effective-medicine

Medical Marijuana A Gateway Drug off Opioid Addiction

The rediscovery of cannabis’s medical use (aka pot or marijuana) is a very interesting recent development with the growing acceptance of the medical use of marijuana. Cannabis utility in treating opioid addiction is being rediscovered and documented by numerous medical journal articles.

Acceptance of a positive drug test for marijuana coupled with traditional patient counselling is more likely to achieve long term positive result versus substituting one addictive opioid drug for another addictive opioid drug. This is compatible with the Center for Disease Control Guidelines for Prescribing Opioids for Chronic Pain [1] recommendations.

"Clinicians should not test for substances for which results would not affect patient management or for which implications for patient management are unclear. For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahyrdocannabinol (THC).”

Additionally in the CDC report

“Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources and the clinician missing opportunities to facilitate treatment for substance use disorder."

Several years ago this subject came up during a debate between Ohio Patient Network’s Executive Director Rob Ryan and Ohio Attorney General Mike Dewine. The Attorney General’s whole argument of marijuana being a Gateway drug was flipped to Marijuana being a Gateway off the hard drugs. More recently Ohio Patient Network was part of panel discussion with the local judicial, health & drug treatment professionals in Portsmouth Ohio. (Note: Portsmouth was the epicenter of the Ohio’s opioid epidemic.) Marijuana, as either a substitute or part of adjunct therapy, was accepted by the members of audience and the panel.

Even the DEA had to recently capitulate to a legal challenge based on the United States Information Quality Act. The DEA was charged with promoting numerous false statement (such as marijuana being a gateway to harder drugs). Their document “The Dangers and Consequences of Marijuana Abuse” has been recently removed.[2]

Now is the time to bury the false classification of marijuana as a dangerous, addictive drug with no medical use; and use it to mitigate the effects of the truly addictive and dangerous drugs. See OPN’s brochure Addiction and Cannabis for more information.[3]

OPN is currently working on assembling the necessary supporting data and will petition the Ohio Medical Board to add addiction to Ohio Medical Marijuana Control Program as a Qualifying condition.

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1-Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI:  http://dx.doi.org/10.15585/mmwr.rr6501e1.

Patient and Caregiver Ohio Rules advancing to next step

The Ohio Board of Pharmacy patient and caregiver rules have filed CSI, the Common Sense Initiative. A presentation of the rule changes were discussed at the last Medical Marijuana Advisory Committee meeting and avaialble in PDF Format at link at end of Article.

A draft of the patient registry was part of the presentation as well as terminal illness, caregiver, veterans and alternate containers were discussed. See the actual rules going forward and comment on the rules. Comments sent to This email address is being protected from spambots. You need JavaScript enabled to view it. will be accepted until Friday, May 5.

Links to PDFs  1-Presentation   2-Rules

 

OPN comments to the Ohio Pharmacy Board on Medical Marijuana Forms and 90 days limits

The public commentary closed Friday March 10th on the draft rules prepared by the Ohio Pharmacy board on Medical Marijuana Forms & Methods of Administration.  These rules also defined what constituted a 90 day supply of Medical Marijuana. The Ohio Pharmacy board is the most conservative of the three administrative agencies involved in writing these rules. Ohio Patient Network has sent in a series of comments to the Ohio Pharmacy Board on their proposed draft rules. Below is a summary of our comments.

Limiting the addition of flavors

The draft rules allowed flavors to be added such as menthol and other flavors to mimic various strains. OPN’s submitted rule change read as follows:

Natural terpenes are acceptable in naturally occurring levels, but any artificial flavors, including menthols and any other flavors intended to mimic marijuana strains, are prohibited from all products intended for use in the vaporization of medical marijuana or other products

Someday marijuana medical products will be regulated by the FDA, then added flavors may be acceptable assuming adequate product testing.  But not today.

Expnsion on use of vaporization devices

While it is well understood and supported that products like e-cigarettes should not be used by youth, vaporization is a perfectly acceptable method of delivery for children and should not be prohibited.  Our suggested rule revision read as follows:

“Vaporization devices must be controlled by parent or guardian of a registered patients under the age of eighteen”.

Expansion of methods of delivery

In a discussion with members of the Pharmacy Board, the use of a nasal spray was brought up and rejected.  Marijuana nasal sprays are a very effective means of delivery for young children with seizures conditions.  In addition to nasal spray the use of a rectal suppository was suggested.  This form may make some culturally uneasy but it has a very high bioavailability or means of transmission of cannabis molecules.  OPN suggested adding spray and suppository to the draft rule as follows:

 

Pursuant to section 3796.06 of the Revised Code approved medical marijuana products include the following forms and routes of administration:  

1. Oil, tincture, capsule, tablet, spray, suppository or edible form for oral administration; 

(Note plant material was included in the draft rules) 

90 Day Supply

The longest and most involved comment involved the limitation on the 90 day supply of plant mater.   A series of comparisons was presented using the various state medical marijuana programs. Also included in the comparison was how much the Federal Government is still supplying to the remaining IND Federal patients from the 1990s on a monthly basis. Our recommendation was the following:  

Tier I product 90 day limits to be increased to 12 ounces.  

We intend to continue pushing for better rules in a patient meeting with the Pharmacy Board soon.  Below are links to the Ohio Pharmacy rules as drafted.

Forms and Administration (Presentation), Draft Rules Forms & Adminsitration and 90 Day Supply Executive Summary