Opioids versus medical marijuana debate begins in Arkansas

As Arkansas moves closer to the Sept. 18 deadline for pot-growing greenhouses and retail dispensaries across the state, one of the key talking points driving acceptance of medical marijuana use is anecdotal stories that legalized cannabis is reducing opioid use and abuse.

In speaking in early August to the Arkansas Association of Counties (AAC), Rep. Doug House, R-North Little Rock, said he has talked with medical marijuana proponents in Colorado and other states who say legalized pot use has caused opioid drug overdoses to decline as much as 40%, but admitted those figures are hearsay.

“There are facts and figures out there, but there is not a real comprehensive study out there,” said House, the chief architect of the state’s medical pot legislation who did not publicly support the 2016 ballot issue to legalized the substance.

Rep. Justin Boyd, R-Fort Smith, and a pharmacist, also said recently his views are “changing slightly” on medical marijuana. Like House, Boyd did not support calls for the legalization of the substance, but said his own research into other markets has caused him to be hopeful – pointing to a 2014 Journal of the American Medical Association study that shows states with legalized marijuana had lower rates of fatal opioid overdose.

“But there is data that suggests that in Colorado opioids are abused less and part of the reason is because marijuana is readily available,” Boyd said at Fort Police Department function earlier this summer. “Other places where medical marijuana is available, opioid use tends to be lowered. I don’t know that we have causation, but to me that is one of the potential bright spots.”

FORMAL STUDY UNDERWAY
Still, the National Institutes of Health (NIH) noted a lack of more in-depth, comprehensive studies on the issue in August when it awarded researchers at Albert Einstein College of Medicine and Montefiore Health System a five-year, $3.8 million grant for the first long-term study to test whether medical marijuana reduces opioid use among adults with chronic pain, including patients with HIV.

According to NIH, millions of Americans experience chronic, severe pain as a result of their health conditions. Many take prescribed opioids, including oxycodone, to help relieve their symptoms. But given the growing dangers of opioid use and misuse, both doctors and patients are seeking safe and effective alternatives to manage pain, NIH officials said.

“There is a lack of information about the impact of medical marijuana on opioid use in those with chronic pain,” said Dr. Chinazo Cunningham, associate chief of general internal medicine at Einstein and Montefiore and principal investigator on the grant. “We hope this study will fill in the gaps and provide doctors and patients with some much-needed guidance.”

Over the past several years, 29 states, plus the District of Columbia, have legalized marijuana use in some form. In most states, chronic pain and HIV/AIDS are qualifying conditions for medical marijuana use. In Arkansas, there are more than a dozen qualifying conditions approved under the Arkansas Medical Marijuana Act of 2017, including cancer, Lou Gehrig’s disease, HIV/AIDS, glaucoma, hepatitis C, Crohn’s disease, ulcerative colitis, PTSD, severe arthritis, Alzheimer’s, and other conditions that produce chronic pain.

NIH officials said researchers have never studied — in any population — whether the use of medical marijuana over time reduces the use of opioids. In addition, there are no studies on how the specific chemical compounds of marijuana, such as tetrahydrocannabinol and cannabidiol, affect health outcomes, function and quality of life. Most studies that have also reported negative effects of long-term marijuana use have focused on illicit, rather than medical marijuana, said the federal research group.

“As state and federal governments grapple with the complex issues surrounding opioids and medical marijuana, we hope to provide evidence-based recommendations that will help shape responsible and effective health care practices and public policies,” Dr. Cunningham said.

PROS AND CONS
Dr. Regina Thurman, chair of the newly-created Arkansas Medical Marijuana Association (AMMA), told Talk Business & Politics there is still much wariness in Arkansas’ pharmaceutical and healthcare communities concerning the medicinal value of pot and other cannabis derivatives.

“Medical marijuana is something new to Arkansas. It is something that (any) of us have experience with, so we are all kind of ‘afraid of the unknown,’ … and how is this going to work,” said Thurman, medical director at Optimal Pain and Wellness in Fayetteville. “No one knows because it hasn’t been tried here in Arkansas. We can only look at the states that have actually approved it.”

Thurman said her Fayetteville clinic treats chronic pain and many of the illnesses that are listed on the state Health Department’s list of qualifying conditions. She said her staff is already discussing how to administer medical marijuana use safely in Northwest Arkansas.

“Being a pain clinic, we are going to have to figure out how to implement medical marijuana here,” she said. “We’ve talked since the (November ballot issue), and we’re still trying to figure it correctly so that our patients will benefit from this and we wont have any problematic issues and that everyone is safe – that is still the big thing.”

The Fayetteville doctor also said she has seen the good and bad sides of the state’s growing opioid epidemic. She said her clinic almost immediately signed up to participate in the state’s Electronic Prescription Monitoring Program (PMP), the state-run online database that now mandates tracking of the prescribing and dispensing of controlled prescription drugs to Arkansas patients.

“We definitely use that in our clinic on a daily basis and … the hope is that all physicians will begin to use this and we can then decrease the rate of patient ‘doctor-hopping’ trying to get opioids.”

But Dr. Indra Cidambi, a New Jersey-based addiction medical expert, is not convinced medical marijuana will help treat chronic pain. Cidambi opposes expansion of medical pot across the U.S., saying it normalizes the popular recreational drug and adolescents will get more exposure to it during important developmental years.

“We will be sending a mixed message legalizing previously illegal drugs while we are in the middle of an opioid epidemic,” Cidambi told Talk Business & Politics. “And I can tell you from my experience of having treated more than 2,000 patients and 10 years of experience in medicine, the first drug that people use is marijuana and then they (use) other illegal drugs, like opioids and cocaine.”

Cidambi, founder and medical director for the Center for Network Therapy in Middlesex, N.J., likened the expansion of medical and adult use marijuana across the U.S. to the growth of alcohol and nicotine nationally. Cidambi said 30% of those who use marijuana may have some degree of marijuana use disorder. Nearly 1 in 10 people who use marijuana will become dependent on it, she said.

‘ILLEGALLY HEALED’
Corey Hunt, co-founder of the social media-driven Illegally Healed online community, promotes testimonials and other content on the medical benefits of marijuana on Facebook, Instagram, Twitter and YouTube videos. Hunt has assembled a group of medical and business professionals to apply for a medical cannabis dispensary license in Mulberry through a company called Natural State Healthcare.
http://illegallyhealed.com/

Hunt said five years ago he walked away from his family’s Tulsa, Okla.-based technology business, PhoneDoctors, to promote Illegally Healed full time after losing his mother-in-law to breast cancer. It was then that the former medical marijuana skeptic said he began to research cancer cures and kept finding patients who praised medical cannabis as a treatment option.

“I came across marijuana and cannabis over and over in people who were using this for a treatment to mitigate the side effects in therapy,” Hunt said. “I (first) thought people were using this to get high and as a party drug …, but I started researching this and started meeting patients who were using this not only for cancer (but) kids who were having 100 of seizures a week and they started marijuana oil and they stopped having (them).”

Hunt said Illegally Healed is now the largest medical marijuana patient community on Facebook, reaching up to 7 million people per week with promotional and educational content on medical cannabis.
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Editor’s note: This is the second of three stories on the opioid issue as it relates to Arkansas. Link here for the first report.