Analysis by Terry Gotham
With the country currently gripped in fear that ACA will be repealed, I’ve started to ponder what options will be left for Americans in the throes of physical dependency if the cuts to medical/addiction funding are as deep as the ones currently being floated. While some proponents of the 21st Century Cures Act note that there’s been a scheduled $1 billion increase in funding for treatment, a repeal would remove at least $5.5 billion in funding to almost 3 million people suffering from substance use disorders. As dozens of states grapple with ever-increasing rates of opiate addiction and overdose, states that have legalized cannabis have discovered something startling.
A study published in the Journal of Pain by a trio of researchers out of the University of Michigan documents a reduction in opiate consumption in Chronic Pain patients who use cannabis. Specifically, medical cannabis uses was associated with a 64% reduction in opioid use. Additionally, 45% of the patients (118 out of the 244 sampled), reported reduced side effect frequency & intensity. In states that have medical marijuana available for their citizens, drivers between the age of 21 and 40 who were killed driving accidents tested positive for opiates significantly less often than drivers of the same age in states that didn’t have medical marijuana available. For example, Montana saw a 1.7% reduction in the number of drivers who tested positive for opioids after their MMJ laws went into effect. And that’s just numbers associated with people behind the wheel. When we evaluate the effect of cannabis consumption on opiate overdoses, the evidence becomes even more compelling.
Back in 2014, Colleen Barry of the Bloomberg School of Public Health at the Johns Hopkins Hospital showed that states with MMJ laws saw a 25% reduction in deaths associated with prescription or illegal opiates. This finding was published in JAMA Internal Medicine. In the last year they had data for, 1,729 fewer people died than were expected in MMJ states. I need to stress this finding. 1,729 people were around that medical experts assumed would have died from opiate use, just because they consumed cannabis in one form or another.
Rosalie Liccardo Pacula of RAND showed that access to medical marijuana dispensaries led to a 16% reduction in opioid overdose deaths. Because, as I’ve talked about before on this blog, it’s not just the fact that the drug is decriminalized, you have to have access to it for you to benefit from it. This finding directly contradicts some of the “for your safety” fuckery we’ve seen on the East Coast, with prohibitionists stymieing progress, preventing dispensaries from actually opening their doors.
Last year, the Journal of Health Affairs published a study confirming the next logical step for healthcare providers in this line of reasoning: MMJ laws reduce prescription med fillings by Medicare Part D enrollees. This could indicate that fewer prescriptions for opiates were being written, ensuring fewer patients get exposure to potent opiates which can lead to addiction. And these findings, taken together are summarized nicely by Pacula in this evaluation done by STAT.
“Overall, we find strong, consistent evidence that medical marijuana dispensaries lead to reductions in opioid-related mortality,” the RAND team concluded. Some people who would otherwise be at risk of abusing opioids, perhaps fatally, must have turned to medical marijuana instead, Pacula said.
It’s not just cannabis that people are turning to for help in dealing with opiate withdrawal and chronic pain. Thailand is attempting to legalize a substance that the DEA attempted to ban last year. After overwhelming opposition from activists, chronic pain patients, addiction treatment specialists & members of Congress, the DEA withdrew the national ban. That substance is Kratom.
The plant (formally known as Mitragyna speciosa) is in the coffee family & native to SE Asia. We have records of it being used for its opiate & stimulant-like properties dating back to 1836, and there is an emerging community of online users providing information to others worldwide on how to buy, sell and prepare the substance. Why? It’s purported to help people become opiate free without withdrawal.
While the usual suspects have declared Kratom to be a dangerous substance, it’s similar to cannabis in that it’s never been responsible for a death. Its pharmacokinetics & toxicology aren’t well understood yet, but it seems to bind to the same mu-opioid receptor as morphine & heroin. Oddly, it also has a stimulating effect because of its receptor activity in the kappa-opioid receptor, which is associated with mood & pain. Others have suggested that this unique chemical profile is why the substance seems to both provide pain relief while also reducing cravings, but this hasn’t been proven with any certainty as of yet.
The most important reason why cannabis or kratom replacement therapy for opiates seems to work is their spectacular lack of toxicity. For those suffering from chronic pain long term, continued opiate use causes habituation, leading to truly heroic doses of opiates. This directly impacts the potential to become dependent. Most Americans currently struggling with heroin started using prescription opiates. The ability to reduce your reliance on opiates while recovering from surgery or an injury is crucial if we’re to make a dent in the exploding numbers of overdoses America is struggling to keep up with.
So, what does that mean for the average Joe? For people who abuse opiates, kratom & cannabis might be the only options they have left if the ACA is repealed and traditional routes of addiction treatment are shuttered. For those recently injured or in recovery, it might be a good idea to think about consuming certain cannabis products like edibles or CBD oil while you consume the opiates your doctor prescribed for you, as they seem to cut the amount you need. Remember, MMJ probably won’t remove your need for opiates entirely, but can substantially reduce the amount you need to take to get relief, which allows a limited supply to last substantially longer.
Anecdotally, small groups of people in Denver, San Francisco, New York & Philly have mentioned they were using kratom as a replacement opiate. One of my sources in Denver stated that even just the potential option of a non-prescription opiate helps them harm reduce. Instead of taking a vicodin, percoset or oxy pill, kratom powder is a much less potent substance that seems to “fit the need” of light opiate craving, but without the potential for life-changing dependency. They also mentioned (which I’d read elsewhere), that they find it easier to modulate their cannabis or kratom consumption than their alcohol, opiate or even caffeine consumption. Which, from a pharmacological perspective makes sense, though I’d caution against taking this anecdata and generalizing from it.
I hope that these tips won’t be necessary and traditional & clinically based treatment programs don’t get chopped down at the knees in the next year or two. But, if it does happen, we can’t rely on those institutions to save us. Online retailers and your local dispensary might become the modern apothecary in the era of Trump. It’s time for us to remember how to take care for ourselves and our loved ones, on the off chance we’ll be forced to.