As West Virginia lawmakers, doctors, pharmacists and law enforcement officers have said time and time again, there is no silver bullet in solving the opioid epidemic.
But in the state with the highest rate of overdose deaths in the nation, officials have often said they want to use every tool in the toolbox to end the crisis.
One potential tool that has not yet been utilized in West Virginia? Medical marijuana.
According to a study published in 2014 in the Journal of the American Medical Association, states with medical cannabis laws were associated with significantly lower state-level opioid overdose mortality rates.
Authored by Marcus A. Bachhuber, the study examined medical cannabis laws and state-level death certificate data in all 50 states from 1999 to 2010. Before 1999, three states had medical cannabis laws. Between 1999 and 2010, an additional 10 states enacted such laws.
The study found that states with medical cannabis laws had a 24.8 percent lower annual opioid overdoses on average than states without them. In 2010, this translated to roughly 1,729 fewer overdose deaths.
West Virginia is one of 22 states that does not have a medical marijuana law on the books.
“I would contend that West Virginia is a great place to have (medical marijuana),” said Del. Mick Bates, (D-Raleigh, District 30). “We could be leading the conversation for an alternative to opioids and narcotics as a part of treatment, as an alternative to what people are doing now.”
Bates, a physical therapist for 23 years, continued, “Clearly, how we’ve been treating many of these conditions, pain in particular, has not been effective. West Virginia is killing its future, and I think this could be part of the solution.”
Sales of opioids soar
Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, according to the Center for Disease Control and Prevention. As sales quadrupled, so have opioid overdose deaths. CDC reported opioids were involved in 33,091 deaths in the United States 2015.
According to data from the U.S. Drug Enforcement Agency, 780 million prescription painkillers were shipped to West Virginia by drug wholesalers during a six-year period when 1,728 residents fatally overdosed.
The Bachhuber study showed that the longer medical cannabis was available, the lower the rate of overdose deaths.
Dr. Ethan Russo, a board-certified neurologist and psychopharmacology researcher in Washington who has completed extensive research on the medical uses of cannabis, said this is a “striking illustration” of what can happen.
“It could be advantageous in dealing with the opioid epidemic,” Russo said.
Another study conducted by the University of Michigan in 2015 indicated that chronic pain patients, who often become dependent on prescription painkillers, could also benefit from the availability of medical marijuana.
In the U.S., an estimated 100 million adults suffer from chronic pain. According to a 2014 Express Scripts’ report, America claims less than 5 percent of the world’s population but it consumes roughly 80 percent of the world’s opioid supply.
“I’ve been treating patients for 23 years,” Bates said. “I see people every day, and pain is one of their major complaints.”
When he first started his practice, he didn’t hear these complaints.
“I used to treat successfully a huge number of patients without pills. But I’ve watched them take over and destroy communities and families, and here we are.”
Patients in the Michigan study reported a 64 percent reduction in their use of opioid pain medications and a 45 percent improvement in their quality of life since using cannabis to manage their chronic pain. They also reported they were using less medications overall, and therefore experiencing fewer side effects.
Dr. Russo explained that cannabis, a botanical medicine, taps into a natural pain suppressing piston in the body, the endocannabinoid system.
The authors of the Michigan study wrote, “Although we caution against using this study to change clinical practice toward cannabis, this study provides intriguing hints of the value of cannabis, as an effective pain medication and as an effective agent against opioid overuse and overdose.”
Factors of addiction
Chronic use of other pain relievers, such as oxycodone or opioid-based drugs, cause brain abnormalities, according to Drs. Thomas R. Kosten and Tony P. George, in their paper, “The Neurobiology of Opioid Dependence: Implications for Treatment.”
Abnormalities that produce drug dependence can disappear within days or weeks after opioid use stops, but the abnormalities that produce addiction are much more complex and long-lasting.
“They may involve an interaction of environmental effects – for example, stress, the social context of initial opiate use, and psychological conditioning – and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent.”
Kosten and George said repeated exposure to escalating dosages of opioids alters the brain so that it functions normally when drugs are present and abnormally when they are not. This causes users to need to take higher dosages of drugs to achieve the same effects.
When a drug user is working toward recovery, relapse is common. The risk of accidental overdose is especially great in the weeks and months after rehabilitation, as the body has a reduced tolerance. Jessie Grubb, a 30-year-old West Virginian who was a recovering heroin addict, accidentally overdosed on pain medication after receiving a prescription following surgery. Eight pills proved a fatal dose, as her tolerance to opioids was gone.
Medical marijuana advocates argue the drug offers increased benefits without the risks associated with opioids.
For example, certain strains of marijuana contain different levels of cannabidiol (CBD) and tetrahydrocannabinol (THC). As Dr. Russo explains, “CBD does not produce a high. It is not intoxicating.”
Studies have shown medical benefits from strains with variant levels of both CBD and THC, but a lot of attention in the medical community is paid to CBD.
“People are probably familiar with what happens when someone takes too much THC — anxiety, panic and even hallucinations and paranoia. Those self-eliminate, meaning they pass in a few hours though and shouldn’t leave permanent problems,” Russo said. “But CBD is remarkably free of side effects.”
Legislation has stalled
Multiple physicians in West Virginia who were asked for their thoughts on medical marijuana refused to comment. Although some studies and anecdotal reports highlight the benefits of the drug, many medical groups, like the American Academy of Neurology, will not give the drug the full stamp of approval because of the limited numbers and sample sizes in current research.
Bates said had he been asked his opinion about medical marijuana five years ago, he would have had a different answer. But after hearing multiple success stories about cannabis-related medical treatment, from states with legalization as well as illegally in West Virginia, Bates can’t help but think the Mountain State needs to get on board.
Last year, he sponsored a bill, HB-4713, calling for the authorization of the medical use of cannabis-based pharmaceutical products. Although the bill did not make it out of committee, Bates felt the introduction of the law was necessary to start the conversation.
He said, “Let’s do this if nothing else.”
Admittedly, with the current makeup of the House of Delegates, Bates said he wasn’t too optimistic about the passage of the bill. But his goal was to start a dialogue and to get people more comfortable talking about a drug that’s long been stigmatized in West Virginia.
“Assumptions are made about the kind of people who use the product for recreational reasons,” Bates said. “It’s fear of the unknown. You have to educate before you can advocate.”
Bates hopes to see West Virginia continue the conversation during this legislative session. He anticipates the introduction of a few marijuana-related bills, some for medical purposes, others for recreation. He plans to reintroduce his bill from last year.
“We can’t continue to just ignore the need. There is a need.”
He pointed to surrounding states who are rapidly moving forward with the issue. He fears if West Virginia will once again be last in line.
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