The Villager – Gottfried and O’Donnell: Combat Opioids with Pot

By Sydney Pereira,  July 26

Manhattan assemblymembers hope medical marijuana can help curb the state’s opioid crisis. Two recent bills aim to increase access to medical pot to reduce the abuse of the potentially deadly painkillers.

One bill, from Assemblymember Richard Gottfried, has passed both the state Senate and Assembly; it would add substance use disorder to the list of conditions legally treatable by medical marijuana, plus would allow the use of medical pot in place of opioids for pain management. Assemblymember Danny O’Donnell’s legislation would add opioid use disorder as a condition treatable by medical marijuana. O’Donnell’s bill passed the Assembly in early June.

“We need to change our worldview about cannabis and marijuana and what it is and how it works,” said O’Donnell, who represents Manhattan Valley, Morningside Heights and the Upper West Side in the 69th Assembly District.

He added that such legislation “is a step in the right direction.”

In New York State, opioid deaths increased by 180 percent between 2010 and 2016, according to a July report by the Department of Health on the potential impact of regulated marijuana. However, some studies suggest that legalizing cannabis in some capacity could reduce opioid deaths.

A 2014 study revealed there were 25 percent fewer opioid deaths in states with medical cannabis laws, STAT News reported. Studies published earlier this year showed evidence that opioid prescriptions decreased where marijuana was legal, and that the reductions were greater in states with both recreational and medical marijuana, according to STAT.

O’Donnell sponsored legislation that specifically adds opioid use disorder to the list of conditions for medical marijuana use. The hope is that recovering opioid addicts could use pot as a way to curb withdrawal symptoms and anxiety. Plus, the law could help people get off opioids entirely rather than replacing one opioid with another, specifically methadone, which is a current common treatment for heroin addiction.

“This is just a tool in a toolbox, but it’s a tool we should not be prohibiting a doctor from using,” O’Donnell said. “We need to do a better job of finding solutions for people who are addicts in the opioid crisis and get them the treatment that they need.

“Obviously, under the care of a doctor, but still, it’s a very necessary first step,” he said.

But research — though promising — often varies. The data showing opioid death reductions in states with legal weed doesn’t prove causation. And another study shows the opposite: that marijuana users have an increased likelihood of developing an opioid addiction or using opioid prescriptions for nonmedical purposes.

“This is a hot topic right now,” said Timothy Brennan, the director of the Addiction Institute at Mt. Sinai West and St. Luke’s medical centers. But, he added, “You’ll see conflicting data out there.”

At the root of the conflicting data, Brennan said, is how difficult it is to study cannabis at all.

Federally, marijuana is listed as a “Schedule 1” drug, alongside drugs including heroin and LSD. Even fentanyl, a powerful and dangerous opioid, is considered “Schedule 2” by the U.S. Drug Enforcement Administration. Controlled clinical trials, where one group of individuals takes a drug and another takes a placebo, are the “gold standard” of research trials. That kind of validation is extremely difficult to determine when, at the federal level, marijuana is illegal and considered unsafe.

The studies that do exist are easy to “poke holes” in, Brennan added.

“Until we change the schedule of cannabis, that’s not likely to change at all,” he said.

Using medical marijuana for chronic pain as a substitute for opioid prescriptions is another route that some believe could mitigate the opioid crisis.

Gottfried’s legislation, which passed the state Senate and the Assembly but has not been signed by Governor Cuomo yet, would make it legal to use medical marijuana as a replacement for prescription opioids for pain management.

A recent study by Northwell Health — which operates the Comprehensive Care Center in the Village at W. 12th St. and Seventh Ave. —illuminates some of the anecdotal, life-changing experiences people have had with managing their pain with medicinal marijuana.

Northwell Health researchers surveyed 138 medical marijuana users ages 61 to 70 suffering with chronic pain from osteoarthritis, spinal stenosis, hip and knee pain, and pain that could not be relieved with steroid injections. Between 18 and 27 percent of patients said they were able to reduce their use of other painkillers one month after beginning medical pot.

“We did get overwhelmingly positive results — even more than we anticipated, I would say,” said Diana Martins-Welch, a physician at Northwell Health’s Division of Geriatric and Palliative Medicine Department. She presented the study at the American Geriatrics Society conference in May and plans to submit the paper to be formally published in the coming months.

“Some [participants] found this to be life-changing for them,” she said, “which really drove the point home that this is not by any means an illicit drug that should be brushed aside.”

Even so, Martins-Welch recognizes that research is limited as long as marijuana remains a Schedule 1 drug. Just weeks after her research was announced, another study with more than 1,500 participants and a longer timeframe found no evidence that cannabis decreased chronic pain or opioid use.

Accessibility and cost is another concern.

In Martins-Welch’s research, negative comments from patients about medical marijuana mostly focused on the out-of-pocket costs and insurance coverage. A one-month supply of medical pot costs, on average, $300, according to Martins-Welch. Medical marijuana accessibility, not necessarily recreational legalization, is critical for her work as a physician.

“I’m pretty ambivalent when it comes to recreational legalization,” she said. “I think alcohol and tobacco are much more harmful substances and they’re legal. … However, it will definitely complicate matters if we’re talking about medicinal cannabis use. We have to make medical programs more accessible.”

Mt. Sinai’s Brennan added that “human beings have been using cannabis for millennia.” People use it for depression, anxiety or increasing their appetite, and he speculated that those marijuana users may never use a pill form that they can pick up from Duane Reade.

“The struggle for physicians is when someone tells me they really benefit from the pot that they buy from their pot dealer,” Brennan said. “That’s wonderful, but I have no idea what they’re ingesting.” A few bong hits that help relieve a headache, he explained, doesn’t tell him the weed’s potency or strain or if it could have been sprayed with something else.

Martins-Welch echoed that sentiment, explaining her patients aren’t trying to get high.

And though she tells her patients that cannabis is not the “panacea” that the Internet says it is, she added her patients often tell her, “I don’t want to feel like a criminal trying to treat myself.”

For her elderly, “snowbird” patients, for instance, they cannot take their medical marijuana prescriptions to Florida during the wintertime.

“I consider [that] to be asinine,” she said. “This is not something they should be scared to do. So what do we do — just give them opiates for the time being?”