We Don’t Just Consume Marijuana

Proof.

Whenever I write anything about the solutions to the opioid epidemic, there’s a question I almost always get from readers: What about medical marijuana?

The question comes in reference to a growing body of research — which I’ve written about before — indicating that the legalization of medical marijuana may lead to a drop in drug overdose deaths. The idea: Marijuana is an effective painkiller, so it could be a substitute for some opioid painkillers that have led to the current overdose epidemic. Because marijuana doesn’t cause deadly overdoses and is less addictive than opioids, replacing some use of opioids with pot could prevent some overdose deaths.

There’s some evidence for medical marijuana reducing opioid deaths

There have been some studies suggesting that medical marijuana could help reduce opioid overdose deaths.

For one, the best review of the research to date about marijuana’s health effects, from the National Academies of Sciences, Engineering, and Medicine, found that there’s “conclusive evidence” for marijuana as a treatment for chronic pain. At the same time, there’s evidence questioning whether opioids really are more effective at treating chronic pain compared to alternative treatments, suggesting that there’s a lot of room to substitute marijuana, at least for some patients.

One potential wrinkle: We already have a lot of non-opioid pain treatments. As Stanford University pain specialist Sean Mackey previously said, there are 200-plus non-opioid pain medications, not to mention nonpharmacological approaches. So marijuana isn’t providing something entirely new here if it’s used for pain treatment. Other studies have produced similar results too, so this isn’t just one outlier study.

We have much better evidence for other policies

While the evidence for medical marijuana isn’t definitive, there is much, much stronger evidence for other interventions in the opioid crisis.

There are anti-addiction medications like buprenorphine and methadone. Studies show that these medications reduce the all-cause mortality rate among opioid addiction patients by half or more and do a far better job of keeping people in treatment than nonmedication approaches. In France, the government expanded doctors’ ability to prescribe buprenorphine in 1995 to confront an opioid epidemic — and overdose deaths declined by 79 percent from 1995 to 1999, according to a 2004 study published in the American Journal on Addictions.

But access to these medications — and treatment in general — is bad. According to a 2016 report by the surgeon general, only 10 percent of people in the US with a drug use disorder get specialty treatment. One reason for that low rate is a lack of supply to meet demand: The White House’s opioid commission, for example, found that 85 percent of US counties have no specialty opioid treatment programs that provide medications for opioid addiction.

An evidence-based approach to tackle the opioid crisis would significantly boost access to treatment. Experts estimate that achieving this could cost tens of billions of dollars a year over several years. But Congress has only appropriated limited-time funding boosts here and there to address the crisis — none of which add up to the tens of billions or anything close to that amount

This is only the tip of the iceberg. As I explained before, experts have many more evidence-based ideas for addressing the opioid epidemic. The problem is the political and legislative response in actually implementing these ideas has long lagged behind the science — so the opioid crisis continues, killing tens of thousands every year.

Again, it’s not that medical marijuana couldn’t help address the epidemic. The evidence does suggest, to me, that it could. But if we have ideas with more evidence behind them, maybe we should try those first before getting too caught up in a scheme with much weaker evidence behind it.

Dr. Ryan

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