Drug Overdoses

Fentanyl isn’t just causing overdoses. It’s making it harder to start addiction treatment

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Packets of buprenorphine stigma
Packets of buprenorphine Elise Amendola/AP

Doctors are reporting a troubling trend when it comes to fentanyl.

The powerful drug, they say, isn’t just causing overdoses — it’s also making it more difficult to begin addiction treatment. In particular, fentanyl appears more likely to cause severe withdrawal symptoms for patients put on buprenorphine, a key medication used to treat opioid use disorder.

The development adds yet another layer of crisis to the country’s drug epidemic, which killed nearly 108,000 Americans last year. Even as fentanyl sends overdose deaths soaring, it threatens to make the world’s most-prescribed addiction drug inaccessible to the increasing number of patients who need it.

“It’s the clinical challenge of my career,” said Sarah Kawasaki, an addiction doctor and psychiatry professor at Pennsylvania State University. Inductions, or the process of starting patients on buprenorphine treatment, have become “progressively more difficult” in the past five years, she said, as fentanyl has spread throughout the drug supply.

To make matters worse, Kawasaki added, buprenorphine is one of just two medications commonly prescribed to treat opioid addiction. The other, methadone, is highly regulated; patients can only access it at specialized clinics that typically require them to appear in person each day to receive a single dose.

“We have 20 different ways to treat strep throat, but two medications that work well in the treatment of opioid use disorder,” Kawasaki said. “When you eliminate one and make the other really hard to get, it is a setup for failure.”

While doctors across the U.S. and Canada, where fentanyl is also pervasive, have reported that buprenorphine inductions have become more difficult in recent years, the phenomenon is hard to measure or explain. Theories include fentanyl’s raw potency, or that it is lipophilic — it sticks to fat molecules — and remains in the body for longer than other opioids.

Buprenorphine is what’s known as a partial agonist, meaning that it binds tightly but incompletely to the same brain receptors that give a euphoric effect when opioids bind to them. But it binds to the receptor awkwardly, like a puzzle piece that doesn’t quite fit. As a result, patients with opioids already in their system can feel what’s known as “precipitated withdrawal” as the addiction medication shoves the fentanyl aside.

As a result, it’s normal for doctors to wait several hours until patients start experiencing withdrawal symptoms before they administer buprenorphine. At that point, the “bupe,” as it is known, helps to treat withdrawal symptoms like anxiety or gastrointestinal distress, as well as eliminate future opioid cravings.

With fentanyl, however, doctors are sometimes forced to wait a full day, if not longer, to make sure buprenorphine doesn’t cause severe discomfort. In some cases, even patients experiencing withdrawal because they refrained from drug use for many hours — typically ideal candidates for buprenorphine — find that their symptoms get worse, not better, once they begin using the medication. Many don’t come back for another dose, known in doctors’ parlance as a “failed induction.”

Doctors warn those failed attempts can be dangerous — not just because they risk patients returning to fentanyl use, but also because those patients might feel so miserable that they refuse to ever try buprenorphine again.

Some clinicians report that patients have become more likely to request methadone, despite its inconveniences. Kawasaki, who works at a clinic that offers both methadone and buprenorphine, said she’s had trouble enrolling patients in a clinical trial about buprenorphine induction because her patients are opting for the drug less likely to cause withdrawal symptoms.

Though the phenomenon is widespread, doctors haven’t reached a consensus about how to move forward. Nor have they received much guidance from medical societies and local health officials, leaving doctors to rely informally on word of mouth, email chains, and new scientific papers.

One recent set of recommendations from the Substance Abuse and Mental Health Services Administration did little beyond acknowledge the issue, warning that patients using fentanyl long-term and at high doses “may not be appropriate for buprenorphine.”

“There’s a patchwork of induction strategies at this point,” said David Fiellin, an addiction physician and the director of Yale University’s Program in Addiction Medicine. “In a lot of ways, we’re in an area without much science.”UPCOMING EVENT

The knowledge gap led Fiellin to issue a recent call in the Journal of Addiction Medicine for “rapid research” analyzing the relationship between the type and quantity of drugs used and difficulties beginning buprenorphine treatment.

In the meantime, however, doctors are employing strategies that vary dramatically. Some have begun administering radically larger amounts of buprenorphine in an effort to overcome withdrawal symptoms by brute force — as much as 32 milligrams, or four times a typical first dose.

Some doctors, like Kawasaki, also use common medications to treat any remaining symptoms of physical discomfort and anxiety, including antihistamines, ibuprofen, and drugs to combat nausea and gastrointestinal problems.

Others have tried the opposite approach: “microdosing” buprenorphine in increasing amounts over the course of several days, avoiding a moment where a sudden, large buprenorphine dose causes immediate withdrawal. Samantha Young, a doctor and researcher at the British Columbia Centre for Substance Use, said she sometimes prescribes shorter-acting opioids typically used for pain, like hydromorphone, to help alleviate withdrawal symptoms as patients build up to larger buprenorphine doses.

“When I teach residents and medical students about buprenorphine, I tell them it’s an art based on the science,” Young said.

Others, still, have tried the controversial approach of administering naloxone, a drug used to reverse opioid overdoses, even to patients who are not overdosing. The result is a very short period of intense withdrawal, setting the patient up for a first buprenorphine dose that alleviates discomfort instead of causing it.

Any strategy that works is promising, Fiellin said. But the fact that it’s become harder for doctors to prescribe buprenorphine is concerning in its own right. While the medication is highly effective, it’s also tightly regulated, meaning convincing doctors who aren’t addiction specialists to prescribe it has long been challenging. The newfound difficulties, he said, risk reversing recent progress.

“There was a period of 10 or 15 years where bupe initiation was not seen as a challenge, so it was much more common that nonspecialists would take on buprenorphine prescribing,” Fiellin said. “Unfortunately, we’re in a situation where now initiation is seen as a huge challenge, and I worry that’s going to set us back with respect to expanding the number of clinicians who are prescribing buprenorphine.”

Still, some physicians remain optimistic. And patients who want to begin buprenorphine treatment shouldn’t despair, they say. Ultimately, buprenorphine induction for people using fentanyl is still possible, despite its difficulties. The pervasiveness of fentanyl in the North American drug supply “does make the induction a bit more challenging,” Young said. “But just so people know: We’ve developed a lot of methods — if you want to get on bupe, and you use fentanyl, great! We can definitely do that for you, without you being in withdrawal.”

Drug Overdoses Are the 9th Leading Cause of Death in the US

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Story at-a-glance

  • Prescriptions for opioid painkillers rose by 300 percent between 2000 and 2009, and Americans now use 80 percent of all the opioids sold worldwide
  • Drug overdoses (63 percent of which are opioids) replaced kidney disease as the 9th leading cause of death in the U.S. as of 2015
  • Addiction affects about 26 percent of those using opioids for chronic non-cancer pain; 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription

According to the U.S. surgeon general, more Americans now use prescription opioidsthan smoke cigarettes.1 This makes sense when you consider prescriptions for opioid painkillers rose by 300 percent between 2000 and 2009,2,3 and Americans now use 80 percent of all the opioids sold worldwide.4

In Alabama, which has the highest opioid prescription rate in the U.S., 143 prescriptions are written for every 100 people.5 A result of this over-prescription trend is skyrocketing deaths from overdoses.6,7

The most common drugs involved in prescription opioid overdose deaths, specifically, include8 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®).

As noted by Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC): “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”9

There are safe options to treat pain, but education — both among doctors and patients — is sorely lacking. This is why I frequently write about this issue, and hope you’ll do your part in spreading the word.

Far too many people in the prime of their life are losing it to painkiller addiction, and often they simply had no idea a prescription painkiller for a temporary injury or pain would send them into the throes of drug addiction.

Drug Overdoses Now 9th Leading Cause of Death in the US

In 2014, prescription drug overdoses, a majority of which involved some type of opioid, killed more Americans than car crashes (49,714 compared to 32,675).10 This held true for 2015 as well, despite 2015 being hailed as the deadliest driving year since 2008.

In all, 38,300 Americans died in car crashes in 201511 — a sharp rise thought to be related to a combination of cheaper gas prices and hence increased travel, and using smartphones while driving.12 A rise in overdoses also suddenly placed drug overdoses in the top 10 leading causes of death in the U.S.

In 2015, 52,404 Americans died from drug overdoses; 33,091 of them involved an opioid and nearly one-third of them, 15,281, were by prescription.13,14,15 Meanwhile, kidney disease, listed as the 9th leading cause of death on the CDC’s top 10 list, killed 48,146.16

The CDC does not include drug overdoses on this list, but if you did, drug overdoses (63 percent of which are opioids), would replace kidney disease as the 9th leading cause of death as of 2015, inching its way toward the 8th slot, currently occupied by respiratory complications such as pneumonia, which took 55,227 lives in 2015.

Why Are Pregnant Women Prescribed Narcotics?

A statistic that shows just how overprescribed and misused opioid drugs are is the prescription rate for pregnant women and women of childbearing age.

Despite carrying risks of pregnancy-related problems and birth defects, shockingly, nearly one-third of American women of childbearing age are prescribed opioid painkillers17 and more than 14 percent of pregnant women were prescribed opioids during their pregnancy.18

Reasons for prescribing these extremely dangerous drugs include back and/or abdominal pain, migraine, joint pains and fibromyalgia. Clearly, if you are planning a pregnancy or are pregnant, you should go to great lengths to avoid narcotic drugs. If you wouldn’t consider taking heroin, you shouldn’t take a narcotic pain reliever.

Yet, in 2015, 27 million Americans either used illegal drugs and/or misused prescription drugs, and addiction to opioids and heroin now costs the U.S. more than $193 billion each year.

Please, take care to avoid becoming part of this devastating trend. Studies show addiction affects about 26 percent of those using opioids for chronic non-cancer pain. Worse, 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription.19

According to the latest data from the National Center for Health Statistics, life expectancy for both men and women dropped between 2014 and 2015, for the first time in two decades, and overdose deaths appear to be a significant contributor.20,21,22

Drug Industry Is Responsible for Mass Addiction

Many believe the drug companies that create and sell these drugs need to be held accountable for America’s rapidly escalating drug problem, especially since several have been caught lying about the benefits and risks of their drugs.

As noted by the Organic Consumers Association,23 the drug industry has “fostered the opioid addiction epidemic” by:

•Introducing long-acting opioid painkillers like OxyContin, which prior to reformulation in 2010 could be snorted or shot. Many addicts claimed the high from OxyContin was better than heroin.

From a chemical standpoint, OxyContin is nearly identical to heroin, and has been identified as a major gateway drug to heroin.

•Changing pain prescription guidelines to make opioids the first choice for lower back pain and other pain conditions that previously did not qualify for these types of drugs.

•Promoting long-term use of opioids, even though there’s no evidence that using these drugs long-term is safe and effective.

•Downplaying and misinforming doctors and patients about the addictive nature of opioid drugs. OxyContin, for example, became a blockbuster drug mainly through misleading claims that Purdue Pharma knew were false from the start.

The basic promise was that it provided pain relief for a full 12 hours, twice as long as generic drugs, giving patients “smooth and sustained pain control all day and all night.”

However, for many the effects don’t last anywhere near 12 hours, and once the drug wears off, painful withdrawal symptoms set in, including body aches, nausea and anxiety. These symptoms, in addition to the return of the original pain, quickly begin to feed the cycle of addiction.24

Drug Enforcement Administration Struggles to Hold Drug Makers Accountable for Black Market Sales

Evidence has repeatedly shown opioid makers have acted with callous disregard for human life, yet they keep getting off the hook with little more than a slap on the wrist. The Washington Post recently published an article detailing the Drug Enforcement Administration’s (DEA’s) failure to bring an opioid maker to justice.25

In 2011, the DEA began investigating Mallinckrodt Pharmaceuticals, one of the largest manufacturers of oxycodone in the U.S. This was the first time the DEA targeted a drug manufacturer for violating laws designed to prevent black market sales of legal narcotics.

To date, it’s also the largest prescription drug case the DEA has ever pursued. Federal prosecutors accused Mallinckrodt Pharmaceuticals of ignoring “its responsibility to report suspicious orders as 500 million of its pills ended up in Florida between 2008 and 2012.”

In all, 66 percent of all oxycodone sold in Florida between those years was shipped to suspected “pill mills” selling prescription drugs to addicts.

In 2010 alone, one distributor, Cincinnati-based KeySource Medical, shipped 41 million oxycodone tablets made by Mallinckrodt to Florida. That’s enough pills to give every man, woman and child in the state 2.5 pills each. Cardinal Health, one of the largest drug distributors in the U.S., was also sending extremely large amounts of Mallinckrodt-made oxycodone pills to Florida.

One Delray Beach doctor named Barry Schultz received 92,400 oxycodone pills from Sunrise Wholesale in just 11 months. He once prescribed 1,000 pills to a single patient, all in one day — a clearly suspect prescription by any reasonable standard.

At the time these enormous shipments were made, the street value of one “oxy” pill was $30. Schultz was sentenced to 25 years in prison in 2016 after being charged with drug trafficking and one case of manslaughter, following the overdose death of one of his patients. As noted in the featured article:26

“‘Mallinckrodt knew through law enforcement reports that Barry Schultz was diverting controlled substances, and that the diverted oxycodone was supplied by Mallinckrodt through Sunrise,’ prosecutors later wrote in an internal document sent to the company. ‘When Mallinckrodt continued to distribute oxycodone to Sunrise for such purposes, and continued to pay incentives in the form of chargebacks for the product sales to Barry Schultz, Mallinckrodt was diverting oxycodone.'”

A pharmacy in Sanford, Florida, also stood in receipt of suspicious amounts of pills. Over the course of four years, it received 5.8 million oxycodone pills — nearly 20 times more than the state average for pharmacies.

By law, drug manufacturers must notify the DEA when suspicious orders such as these occur. Mallinckrodt stood accused of 44,000 federal violations, totaling $2.3 billion in fines. In all, federal prosecutors claimed 222,107 Florida orders were “excessive” and should have been reported to the DEA as suspicious.

Oxycodone Maker Gets Off Scot-Free — Again

Yet, despite a massive five-state investigation spanning several years, the U.S. government has taken no legal action against Mallinckrodt, and likely never will. “Instead, the company has reached a tentative settlement with federal prosecutors,” The Washington Post writes, adding:

“Under the proposal, which remains confidential, Mallinckrodt would agree to pay a $35 million fine and admit no wrongdoing … The case shows how difficult it is for the government to hold a drug manufacturer responsible for the damage done by its product. DEA investigators appalled by rising overdose deaths said they worked for years to build the biggest case of their careers only to watch it falter on uncertain legal territory and in the face of stiff resistance from the company.

‘They just weren’t taking this seriously, and people were dying,’ said a former law enforcement official who spoke on the condition of anonymity because the case is pending … ‘It wasn’t their kids, their wives, their husbands, their brothers. It was some hillbilly in Central Florida, so who cares?'”

A $35 million fine is a drop in the bucket for a company that boasts $3.4 billion in annual revenue, with a net profit of $489 million,27,28 and will do absolutely nothing to deter it or other drug companies from continuing business as usual. As noted by The Washington Post:

“Drug manufacturers have paid much larger fines for other misdeeds. Glaxo­SmithKline was fined $3 billion, and Pfizer was fined $2.3 billion for illegally promoting off-label drug use and paying kickbacks to doctors. Purdue Pharma paid a $600 million fine, and three of its executives pleaded guilty to charges that they misled regulators, doctors and patients about the risks of the painkiller that is widely blamed for setting off the nation’s opioid crisis: OxyContin.

All of those cases were initiated by the Food and Drug Administration [FDA]. The largest fine the DEA has levied against a drug distributor was the $150 million that McKesson, the nation’s largest drug wholesaler, recently agreed to pay following allegations that it failed to report suspicious orders of painkillers. For a company the size of Mallinckrodt, a $35 million fine is ‘chump change,’ one government official said.”

Drug Industry Ensures Leniency by Hiring DEA and DOJ Agents

Last year, seven U.S. senators demanded to find out why there has been such a sharp decline in enforcement actions by the DEA against wholesalers suspected of distributing prescription narcotics to the black market.29

According to The Washington Post, DEA lawyers began delaying and blocking enforcement efforts by DEA agents against opioid distributors in 2013, suddenly insisting on increasingly higher standards of proof before moving cases forward. This included proof of intent — a factor that is very difficult to prove and typically only required in criminal cases.

In 2011, the DEA took 131 actions against distributors. By 2014, that number had dropped to 40. In that same time frame, the number of “immediate suspension orders” dropped from 65 to nine. (The suspension order allows the agency to freeze shipments of narcotics, effective immediately.) The question is why. I’ve written about the dangers of the revolving door policy that allows regulators to be hired by industry and vice versa on numerous occasions.

In this case, former DEA and Department of Justice (DOJ) officials hired by the drug industry fought for lenience and a “soft approach” to the burgeoning drug addiction problem.30 They succeeded, thereby allowing the problem to grow more or less unrestrained, despite official promises to the contrary. Many DEA officials did in fact suspect Clifford Lee Reeves II, the lawyer in charge of approving their cases, of secretly working for the drug industry.

New FDA Chief Unlikely to Take Hard Line Against Opioids

Unfortunately, President Trump’s nominee for head of the FDA, Dr. Scott Gottlieb, is also in the opioid industry’s pocket, having received nearly $45,000 in speaker’s fees from opioid manufacturers and distributors.31 During his confirmation hearing, Gottlieb stated he believes the U.S. opioid crisis is a “public health emergency on the order of Ebola and Zika” that requires dramatic action, and promised that developing a strategy to curb the opioid epidemic would be his “highest and most immediate priority.”32

The question is whether or not he’ll actually follow through. Gottlieb’s drug industry ties are so significant, he’s agreed to recuse himself for one year from decisions involving more than 20 different drug companies with whom he has decades’ long financial connections.

As noted by Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University:33 “Our country is in desperate need of an FDA commissioner who will take on the opioid lobby, not one who has a track record of working for it.” Senator Edward Markey (D-Mass) also criticized Trump’s choice for the FDA saying,34 “Gottlieb’s record indicates that he would not take the epidemic and the FDA’s authority to rein in prescription painkillers and other drugs seriously.”

Prescription Painkillers Are Gateway Drugs to Heroin and Other Deadly Highs

Oxycontin and other opioid pain killers have been identified as the primary gateway drugs to heroin.35 Chemically, these drugs are very similar and provide a similar kind of high. According to a 2013 U.S. Substance Abuse and Mental Health Services Administration report, nearly 80 percent of people who use heroin have previously used prescription painkillers.36 Opioids work by attaching to opioid receptors in your brain, thereby blocking pain signals.

This also has the effect of creating a sensation of pleasure or euphoria — and addiction. Over time they can also result in increased pain perception, setting into motion a cycle where you need increasingly larger doses, making a lethal overdose more likely.

Oxycontin’s high rate of addiction is the result of a short half-life (the amount of time the drug stays in your system before you are left wanting more). Opioids are also very potent immune suppressors. As such they can wreck your health in serious ways, leaving you far worse off than where you started.

Many users are also turning to much stronger types of opioids, such as fentanyl, which is seeing the fastest rate of growth in use. Deadly overdoses involving fentanyl rose by 50 percent between 2013 and 2014, and another 72 percent between 2014 and 2015. Fentanyl is a synthetic opioid that can be anywhere from 500 to 1,000 percent more potent than morphine.

Besides a more potent high, price is another factor driving its popularity. Since it can be created in a lab, it’s far cheaper than heroin, which in turn is cheaper than prescription opioids.

A recent NPR story37 reveals the tremendous impact fentanyl is having on many people’s lives. Allyson, a 37-year old client at the AAC Needle Exchange and Overdose Prevention Program in Cambridge, Massachusetts, says she’s lost 30 friends to these deadly painkillers. “Basically, my entire generation is gone in one year,” she said.

Are You or Someone You Love Addicted to Painkillers?

Some of the marketing material for opioids claims the drug will not cause addiction “except in very rare cases,” describing the adverse effects patients experience when quitting the drug as a “benign state” and not a sign of addiction. This simply isn’t true. Panic is one psychological side effect commonly experienced when quitting these drugs, and this can easily fuel a psychological as well as physical dependence on the drug.

It’s important to recognize the signs of addiction, and to seek help. If you’ve been on an opioid for more than two months, or if you find yourself taking higher dosages, or taking the drug more often, you’re likely already addicted and are advised to seek help from someone other than your prescribing doctor. Resources where you can find help include:

With all the health risks associated with opioid painkillers, I strongly urge you to exhaust other options before resorting to these drugs. For a long list of alternative pain treatments, please see my previous articles, “Treating Pain Without Drugs,” and “New Treatment Guidelines for Back Pain Stress Non-Drug Interventions.”

Source:.mercola.com

Can Medical Marijuana Fight the Opioid Epidemic?

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In 2014, more people died from drug overdoses than in any other year on record. More than 6 out of 10 of these deaths involved opioids.1 These powerful medications are often prescribed to people for chronic pain relief, although they often fail at this purpose.

medical cannabis

Story at-a-glance –

  • A first-of-its-kind study is under way to directly compare marijuana with opioids for chronic pain relief
  • Increasing research suggests medical marijuana is an effective agent for pain relief with fewer side effects and risks compared to prescription opioids
  • An increasing number of states are moving to decriminalize the use of marijuana for medical, and in some cases recreational, uses

Where they do excel is in triggering addiction and subsequent overdose deaths — the rate of such deaths, including prescription opioid pain relievers and heroin, have nearly quadrupled since 1999.

According to a report from the U.S. Department of Health and Human Services, on an average day in the U.S. more than 650,000 opioid prescriptions are dispensed and 78 people die from a related overdose.2

Further, each year $55 billion is spent in health and social costs related to prescription opioid abuse, and another $20 billion is spent in emergency department and in-patient care for opioid poisonings.3

Could Medical Marijuana Replace Opioids as a Pain Reliever?

It’s clear that urgent action needs to be taken to fight the opioid epidemic, including finding safer, more effective options for pain relief.

Medical marijuana, which has far fewer side effects and is effective for pain relief, fits the bill, and a new study will finally pit the two against each other to test marijuana’s potential as a replacement.

This is newsworthy in itself, as hurdles to studying marijuana are immense. On a federal level, the herb is still considered a Schedule 1 controlled substance alongside other Schedule 1 drugs like heroin, LSD, Ecstasy, methaqualone and peyote.

Marijuana received this label in 1970 when the Controlled Substance Act was enacted. This act labeled marijuana as a drug with a “high potential for abuse” and “no accepted medical use” — the latter of which, in particular, is being increasingly disproven.

It’s a catch-22, however, because the Drug Enforcement Agency (DEA) has made it so difficult to conduct the marijuana research necessary to prove that it does have medicinal uses.

In the case of the upcoming study, which is being led by neuroscientist Emily Lindley at the University of Colorado’s Anschutz Medical Campus, it took two years to meet federal requirements imposed on researchers looking to study marijuana.

For instance, the university had to spend about $15,000 to create a secure storage facility to contain the marijuana being used in the study, lest it fall into the wrong hands.

Ironically, marijuana is legal in the state of Colorado, for both recreational and medicinal use, so anyone over the age of 21 can drive to a dispensary and purchase up to an ounce of the green herb, “no questions asked.” As The Atlantic reported:4

“The current status of medical marijuana research is rife with irony. As states have liberalized marijuana laws, they’ve created new opportunities: Lindley’s grant is part of $9 million Colorado awarded for medical research in 2014, using tax money from marijuana sales.

But since pot remains illegal at the federal level, researchers have to jump through regulatory hoops — lots of them — to do legitimate research.”

Opioid Overdose Deaths Decreased in States Where Marijuana Is Legal

Lindley’s study will involve 50 patients with chronic back and neck pain, who will receive marijuana, the opioid oxycodone or a placebo for their pain. They will be assessed for pain levels and treatment side effects in what will be the first study to directly compare marijuana with opioids for chronic pain relief.

The idea for the study came from a survey of University of Colorado Hospital Spine Center patients. One-fifth of those who responded said they used marijuana for pain relief, and three-quarters of them said it worked as well as or better than opioid pain relievers.5

There are other signs that marijuana makes sense for chronic pain sufferers as well. In states where medical marijuana is legal, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent after two years and up to 33 percent by years five and six.6

Among seniors, legalizing marijuana resulted in a reduction in the use of prescription drugs “for which marijuana could serve,” according to a study published in Health Affairs, and even led to reductions in spending in Medicare Part D, which pays for prescription drugs.7

If every state legalized medical marijuana, the researchers estimated Medicare Part D savings of $400 million each year.

7 of 9 States Voted On, and Approved, Marijuana Reforms

Marijuana is still illegal to posses in the U.S. at the federal level, and people are still being illegally arrested for its use, even in states where marijuana has been legalized. The Daily Beast reported on the “still selectively draconian law enforcement approach to marijuana.”8

“In September of this year a helicopter landed in the garden of 81-year-old Amherst woman Margaret Holcomb, as part of a series of such raids around the area.

Massachusetts National Guardsmen and state police promptly seized her single marijuana plant she had been cultivating to help her arthritis and glaucoma.

Earlier this summer, a similar raid was conducted on the home of an 81-year-old Martha’s Vineyard cancer survivor, Paul Jackson, who cultivated a number of plants for use in medicinal tea. Jackson had used the tea to help his wife, now deceased, deal with the pain of pancreatic cancer.”

The strong-arm tactics are puzzling, especially considering that more states are decriminalizing the plant.

In the November election, for instance, nine states voted on marijuana measures, and all but two were approved (among those not approved, one was rejected and one was too close to call). The successful measures included the following:9

✓ Arkansas: Approved a measure to legalize marijuana for certain medical conditions and establish medicinal dispensaries and a state regulatory agency.
✓ California: Approved a measure to legalize up to six plants per residence and 1 ounce of marijuana for private consumption for anyone 21 and over. In addition, a state regulatory agency, 15 percent tax on top of existing sales tax and a cultivation tax were established.
✓ Florida: Legalized marijuana for cancer, epilepsy, HIV, post-traumatic stress disorder (PTSD) and other conditions and established medicinal dispensaries and regulation by the Florida Department of Health.
✓ Massachusetts: Approved up to 1 ounce for private consumption for anyone 21 and over along with up to 12 plants per residence. A retail sales tax of 3.75 percent on top of existing sales tax was established.
✓ Montana: Residents voted to give patients easier access to medical marijuana, which is already legal in the state, including by repealing a measure that limited licensed providers to serving only three patients or less.
✓ Nevada: Up to 1 ounce for private consumption for anyone 21 and over, and up to six plants per residence for anyone not living within 25 miles of a dispensary, were approved.

Regulation will be overseen by the Nevada Department of Taxation, and an additional 15 percent tax was established for marijuana growers, with revenue planned to go toward education.
✓ North Dakota: Approved a measure to legalize marijuana to treat cancer, epilepsy, HIV, PTSD, chronic back pain and other conditions.

Up to eight plants per residence for anyone not living within 40 miles of a dispensary was also approved. Regulation by the North Dakota Department of Health and medicinal dispensaries were established.

Pain-Relieving Effects of Marijuana

Despite the popularity of opioids for treating chronic pain, they often fail to provide long-lasting relief while posing considerable risks of side effects and addiction. As noted in BMJ:10

“Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy … the long-term effectiveness and safety of opioids are unknown.

… Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short-term side effects are constipation, nausea, sedation and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction.”

Marijuana, on the other hand, contains cannabinoids that interact with your body by way of naturally occurring cannabinoid receptors embedded in cell membranes throughout your body. There are cannabinoid receptors in your brain, lungs, liver, kidneys, immune system and more. Both the therapeutic and psychoactive properties of marijuana occur when a cannabinoid activates a cannabinoid receptor.

Research is still ongoing on just how extensive their impact is on our health, but to date it’s known that cannabinoid receptors play an important role in many body processes, including metabolic regulation, cravings, pain, anxiety, bone growth and immune function.11

Some of the strongest research to date is focused on marijuana for pain relief. In one study, just three puffs of marijuana a day for five days helped those with chronic nerve pain to relieve pain and sleep better.12 Further, according to a study in the Journal of Pain Research:13

“ … [S]ignificant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia and cancer.”

As for the potential for abuse, a study published in Pain Medicine, which assessed rates of problematic use among people using opioids or medicinal cannabis (MC) for chronic pain, found:14

“Problematic use of opioids is common among chronic pain patients treated with prescription opioids and is more prevalent than problematic use of cannabis among those receiving MC.”

Even Children Are Being Poisoned by Opioids

It’s not only adults that are affected by the opioid epidemic. A recent JAMA Pediatrics study analyzed more than 13,000 U.S. hospital discharge records and found that hospitalizations among children for opioid poisonings increased by nearly two-fold from 1997 to 2012.15

While hospitalization rates were highest among older adolescents, the largest percent increase occurred among toddlers and preschoolers. Meanwhile, a synthetic opioid called U-47700 (also known as “pink” or “pinky”), has been linked to dozens of deaths across the U.S.

U-47700 is nearly eight times more potent than morphine and is legal to purchase in most states. It can also be legally purchased online in the form of powder, pills or nasal spray. U-47700 was originally created as an alternative to morphine, but it’s untested in humans and is toxic even in small doses.

The drug may cause sedation, slowed breathing and death, and it’s often mixed with other substances. Even one pill can be deadly but, to date, the DEA has yet to enact a ban.16

DEA Denies Petitions to Reschedule Marijuana — Again

For decades, various groups have petitioned the DEA urging them to reschedule marijuana. In 1988, DEA administrative law judge Francis Young recommended unscheduling cannabis altogether in response to an activist-group petition. He ruled, “marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.”17

The DEA denied the petition, along with a handful of others thereafter. Even when the Institute of Medicine acknowledged marijuana as a substance with medical uses and relatively low potential for abuse, the DEA again denied the resulting petitions, citing a lack of research — research that is being stymied by the nonsensical schedule I classification. In August 2016, the DEA again denied two more petitions.18

On a brighter note, the DEA did state that it will end the current requirement that only the National Institute on Drug Abuse (NIDA) can grow marijuana for research purposes, which may make it easier for marijuana research to take place.19

For the record, even the American Academy of Pediatrics (AAP) updated their policy statement on marijuana, acknowledging that cannabinoids from marijuana “may currently be an option for … children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate.”20

While frowning on recreational use, the AAP gave their “strong” support for research and development as well as a “review of policies promoting research on the medical use of these compounds.” They recommended downgrading marijuana from a schedule I drug to a schedule II drug in order to facilitate increased research.

Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care.

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The use of drugs other than alcohol is a leading cause of fatal injury in the United States, accounting for more than 40 000 deaths per year.1 Increases in the rate of drug-attributable deaths over the past 2 decades have been fueled by overdoses of illicitly used prescription drugs (such as opioids and sedatives, sometimes in combination with alcohol). In 2011, an estimated 1 280 134 hospitalizations were related to drug overdoses nationwide, of which 1 021 563 (80%) involved drugs only and 258 571 (20%) involved drugs in combination with alcohol.2 National roadside research surveys have detected more drivers on roads after using drugs than alcohol,3 and several meta-analyses indicate that fatal traffic crash risks of drivers who have simultaneously used drugs and alcohol exceed the fatal crash risk of driving after either alone.4,5 In addition, marijuana use has increased in the past decade,6,7 perhaps accelerated by legalization of medical marijuana in 22 states and Washington, DC, and legalization of recreational use by Colorado and Washington State. These public health trends underscore the need for continuing research to develop effective interventions for unhealthy drug use, and the emphasis on primary care in health care system reforms suggests that approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use should be evaluated in a variety of clinical settings.

Prescription Drug Overdoses Rising Sharply Among Women.

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Deaths attributed to prescription opioid overdose rose fivefold among women between 1999 and 2010, according to an MMWR article. The increase among men was lower, at 3.5-fold, although men remained more likely to overdose than women.

Analyzing two national databases, CDC researchers also found that in 2010, more than 15,000 drug overdose deaths occurred among women. Since 2007, more women have died from drug overdoses than vehicle accidents. Prescription drugs were involved in 85% of overdose cases with drug-specific information; of these, opioids were implicated in 71%. In addition, women had nearly 950,000 emergency department visits for drug abuse or misuse, most often for cocaine/heroin, benzodiazepines, and prescription opioids.

MMWR‘s editors urge providers to screen and monitor patients for substance abuse and mental health issues when prescribing opioids. They also emphasize the risks posed by opioid abuse during pregnancy, advising clinicians to discuss pregnancy plans with patients who are using the drugs for medical and nonmedical reasons.

Source: MMWR