Do We Need Pot To Fight The Opioid Epidemic?

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Later in the hour, a new crop of exoplanets from NASA’s Kepler mission, but first, as Attorney General Jeff Sessions said recently, the US is, quote, in the midst of an historic drug epidemic. Opioid and heroin addiction kill 91 people in the US every day. But in his letter to Congress, Sessions was requesting permission to prosecute medical marijuana providers. Why is that? What’s the connection?

Perhaps he’s under the impression that marijuana use leads people into harder stuff, the old gateway drug principle. But studies suggest that in states where medical marijuana has been made legal, there is actually less opioid use. So going after providers in those states could make an already terrible and historic drug epidemic a lot worse. Here to discuss this with me is Dina Fine Maron, editor for Medicine and Health at Scientific American, David Bradford, professor of Public Health at the University of Georgia. Welcome to Science Friday.

DINA FINE MARON: Hi, Ira.

DAVID BRADFORD: Thank you.

IRA FLATOW: Hi, there. Dina, what Sessions wrote was pretty cryptic, because he seemed to refer to our historic drug epidemic, and then he went on to talk about cracking down on marijuana. What’s going on here?

DINA FINE MARON: Right, Yeah. It is a very misleading characterization of the current drug epidemic in our country, which as you mentioned in the open, is really an opioid epidemic, which means heroin, prescription drug abuse, fentanyl, not at all about marijuana or medical marijuana, but Attorney General Jeff Sessions has long said that medical marijuana is overhyped and is contributing to this, quote, unquote, “epidemic.”

IRA FLATOW: Is there any evidence to suggest that marijuana is contributing to the epidemic, like a gateway drug?

DINA FINE MARON: In short, no. The National Institute on Drug Abuse has looked at the science of that idea of a gateway drug, and they do say that marijuana may prime the brain as alcohol might to have an enhanced response to drugs, but the majority of people who use weed do not go on to use other, harder substances. And the reality here is that all the literature suggests that marijuana is not as addictive or as lethal as opioids.

Indeed, as you mentioned, states with medical marijuana programs have significantly fewer deaths from prescription painkiller opioids and the reality is, is that literature, right now, suggests that if anyone is using an opioid, whether it be a prescription painkiller or something like heroin, a prescription painkiller is more likely to lead to a drug abuse, because it’s more addictive and obviously can be more lethal. So really, if we stopped medical marijuana programs that are now in place in 29 states and Washington D.C. right now, the science suggests we would worsen the opioid epidemic. According to the National Institute on Drug Abuse, nearly half of young people who inject heroin first abused prescription opioids.

IRA FLATOW: David are your studies that helped shed some light on whether or not legalized marijuana is making the opioid epidemic better in states, were you surprised by your results?

DAVID BRADFORD: You know, I would say we really weren’t. My co-author, Ashley Bradford, who’s also my daughter as it turns out, and I have two studies in the journal Health Affairs, which is a leading peer reviewed health policy journal in the world and in the first one we took a look at the impact of medical marijuana laws on prescription use in Medicare and what we found there was significant reductions in prescription use, most notably among pain medications. And the largest plurality of those would be opiates.

We redid the study for Medicaid just this past month in Health Affairs and again, found large reductions in the use of prescription pain medications when states turned on medical cannabis laws. And I would say, we’ve done some additional work with colleagues, here at University of Georgia, Amanda Abraham and Grace Adams, looking at deaths at the county level and when states turn on dispensary based medical cannabis laws, we see significant reductions in opiate related deaths. In fact, we estimate that in 2014, if all states had turned those on, we would have saved almost 2000 lives that year.

IRA FLATOW: So are you saying that if you make medical marijuana legal, you could turn the tide on opiate deaths?

DAVID BRADFORD: Well, the estimates that we have with the paper that we just presented at an international health policy conference a couple of months ago would suggest that we are looking at reductions that are in the 2% to 3% range. So this is– there is no one silver bullet to the opiate crisis. This is a crisis with many roots to it, but unfortunately with the introduction of fentanyl into the black market here in the United States, it seems that the crisis is accelerating again, so we absolutely need to use every tool in our arsenal. And as has Dina has just said, cannabis is a safe drug relative to the opiates.

The ratio of the fatal dose to the effective dose for a drug like heroin, for example, is five. Five times the typical dose of heroin will kill you. There has never been a documented case of death from cannabis use, and so relative to opiates, relative to alcohol, where that ratio is 10, cannabis is definitely safer and to the extent that the National Institutes of Sciences Engineering and Medicine just this past January issued a comprehensive report where they said there is conclusive evidence that the cannabis can be effective at managing pain.

So to the extent, we can divert people from initially starting on opiates through legitimate prescriptions, we divert them from the path of abuse and then the path of death. And it does seem that cannabis could be one tool in the arsenal to do that.

IRA FLATOW: Dina, if this amendment that Sessions is talking about, one that sort of directs the federal government not to go after medical use of marijuana in the states, if that does not get renewed, what could happen?

DINA FINE MARON: Yeah, so what we’re talking about here is that Rohrabacher-Farr amendment, which is named after the legislators that initially suggested this bill, and it keeps the Department of Justice from using taxpayer money to interfere with state medical marijuana programs. So it expires at the end of the fiscal year right now, which is the end of September, and if it’s not renewed, that means that Jeff Sessions and his office could go ahead and prosecute dispensaries.

And in that situation, it would really probably have a chilling effect on both the growth of the medical marijuana industry, which has been growing in recent years and also have an intimidating effect on patients, both making it more difficult for them to get this substance that many of them consider a lifeline and also making them feel like maybe they are doing something wrong by trying to seek it in the first place. So it would have a really big problem.

IRA FLATOW: Is there any sign that this would be a popular move for him to do?

DINA FINE MARON: Really, there’s not. Obviously, the states have spoken by legalizing medical marijuana in the majority of US states right now. And there’s a significant amount of literature showing that people want medical marijuana to be available, both scientific literature that’s looked at the before and after when state laws have come into effect, and also just anecdotal polls that have taken place, where people say, yeah, they were in favor of medical marijuana. One of the interesting things, as well, is that the US Department of Justice, which, obviously, Jeff Sessions heads up, puts out an annual report, the Drug Enforcement Administration, which is under the Department of Justice. They put out an annual report on drug threat assessments to the country, and the latest report available enumerate the top threats to the country from drugs and medical marijuana wasn’t one of them.

IRA FLATOW: All right, David, in your study you touched on this a little bit. I want to revisit it just for a second. Was there any difference between states that have legalized recreational cannabis versus just medical marijuana?

DAVID BRADFORD: You know, that’s a great question and one of the unfortunate things is that, well, from a researcher standpoint, is that the experience of states with recreational cannabis is very new relative to the data we have. There’s an unfortunate lag in when large quantitative data sets are available and when the current– the world actually happened it, they were measuring and so recreational cannabis came online in Colorado at the end of 2000– in 2014, and we just don’t have the data to study that.

I will say that preliminary evidence coming out of Colorado and out of the state of Washington and out of the state of Oregon suggests that, in fact, recreational cannabis has not led to the sorts of problems that opponents might have suspected. Indeed, there is some evidence that things, like traffic fatalities, have actually gone down as a consequence.

IRA FLATOW: And the fact we have talked about this before on the program and the fact that marijuana is classified as a Schedule I drug, Dina, doesn’t that make it even more difficult for researchers to come up with new data?

DINA FINE MARON: Exactly, yeah. That federal status, which again, is put in place by the US department of Justice’s Department of Drug Enforcement Administration make it– means that researchers have difficulty obtaining marijuana to conduct the comprehensive studies that would be necessary to clarify the potential benefits of medical marijuana. And that obviously is taking place, even as many states have defied that federal prohibition and the cannabis industry certainly is booming.

IRA FLATOW: So is this– so are we talking more, when we talk about Attorney General Sessions, are we talking more about politics, versus evidence, here, Dina?

DINA FINE MARON: It certainly seems that way. Obviously, I don’t know what’s going on and Jeff Session’s head, but this does seem to be strongly a political move since it’s not an alignment with science or what the annual report from his own agency suggests.

IRA FLATOW: It would seem that with the growing popularity of medical marijuana and states, more and more states, getting into legalizing it and other states going with recreational marijuana, this is a tide that’s not going to be turned back.

DINA FINE MARON: Exactly. Yeah, it would be interesting and, obviously, terrible for patients, but if the amendment is not renewed, I would think, would lead to a court case that would play out through the system if a dispensary is prosecuted, and then that moves into a larger level, that would sort of be a test balloon to see where states and where dispensaries stand, as opposed to the Department of Justice’s stance.

IRA FLATOW: And see how much money is being made in the industry of marijuana, industry and other companies getting into it. You have– you have meetings of marijuana makers and producers and suppliers. You have all kinds of people getting together to get ready for this new industry. I would imagine there’s a lot of pushback coming from there also.

DINA FINE MARON: Yeah, I mean, it’s interesting, a recent study found that chronic pain sufferers that used cannabis reported a 64% drop in opioid use, as well as fewer negative side effects and a better quality of life than they experienced under opioids. So there’s definitely a tide from the medical patient community of folks that really seem to be happy with the cannabis opportunity.

IRA FLATOW: We did reach out to Attorney General Sessions’ office to reply, and we did not get any response from them, but I want to thank you both for taking time to be with us today. Dina Fine Maron, editor for Medicine and Health at Scientific American, David Bradford, professor of Public Health, University of Georgia. Thanks again for taking time to be with us.

DINA FINE MARON: Thanks.

DAVID BRADFORD: Thank you.

IRA FLATOW: We’re going to take a break and when we come back, getting to know the placenta. Yes, I said the placenta. Didn’t you get up this morning and say, hey, I’d love to talk about the placenta? Well, it is a really interesting organ that really gets little attention, and if you’re a parent, you have paid attention to it before, but we’ll talk about what we need to know and what we don’t know yet about how the placenta works. So stay with us. We’ll be right back after this break.

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