Mary Chris Jaklevic is a reporter-editor at HealthNewsReview.org. She tweets as @mcjaklevic.
In a promo for his upcoming report on the role of marijuana in alleviating the opioid crisis, CNN chief medical correspondent Sanjay Gupta, MD, beckons viewers: “Join us as we investigate a search for answers and meet potential pioneers and outspoken critics. Whether you struggle with opioids or know one of the millions who do, decide for yourself.”
Decide for yourself?
He seems to suggest that legalizing medical marijuana is an issue on which reasonable people may disagree.
But Gupta has already made up his mind (for a second time) about medical marijuana, and he wants the world — and particularly U.S. Attorney General Jeff Sessions — to know about it.
On Tuesday Gupta published an open letter calling on Sessions to support legalized medical marijuana, asserting that it could save the lives of up to 10,000 people a year who are addicted to opioids.
The letter was announced on CNN’s web site right under that promo for his upcoming documentary, “Weed 4: Pot vs. Pills”:
We’ve written many times about Gupta’s showboating, where he injects himself into stories in ways that undermine journalistic objectivity and raise significant ethical concerns. It happened when Gupta reported on his own delivery of medical care to Haitian earthquake victims, as well as when he subjected himself to a coronary artery calcium scan as part of a “mission to never have a heart attack.”
We’ve also seen him cast aside journalistic independence to be considered for the post of surgeon general under the Obama administration.
Gupta often portrays himself as simultaneously a journalist, a doctor, and an advocate. Sometimes those roles conflict, and this is one of those times.
At the heart of Gupta’s four-page public plea to Sessions was this sweeping claim: “If we had to start from scratch and design a medicine to help lead us out of the opioid epidemic, it would likely look very much like cannabis.”
But he didn’t acknowledge the extensive limitations of the data behind that assertion, as the public should expect a journalist and a medical doctor to do.
Take research by the Rand Drug Policy Research Center showing declines in opioid overdose deaths in states with legalized marijuana, about which he wrote: “Though it is too early to draw a cause-effect relationship, these data suggest that medicinal marijuana could save up to 10,000 lives every year.”
The very significant uncertainties about whether marijuana is actually responsible for those declines went unexplored.
Further, Gupta didn’t say it’s unclear whether that association can be sustained. Rosalie Liccardo Pacula, co-director of the research center, has pointed out that the link between legal marijuana and fewer opioid deaths has declined as states have tightened medical dispensary regulations and as the opioid crisis has shifted from prescription opioids to heroin and fentanyl.
“This is a sign that medical marijuana, by itself, will not be the solution to the nation’s opioid crisis today,” she said in a news release.
Gupta wrote that cannabis is “proven to offer relief” from symptoms of opioid withdrawal such as rapid heart rate, nausea and vomiting, excessive sweating, anorexia and anxiety.
Where’s the proof? He cited “longstanding evidence that cannabis helps chemotherapy-induced symptoms in cancer patients, and those symptoms are very similar to opioid withdrawal,” linking to a paper by a doctor funded by four cannabis companies.
But do conclusions that apply to chemotherapy hold for treatment of opioid withdrawal?
Sean Hennessy, PharmD, PhD, a professor of epidemiology at the University of Pennsylvania who served on a panel of medical experts that produced a sweeping 2017 National Academies of Sciences, Engineering, and Medicine report on cannabis health effects and also has consulted with GW Pharmaceuticals, a biotech company focusing on prescription cannabinoid medicines, told HealthNewsReview.org in an email he’s unaware of any data from controlled trials on whether cannabis helps people quit opioid use.
“As far as I know, it’s not been rigorously studied,” Hennessy said. “Dr. Gupta seems to be aware of case reports. In this way, some statements in his letter may overstate the documented benefits of cannabis.”
Gupta wrote, “All over the country, I have met patients who have weaned themselves off of opioids using cannabis.” He relates the story of an attorney who suffered opioid withdrawal symptoms and found pain relief with marijuana “with hardly any side effects.”
But while anecdotes may be valuable for providing clues on the direction research should take, they don’t amount to evidence of a benefit.
“I have a whole bag of anecdotes that say the opposite of what he’s saying,” said Colorado Springs pain doctor Ken Finn, MD, who serves on the medical advisory board of Parents Opposed to Pot. “That does not make good science.”
Gupta acknowledged demonstrated effectiveness of medication-assisted treatment for opioid addiction, but related one researcher’s concern that it might “cause ongoing disruption to the glutamatergic system, never allowing the brain to fully heal.”
He wrote that “compounds found in cannabis can heal the diseased addict’s brain, helping them break the cycle of addiction.” The basis for that statement appeared to be an idea under study that cannabidiol, a compound in marijuana, might be able to curb opioid cravings.
But Gupta treated that concept as settled science — not as a tentative hypothesis that required testing in rigorous studies:
This new science sheds lights on stories like the one I heard from Doug Campbell of Yarmouth, Maine. He told me he had been in and out of drug rehab 32 times over 25 years, with no success. But soon after starting cannabis, he no longer has “craving, desire and has not thought about (opioids) at all, period.”For the past 40 years, we have been told that cannabis turns the brain into a fried egg, and now there is scientific evidence that it can do just the opposite, as it did for Campbell. It can heal the brain when nothing else does.
This isn’t the first time Gupta — a neurosurgeon — has offered up his views on marijuana policy.
In 2009, he published an op/ed in Time magazine saying he opposed the legalization of marijuana. He acknowledged some evidence of medical benefit, then wrote that he was “unimpressed with the (then) proposed legislation, which would legalize marijuana irrespective of any medical condition.”
Back then he wrote about “numerous deleterious health consequences” including possible addiction, affects on short-term memory, impaired cognitive ability, depression or anxiety, lung damage, and impaired driving.
None of those potential ill effects were addressed in this week’s letter, or when Gupta reversed his stance in 2013, days before the CNN ran the first of his series of reports on marijuana. Gupta said what he learned in the process of reporting changed his mind:
I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.
That could be. But now, Gupta has committed a different sin by selectively ignoring facts that don’t support his advocacy perspective.
In both cases, he failed to point out the void of reliable data on marijuana’s benefits and harms that stymies decision-making.
In both cases, the public loses.