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Strong on sources, weak on data: CBS story on using marijuana for painkiller addictions

 

 

Some patients and doctors say medical marijuana could help wean people off painkillers and heroin, but others argue there is not enough scientific data to support it.

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The growing number of patients who claim marijuana has helped them drop theirpainkiller habit has intrigued lawmakers and emboldened advocates. Many are pushing for cannabis as a treatment for the abuse of opioids and illegal narcotics such as heroin, and as an alternative to painkillers.

It’s a tempting sell in New England, hard hit by the painkiller and heroin crisis. But there’s a problem: There is very little research showing marijuana works as a treatment for such addictions.

Advocates argue a growing body of scientific literature supports the idea, pointing to a study in the Journal of Pain this year that found that chronic pain sufferers significantly reduced their opioid use when taking medical cannabis. Another study, published last year in the Journal of the American Medical Association, found cannabis can be effective in treating chronic pain and other ailments.

The research falls short of concluding marijuana helps wean people off opioids – Vicodin, Oxycontin and related painkillers – and heroin, though. Many medical professionals say there’s not enough evidence for them to confidently prescribe it.

In Maine, which is considering adding opioid and heroin addiction to the list of conditions that qualify for medical marijuana, Michelle Ham said marijuana helped her end a years-long addiction to painkillers prescribed for a bad back and neck. Tired of feeling “like a zombie,” the 37-year-old mother of two decided to quit cold turkey, which she said brought on convulsions and other withdrawal symptoms. Then, a friend mentioned marijuana, which Maine had legalized in 1999 for chronic pain and scores of other medical conditions. Ham gave it a try in 2013 and said the pain is under control and she hasn’t gone back on the opioids.

“Before, I couldn’t even function. I couldn’t get anything done,” Ham said. “Now, I actually organize volunteers, and we have a donations center to help the needy.”

Bolstered by stories like Ham’s, doctors are experimenting with marijuana as an addiction treatment in Massachusetts and California. Supporters in Maine are pushing for its inclusion in qualifying conditions for medical marijuana. Vermonters are making the case for addiction treatment in their push to legalize pot.

Authorities are also desperate to curb a sharp rise in overdoses; Maine saw a 31 percent increase last year, and drug-related deaths in Vermont have jumped 44 percent since 2010. Vermont officials also blame opioid abuse for a 40 percent increase over the past two years of children in state custody.

“I don’t think it’s a cure for everybody,” said Maine Rep. Diane Russell, a Portland Democrat and a leader in the state effort to legalize marijuana. “But why take a solution off the table when people are telling us and physicians are telling us that it’s working?”

Most states with medical marijuana allow it for a list of qualifying conditions. Getting on that list is crucial and has resulted in a tug of war in many states, including several in which veterans have been unsuccessful in getting post-traumatic stress disorder approved for marijuana treatment.

This month, Pennsylvania became the 24th state to legalize medical marijuana. Sen. Mike Vereb, a Republican, called on lawmakers to take on what he called “the number-one killer in Pennsylvania” – opioid abuse.

“Opioid abuse has no party, has no color, has no religion,” Vereb said. “Let’s face it, that’s the killer. What we’re doing today is the healer.”

It’s hard to argue against anecdotal evidence when you are in the middle of a crisis, said Patricia Hymanson, a York, Maine, neurologist who has taken a leave of absence to serve in the state House. “But if you do too many things too fast, you are sometimes left with problems on the other end.”

In New Hampshire, where drug deaths more than doubled last year from 2011 levels, the Senate last week rejected efforts to decriminalize marijuana.

There are some promising findings involving rats and one 2014 JAMA study showing that states with medical marijuana laws had nearly 25 percent fewer opioid-related overdose deaths than those without, but even a co-author on that study said it would be wrong to use the findings to make the case for cannabis as a treatment option.

“We are in the midst of a serious problem. People are dying and, as a result, we ought to use things that are proven to be effective,” said Dr. Richard Saitz, chair of the Department of Community Health Sciences at the Boston University School of Public Health.

Cannabis could have limited benefits as a treatment alternative, said Harvard Medical School’s Dr. Kevin Hill, who last year authored the JAMA study that found benefits in using medical marijuana to treat chronic pain, neuropathic pain and spasticity related to multiple sclerosis. But he urged caution.

“If you are thinking about using cannabis as opposed to using opioids for chronic pain, then I do think the evidence does support it,” he said. “However, I think one place where sometimes cannabis advocates go too far is when they talk about using cannabis to treat opioid addiction.”

The findings in the Journal of Pain study that found chronic pain sufferers reduced their opioid use when using medical pot were limited because participants self-reported the data.

Substance abuse experts argue there are already approved medications. It would also be wrong to portray marijuana as completely safe, they say, because it can also be addictive. But supporters point to doctors like Dr. Gary Witman, of Canna Care Docs, who has treated addicts with cannabis at his offices in Fall River, Stoughton and Worcester, Massachusetts. Since introducing the treatment in September, Witman said 15 patients have successfully weaned themselves off opioids. None have relapsed.

“When I see them in a six-month follow up, they are much more focused,” Witman said. “They have greater respect. They feel better about themselves. Most importantly, I’m able to get them back to gainful employment.”

Could marijuana help treat painkiller and heroin addiction?

Our Review Summary

iStock_000048592984_SmallThis relatively thorough story discusses a major question: If we can substitute one drug (in this case, marijuana) for others that have a high risk of abuse, especially opioid painkillers. The story relies heavily on anecdotes from those who believe that cannabis can be an effective treatment. While these anecdotal benefits are weighed against the perspectives of outside researchers, we are never given much fine detail of what their actual research shows.

 

Why This Matters

This is very important public health question that needs a thorough discussion in policy circles as well as the media: If marijuana can be safely used, or substituted in people who have opioid or illegal narcotic addictions, is it possible to wean people off these more dangerous drugs?

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The article does a disservice by not mentioning the costs of medical marijuana, even if it is hard to estimate it. If cannabis becomes a major substitute for opioids, the economic implications of this could be huge both for individuals and society.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

There are many mentions of research studies and evidence but very little detail in terms of quantified benefits. Even the mention of the 2014 JAMA study showing that “states with medical marijuana laws had nearly 25 percent fewer opioid-related overdose deaths than those without,” would have been more complete if we’d known what that amounted to in absolute terms. The implications are that a 25% drop in opioid overdoses would be huge, but we’re not really sure.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

There are some known or suggested harms of chronic marijuana use, yet there was not much mention of those harms in this story.  The one harm mentioned is a significant one: marijuana also can be addictive.

However, the article didn’t mention others risks of inhaling marijuana, such as lung disease, as well as effects on motivation, and other cognitive issues, especially when the dose isn’t being well controlled when smoked.

Does the story seem to grasp the quality of the evidence?

Satisfactory

This report included plenty of commentary that suggested caution in interpreting findings from marijuana research in treating opioid-related pain or addiction. Good limitations are mentioned, such as when one interviewee, commenting on the Journal of Pain finding that chronic pain sufferers “reduced their opioid use when using medical pot.”  He added that these findings “were limited because participants self-reported the data.”  This is the kind of nuance that is important to mention.

Does the story commit disease-mongering?

Satisfactory

There is no obvious disease mongering in this story. Opioid addiction is real and very problematic.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

There sourcing is a strong point for the story. Also, there are no apparent conflicts of interest.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Alternatives were not adequately discussed. There are a wide range of alternatives for pain control other than opioids and marijuana treatment options, such as non-opioid analgesics and physical therapy. Also, the prescription drug Marinol is a medicine with the active ingredient of marijuana (THC) that’s approved to treat the nausea of chemotherapy and for appetite stimulation in HIV patients, and the dosing can be better controlled.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The article adequately discusses that availability varies widely from state to state.

Does the story establish the true novelty of the approach?

Satisfactory

This story establishes that using marijuana for opioid addiction is a relatively new idea that’s not yet properly understood by medical research.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Due to the wide range of interviewees quoted, this story does not appear to rely on a news release.

Total Score: 5 of 10 Satisfactory

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