This 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.
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?
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.
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.
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.
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.
There is no obvious disease mongering in this story. Opioid addiction is real and very problematic.
There sourcing is a strong point for the story. Also, there are no apparent conflicts of interest.
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.
The article adequately discusses that availability varies widely from state to state.
This story establishes that using marijuana for opioid addiction is a relatively new idea that’s not yet properly understood by medical research.
Due to the wide range of interviewees quoted, this story does not appear to rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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