Colorado Law: Replace Opioids With Cannabinoids!

In two other states, Pennsylvania and New Jersey, patients diagnosed with opioid use disorder may be advised to use medical marijuana instead of opioids. And as of July, individuals in Nevada who are dependent upon opioids also qualify.

In most states where medical marijuana is legal, it can be accessed for general pain relief. But now in Colorado, post-operative patients or those struggling with acute pain from an injury can potentially use medical marijuana instead of opioids.

“It was designed to give physicians a legal, open option to discuss [medical marijuana use] with patients,” said Colorado Rep. Edie Hooton, a Democrat, who co-sponsored the bill. “It normalizes the conversation around the issue.”

Research does not yet categorically support the idea that medical cannabis can replace opioids or reduce opioid dependence or overdose.

Last year, the Minnesota Department of Health released the results of its study of 2,245 patients taking medical marijuana for “intractable pain,” which is chronic. (The Colorado bill focuses on acute pain.) Of the 353 patients who self-reported that they were using opioids when they began consuming medical marijuana, 63 percent had reduced or eliminated their opioid use after six months.

But another 2018 study published in the Journal of Addiction Medicine found the opposite — that medical marijuana users “were significantly more likely to report medical use of prescription drugs in the past 12 months.”

“The science for this is really in its infancy, and policy is far outpacing what we know based on evidence,” said Ziva Cooper, research director at the University of California, Los Angeles, Cannabis Research Initiative. “We’re very far from coming up with a conclusive statement saying cannabis can be helpful as a substitute for opioids based on controlled studies.”

Much of the excitement surrounding the potential for cannabis to reduce opioid-related deaths originated with a 2014 study published in JAMA Internal Medicine, which found that between 1999 and 2010, states with medical cannabis laws saw close to a 25 percent reduction in opioid overdose deaths.

Those results were recently challenged when a new study expanded the original analysis through 2017 and found that states with medical cannabis laws had a nearly 23 percent increase in overdose deaths.

“Cannabinoids have demonstrated therapeutic benefits, but reducing population-level opioid overdose mortality does not appear to be among them,” the authors concluded.

One of the researchers went so far as to say, in a JAMA editorial published several months before the new study, “substituting cannabis for opioid addiction treatments is potentially harmful” and that the recommendation for substituting medical cannabis for opioids does not “meet the standards of rigor desirable for medical treatment decisions.”

Yet state lawmakers said there’s enough promising evidence to support opening up a dialogue between physicians and patients about options when it comes to acute pain.

“We want to give folks a legitimate alternative,” said Amanda Bent, former policy manager with the Colorado office of the Drug Policy Alliance, which supported Colorado’s legislation.

Hooton said the bipartisan bill was never “about treating opioid addiction.” Yet others openly promoted it as a way to curb opioid use and overdose fatalities, which lines up with its portrayal in other states.”