The White House commission on addiction and opioids, led by New Jersey Gov. Chris Christie, released its final report Wednesday, listing 56 recommendations for addressing the country’s overdose epidemic. There are many solid recommendations in the report, such as training doctors to better prescribe these painkillers and mandating that health-care providers check drug-monitoring data before prescribing opioids to patients to make sure the patients aren’t “doctor shopping.”
But one point in the report stands out: the commission’s disappointing refusal to endorse marijuana as a possible alternative pain management drug.
No doubt the commission felt the need to mention the topic of marijuana due to popular demand, having received thousands of public comments on the role that marijuana could play in pain management. And there’s good reason for the public’s interest.
The most thorough, up-to-date research on the effects of marijuana that we have — a review of more than 10,000 studies that was published by the National Academies of Sciences, Engineering and Medicine this year — found that there is “strong evidence” that marijuana is effective at dealing with chronic pain in adults relative to a placebo.
But we don’t have to simply take the word of scientists. Just look at the practical effects of marijuana in states where it’s available. One study from 2014 found that states that legalized medical marijuana had, on average, 25 percent fewer deaths from opiate overdoses than other states. And a study published in the American Journal of Public Health last month concluded that legalizing marijuana in Colorado led to a “reversal” in the rising numbers of fatal overdoses.
So why did Christie’s commission refuse to acknowledge marijuana’s potential as a pain management drug? The report cites a study published this year that found that “marijuana use led to a 2½ times greater chance that the marijuana user would become an opioid user and abuser.” It also cited “a lack of sophisticated outcome data on dose, potency and abuse potential for marijuana.”
The “lack of data” argument is ironic: Federal law classifies marijuana as a Schedule 1 substance, making it very difficult for scientists to thoroughly study it for potential medical use.
But even more frustratingly, the commission fails to note key limitations in the study it cited. The study is based on two surveys, three years apart (one from 2001 to 2002 and the other from 2004 to 2005), asking people about their history of drug use. Those who reported using marijuana in the first survey — including those who reported having chronic pain that interfered with their daily life — were more likely to report nonmedical prescription opioid use in the second. That’s alarming and certainly should be noted for policymakers, but it doesn’t tell us anything about why people used marijuana.
“The results may be different if you narrow it down to medicinal use,” said Mark Olfson, a professor of clinical psychiatry at Columbia University and co-author of the study. He also noted that the culture of marijuana has substantially changed since the surveys were conducted, adding, “The results may also be different if we did it today.”
In other words, we need more research to cultivate a robust understanding of whether marijuana use can be a slippery slope to opioid addiction. In the meantime, what we do know is that most marijuana users do not end up abusing prescription opioids, and legalization experiments have suggested there is no link.
Given this real-world and clinical evidence, it’s really hard to see what we should discount marijuana as a potential tool to manage pain. Yet some in the Trump administration have done this. Regarding the possibility of using marijuana to treat chronic pain or counter opiate abuse, Attorney General Jeff Sessions once said: “Give me a break. This is the kind of argument that’s been made out there to just — almost a desperate attempt to defend the harmlessness of marijuana or even its benefits. I doubt that’s true. Maybe science will prove I’m wrong.”
Maybe it won’t even matter if science proves that he is wrong. Maybe he and the rest of the Trump administration are so bitterly opposed to marijuana that they will overlook policies that could actually save lives and ameliorate one of the worst public-health crises in the history of the United States.