Using medical marijuana to help cure opioid addiction may seem counterintuitive.
But a growing number of physicians and patient advocates say marijuana should be added to the list of traditional treatment options, pointing to studies that show it helps reduce opioid cravings and withdrawal symptoms.
A bill being considered by lawmakers in Maryland would make it the fourth state to explicitly legalize the use of marijuana to treat opioid-abuse disorder, following Pennsylvania, New York and New Jersey.
The effort is strongly opposed by many in the medical establishment, who say there is insufficient research to show that marijuana is an effective treatment and warn that about 10 percent of cannabis users become addicted to it.
Supporters counter that large-scale research at the federal level is unlikely so long as marijuana remains a Schedule I drug, a classification for drugs deemed to have no medical value and a high potential for abuse.
Some of the loudest voices in the discussion so far have been members of the medical marijuana industry, who could profit if the bill is passed, and those who work with the three anti-opioid treatments already approved by the federal government — methadone, buprenorphine and naltrexone — who could lose clients if people turn to cannabis to treat withdrawal symptoms.
The Maryland bill has not yet been scheduled for a committee vote.
After similar legislation failed to advance last year, Maryland’s medical marijuana commission studied the issue, concluding there is “no credible scientific evidence” that marijuana can successfully treat opioid addiction, though it also found that states that have implemented medical cannabis laws saw reductions in opioid prescriptions for pain among Medicaid and Medicare enrollees and experienced fewer opioid overdose deaths.
The commission did not offer a clear recommendation on whether lawmakers should approve the bill, which would add opioid-abuse disorder to the list of “qualifying medical conditions” that can be treated with medical cannabis.
Opioid-related overdose deaths have soared in recent years in Maryland, with 1,185 in the state in the first half of 2018, the most recent data available. The vast majority of those deaths were related to fentanyl, a synthetic drug that can be 50 times stronger than heroin.
Advocates say the increasing number of overdose deaths underscores the need for new solutions.
“Yes, there needs to be more research,” said Gail Rand, a patient advocate and the chief financial officer for ForwardGro. “However, we believe there is enough research, especially considering the urgent need.”
Patricia Frye, a physician in Takoma Park, said her patients who use marijuana and opioids to treat chronic pain need smaller doses of opioids than those who eschew cannabis. She said she has also observed decreases in anxiety and depression among users of medical marijuana.
Frye said it should not be a deterrent that marijuana can be addictive because opioids are far more lethal.
“They may be unproductive or sit on the couch, but [marijuana] won’t kill them,” she said. Studies show the addiction rate for marijuana is about 10 percent.
Joseph Adams, a physician associated with the Maryland-D.C. Society of Addiction Medicine, testified against the legislation, saying it was part of a “desperate effort” to find alternatives to traditional methods for treating addiction, which he said are unfairly stigmatized. He is the medical director of a methadone program with several locations in Baltimore.
Listing opioid-abuse disorder as a qualified medical condition could increase opioid-related overdose deaths, Adams said, because patients could stop using methadone or other proven treatments.
Adams’s organization is part of a cohort of drug policy groups — which includes the U.S. Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the American Society of Addiction Medicine and the National Council on Alcoholism and Drug Dependence — that oppose using marijuana to treat opioid addiction without more research.
The states that have allowed marijuana to be used to treat opioid addiction have done so with a variety of restrictions. Regulations in Pennsylvania, for example, only permit physicians to prescribe medical cannabis if traditional treatments fail, or if cannabis is used in conjunction with traditional treatment options.
Physicians in Maryland already can authorize marijuana for opioid addicts if their patients have “severe or chronic pain.”
Supporters of the bill say explicitly including opioid-abuse disorder in the list of qualifying conditions is necessary for more doctors to begin seeing marijuana as a viable treatment option.
“People are educated enough now to understand that medical cannabis can help with pain, but until it becomes brought to the public’s attention more, I don’t think it’s a go-to to deal with opioid-abuse disorder,” Rand said in an interview. “And it should be.”