The Health 202: No, legalizing medical marijuana doesn't solve the opioid crisis

THE PROGNOSIS

Jason Roberts, the head of cultivation at Loving Kindness Farms, checks one of his marijuana plants in a grow room wearing green lights to avoid waking them during their night cycle in Gardena, Calif. (Richard Vogel/AP)

Marijuana legalization is enjoying a surge of support, both among American voters and 2020 presidential candidates. But that enthusiasm has led to some hasty claims about the drug’s usefulness that aren’t borne out by research.

Five years ago — as the country’s opioid crisis had just started garnering national attention — a study got a lot of buzz suggesting that opioid overdose deaths were 25 percent lower in states that had given the nod to medical marijuana. At the time, policymakers were starting to search for the best ways to respond to the crisis, and the public was just starting to learn about the so-called “Lazarus drug” Naloxone, which rapidly reverses opioid overdoses.

But now, Stanford University researchers have released a new study finding the exact opposite: States that allowed marijuana use for medical purposes actually had 23 percent more deaths from opioid overdoses, when they looked over a longer period of time.

“The new work appears to be a cautionary tale about inferring cause and effect — wanting research to show something it can’t because the nation is in the grip of a deadly opioid epidemic or because there is money to be made by offering possible solutions,” my Post colleague Lenny Bernstein writes.

It was intriguing to think that the problem of opioid overdoses, which have taken more than American 400,000 lives in the past two decades, could have such a simple solution upon which states were already embarking. Thirty-three states plus the District of Columbia now allow the use of medical marijuana. Last week, New Mexico joined New York, New Jersey and Pennsylvania in approving it specifically for patients addicted to opioids.

(Although not every state is embracing medical marijuana products. Iowa Gov. Kim Reynolds (R) vetoed a bill last month that would have expanded a medical cannabidiol program allowing capsules and extracts, saying the state needs to “proceed cautiously” on changes.)

South Bend, Ind., Mayor Pete Buttigieg, who is seeking the Democratic presidential nomination, criticized the veto:

The correlation between medical marijuana and lower opioid overdose seemed to be confirmed in a 2014 study by Johns Hopkins researchers, who found 24.8 percent fewer deaths in the period from 1999 to 2010 after states passed laws legalizing medical marijuana. The Stanford researchers came up with very similar results while looking at the same time period, but the data reversed once they extended the analysis to 2017.

“A lot of people interpreted the first study as causal because it’s congenial to their goals,” Chelsea Shover, a postdoctoral fellow in psychiatry who was part of the Stanford research team, told Lenny. “It did not say that one is causing the other.”

“I wish it were true,” she added. “I wish that passing medical cannabis [laws] would solve the opioid crisis. But the evidence doesn’t support that.”

Shover told Lenny the conflicting results could be related to the fact that only 13 states had medical marijuana laws for the initial study, and many of them were in the West, where the opioid epidemic arrived later. Many more states had approved medical use of marijuana by the end of the study time period, leaving researchers with few states to use for comparison.

Two-time cancer survivor and medical marijuana cardholder Bill Blazina, 73, smokes a marijuana joint on the deck of his neighbor's home in Waldport, Ore. (Gillian Flaccus/AP)

Of course, marijuana could still hold some value for trying to combat opioid abuse — especially given the public’s increasing acceptance of it. Because it’s useful as a nonaddictive pain reliever, it can give doctors better options when seeking relief for their patients.

Three in 4 Americans back medical marijuana, although it’s not yet recognized by the federal government as a medically beneficial drug. Support for recreational use of marijuana has also rapidly risen, with 2 out of 3 people now in favor of legalizing it broadly.

The Democratic presidential candidates have been paying close attention to public opinion. The field of 2020 candidates nearly all agree marijuana should be decriminalized.

Former vice president Joe Biden, who for years opposed the idea, said last month that people shouldn’t be prosecuted for smoking marijuana and added that as president he would allow states to keep making their own decisions on the matter. Even former Colorado governor John Hickenlooper, one of the moderate Democrats in the race, signed some marijuana laws in his state after initially characterizing the legalization of recreational pot as “reckless.”

Here's what some other presidential contenders have said. Sen. Cory Booker (D-N.J.):

Sen. Kamala Harris (D-Calif.):

And, of course, Sen. Bernie Sanders (I-Vt.), perhaps the most vocal candidate on the issue:

A Planned Parenthood clinic is seen in St. Louis. (Jeff Roberson/AP)

AHH: A judge issued a preliminary injunction that will allow Missouri’s last abortion clinic to remain open for at least another 10 days, saying the state's health department must decide by June 21 whether to grant the clinic's license renewal application.

“The department has so far refused to do so, citing health concerns officials say they found during an annual inspection,” our Post colleague Reis Thebault reports. “But the preliminary injunction that Circuit Court Judge Michael Stelzer granted Planned Parenthood prevents its license from expiring until he makes another ruling.”

“The ruling, Stelzer stressed, is not an opinion on whether the license should be approved or denied,” Reis adds.

If the department decides not to renew the clinic’s license, it would become the only state in the country without a clinic that performs abortions. It would be the first time since 1974 that has been the case in the United States.

“While this is welcome relief for patients and providers at Planned Parenthood, this fight is far from over,” Colleen McNicholas, a doctor at the clinic, said in a statement about the ruling. “Abortion access in Missouri is hanging on by a thread … We are too close to losing our rights and freedoms and we will not back down today, tomorrow, or ever.”

Abortion rights activists rally outside of the Georgia State Capitol. (Alyssa Pointer/Atlanta Journal-Constitution/AP)

OOF: More than 180 CEOs of companies such as Twitter, Atlantic Records and Warby Parker signed an open letter condemning stricter state antiabortion laws, charging that the restrictions threaten “the economic stability of their employees and customers, and makes it harder to build a diverse workforce and recruit talent,” our Post colleague Rachel Siegel reports.

The letter appeared as a full-page ad in Monday’s New York Times. It marks the latest effort from leaders in the business community to put pressure on states that passed abortion restrictions.

“Several industries have moved to exert pressure on states that limit access to abortion,” Rachel writes. “Some of the biggest names in Hollywood — including Walt Disney and WarnerMedia — have suggested that they might pull their business from Georgia if its new law survives a court challenge. Filmmaking is a $9.5 billion industry in Georgia that created more than 92,000 jobs last year, according to a McKinsey study.”

As companies consider how to respond, Democrat and former Georgia gubernatorial candidate Stacey Abrams has urged Hollywood leaders to keep businesses in the Georgia and to “#StayandFight” by financially supporting groups challenging the state’s new ban. 

Insys Therapeutics founder John Kapoor leaves federal court in Boston earlier this year. The Arizona company filed for Chapter 11 bankruptcy protection on Monday. (Steven Senne/AP)

OUCH: Insys Therapeutics has filed for bankruptcy protection, just days after agreeing to a $225 million settlement over federal charges related to its sale of a highly addictive fentanyl spray. It’s the first time a pharmaceutical company has filed for Chapter 11 protection to help pay for expenses related to its role in the ongoing opioid epidemic in the United States, our Post colleague Taylor Telford reports.

But other drugmakers could follow suit. Taylor reports OxyContin maker Purdue Pharma is reportedly considering bankruptcy as it deals with lawsuits from numerous states over its role in the opioid crisis. The Arizona-based Insys settlement will end criminal and civil investigations into allegations the company was involved in a bribery scheme meant to get physicians to illegally prescribe the spray, Subsys, to patients who may not have needed the drug.

The company “said it will continue operating while it considers selling its assets to cover the settlement. It will use its cash to stay afloat, including payment of employee wages and benefits, and will seek court approval to pay its suppliers and vendors in full.”

A naturalization ceremony at the U.S. Citizenship and Immigration Services offices in Atlanta. (Kevin D. Liles/For The Washington Post)

— The Trump administration has proposed a change to a federal rule that has enabled older individuals with mental or physical disabilities who are also unable to communicate in English to qualify for benefits.

But the Social Security Administration now says the inability to read, write or speak in English isn’t necessarily a major barrier, The Post’s Kimberly Kindy reports.

"Members of Congress are squaring off over the proposal, with several Democrats saying the Trump administration is promoting an unnecessary and polarizing policy change that discriminates against older workers and is anti-immigrant,” she writes. “Some Republicans who favor the rule change say the current system is antiquated and does not take into account how multilingual U.S. citizens and residents have become.”

The agency predicts if the proposed rule is finalized, there would be about 6,500 applicants a year who would no longer quality for benefits, which the administration expects will save $4.6 billion.

“Altogether, 8.5 million people receive some form of federal disability insurance at an annual cost of about $133 billion, agency records show,” Kimberly writes. “Current projections show the program will have insufficient funds to pay all claims as soon as 2052.”

California Gov. Gavin Newsom (D) gestures to a chart as he discusses his revised state budget during a news conference in Sacramento on May 9. (Rich Pedroncelli/AP)

— California Gov. Gavin Newsom (D) reached an agreement over the weekend with the state’s Democratic-controlled legislature to include in his first budget funding to extend public health insurance to cover young adult undocumented immigrants, our Post colleague Scott Wilson reports.

California will be the first state to make such a move. The budget agreement will allow for coverage for immigrants up to 25 years old who can sign up for Medi-Cal, the state health insurance plan for low-income people.

In response to the deal, the California Immigrant Policy Center called the funding for expanded coverage “a clear step forward” but also said the “exclusion of undocumented elders from the same health care their U.S. citizen neighbors are eligible for means beloved community members will suffer and die from treatable conditions.”

 “The expansion, which is expected to affect about 90,000 young adults, would begin Jan. 1 and is estimated to cost $98 million in its first year, a small fraction of the state’s roughly $213 billion budget,” Scott writes. “The full legislature must vote by June 15 on the budget deal, which is expected to pass easily.”

— A hotel in the small town of Yale, Mich., is offering a free stay and transportation to women who come to the state to get an abortion. The manager of the Yale Hotel posted on Facebook offering her help to women who need to travel to Michigan amid new restrictions that have made it more difficult to obtain an abortion elsewhere, as our Post colleague Antonia Noori Farzan reports.

“Dear sisters that live in Alabama, Ohio, Georgia, Arkansas, Missouri, or any of the other states that follow with similar laws restricting access,” Shelley O’Brien, 55, wrote in a Facebook post. “We cannot do anything about the way you are being treated in your home state. But, if you can make it to Michigan, we will support you with several nights lodging, and transportation to and from your appointment.”

(iStock)

— A new nonpartisan group, Mental Health for US, wants the 2020 candidates to talk more about mental health and substance abuse.

They’re launching a new effort to get presidential contenders and congressional candidates to share their stances on policy proposals that address mental health services and the addiction crisis, Stat’s Megan Thielking reports.

The group, which launched yesterday, “aims to push candidates in both parties to be more vocal about their policy ideas to improve mental health care — particularly as the 2020 election increasingly centers on health care issues like expanding Medicare or lowering the price of prescription drugs,” Megan writes. “It’s the product of a collaboration between some of the nation’s most prominent mental health groups, including the National Alliance on Mental Illness, the American Foundation for Suicide Prevention, and the Jed Foundation."

Former Rhode Island congressman Patrick Kennedy (D), who co-chairs the new group, called it a “formative time in policymaking in our country … Having the advocacy community speak with one voice … that’s the best chance we have at making real progress.”

— And here are a few more good reads: 

Analysis | Power Up: Hyde Amendment fight is coming to Congress

But Nancy Pelosi is unlikely to allow a floor vote.

Jacqueline Alemany

Fact Checker

Did Bernie Sanders ‘consistently’ vote against the Hyde Amendment?

He says he has always voted against efforts to deny public funding for abortions. But he has voted for spending bills that deny such funds.

Glenn Kessler

‘Death by a thousand lawsuits’: The legal battles that could dog ‘Medicare for All’

Health care always ends up in the courts. Single-payer would be no different.

Politico

South Carolina’s Bid To Add Medicaid Work Requirements Now At CMS

CMS on Monday opened a federal public comment period on South Carolina’s request to join other conservative states in adding work requirements to their Medicaid programs

Inside Health Policy

Maine Expands List of Abortion Providers

Maine is making it easier to get an abortion with the governor's signing of a bill Monday to allow medical professionals who are not doctors to perform the procedure.

Associated Press

How Measles Detectives Work To Contain An Outbreak

Across the nation, public health departments are redirecting scarce resources to try to control the spread of measles. Their success relies on shoe-leather detective work that is one of the great u…

Kaiser Health News

When kids get the chickenpox vaccine, they're less likely to get shingles

A large new study shows that children who are vaccinated against the virus that causes chickenpox also have a lower risk of getting shingles in childhood.

Stat

They Just Won’t Die: Dark Web Drug Sellers Resist Police Crackdowns

The notorious Silk Road site was shut down in 2013. Others have followed. But the online trafficking of illegal narcotics hasn’t abated.

New York Times

Vaping device maker Juul pledges $7.5 million to research impact of e-cigarettes

E-cigarette use among teens has been called "an epidemic" by the FDA

CBS News

Today

• The House Ways and Means Subcommittee on Worker and Family Support holds a hearing on federal support for responsible fatherhood 

Coming Up

• The House Energy and Commerce Subcommittee on Health holds a hearing on surprise medical bills on Wednesday.
• The House Science Committee holds a hearing on combating sexual harassment in science on Wednesday.
• The House Ways and Means Committee holds a hearing on pathways to universal health coverage on Wednesday.

Did Bernie Sanders ‘consistently’ vote against the Hyde amendment?: