It may seem counterintuitive to use medical marijuana to help cure opioid addiction.
However, an increasing number of doctors and patient advocates say that marijuana should be added to the list of traditional treatment options, pointing to studies that show that it helps reduce opioid cravings and symptoms of withdrawal.
Following Pennsylvania, New York and New Jersey, a bill considered by lawmakers in Maryland would make it the fourth state to explicitly legalize the use of marijuana to treat opioid abuse disorder.
Many in the medical establishment strongly oppose the effort, who say that there is not enough research to show that marijuana is an effective treatment and warn that about 10 percent of cannabis users become addicted to it.
Supporters say that large-scale federal research is unlikely as long as marijuana remains a drug in Schedule I, a classification of drugs deemed to have no medical value and a high potential for abuse.
Some of the loudest voices in the debate so far have been members of the medical marijuana industry, who could benefit 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 use cannabis to treat symptoms of withdrawal.
The Maryland bill has not yet been planned for a vote in the committee.
After similar legislation failed last year, the Maryland medical marijuana commission studied the issue, concluding that there is “no credible scientific evidence” that marijuana can treat opioid addiction successfully, although it also found that states that have implemented medical cannabis laws have seen reductions in opioid prescriptions for pain in Medicaid and Medicare enrollees and experience.
The Commission did not provide a clear recommendation as to whether legislators should approve the bill, which would add an opioid disorder to the list of “qualifying medical conditions” that can be treated with medical cannabis.
Opioid-related overdose deaths in Maryland have risen in recent years, with 1,185 in the state in the first half of 2018, the latest available data. Fentanyl, a synthetic drug that can be 50 times stronger than heroin, was the vast majority of these deaths.
Advocates say the growing number of deaths from overdose underlines 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 doctor in Takoma Park, said her patients who use marijuana and opioids to treat chronic pain need lower opioid doses than those who avoid cannabis. She said that medical marijuana users have also seen decreases in anxiety and depression.
Frye said that marijuana should not be a deterrent because opioids are much 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.
A doctor associated with Maryland-D.C., Joseph Adams. The Addiction Medicine Society testified against the law that it was part of a “desperate effort” to find alternatives to traditional methods of treating addiction, which he said were unfairly stigmatized. With several locations in Baltimore, he is the medical director of a methadone program.
Listing opioid abuse disorder as a qualified medical condition may increase overdose deaths associated with opioids, Adams said, as patients may stop using methadone or other proven treatments.
Adams’s organization is part of a cohort of drug policy groups —
With a variety of restrictions, the states that allowed marijuana to be used to treat opioid addiction have done so. For example, regulations in Pennsylvania allow doctors to prescribe medical cannabis only if traditional treatments fail or if cannabis is used in conjunction with traditional treatment options.
If their patients have “severe or chronic pain,” doctors in Maryland can already authorize marijuana for opioid addicts.
Supporters of the bill say that it is necessary for more doctors to see marijuana as a viable treatment option to explicitly include opioid abuse disorder in the list of qualifying conditions.
“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.”