Cannabis and Opioids: Yes, we need more research, but that's not an excuse to slow expansion of access

Today's New York Times talks about New Hampshire's hesitancy to join other states in decriminalizing and expanding access to marijuana because of fears of the public health risks in the midst of still reckoning with the harm caused by opioids. For my fuller perspective on this issues, read Chapter 9 of The United States of Opioids, where I address the risks and promise of cannabis in detail, including some of the following ideas:

1. The Data is that Cannabis Access Reduces Overdose Deaths:  The critical data point that New Hampshire and other states hesitating to expand access to cannabis should be paying attention to is that, in decriminalized states like Colorado, the rates of opioid overdose deaths have gone down. According to a 2014 study published in JAMA Internal Medicine, between 1999 and 2010, states that made marijuana legally available for medical purposes had nearly a 25% lower annual rate of opioid analgesic overdose deaths. In 2010, that translated to 1,729 fewer people dying. Even after suicides are excluded from the data and heroin overdoses were added in, the data shows the same association--more access to cannabis means fewer opioid-related deaths. Period.

2. How Marijuana Access Impacts Opioid Use: In The United States of Opioids, I share insights from a September 2018 University of Pittsburgh study that identified that, over the past 40 years, when you combine together all of the various sub-epidemics of drug abuse (heroin, prescription opioids, cocaine, methamphetamine, etc.), the resulting data forms a tight, linear, exponentially rising curve of overdose deaths. What this data signifies, among other things, is that illegal drug use operates with market efficiency. Whether use is recreational or self-medication, whenever government pushes down on the availability of one kind of drug, suppliers and user demand simply shifts to another drug. We see this playing out in opioid use. The government cracked down on prescription opioids, and traffickers filled the void with black tar heroin. The government cracked down on heroin, and traffickers increased their importation of fentanyl. It makes perfect sense that giving users access to marijuana means some people will choose an option other than opioids. If expanded marijuana access saves lives, that should be the end of the conversation.

3. Enough Already With the "Reefer Madness" Propaganda: People opposed to cannabis decriminalization are excited about Alex Berenson’s book, Talk to Your Children, decrying the menace of marijuana. Berenson's book links cannabis use to psychosis. While there is no question that cannabis raises multiple health concerns that demand attention, this alarmist message is hard to take seriously. Thanks to a growing body research done outside of the United States (in places where the government has not obstructed research), we now have evidence that, along with the risks, cannabis has numerous valuable therapeutic applications. Moreover, as I write about in The United States of Opioids, in striking contrast to opioids, there is no dosage at which cannabis kills people. That difference is why we have an opioid crisis and not a cannabis crisis. 

4. Thinking about Cannabis as Similar to Alcohol: In light of that growing body of research about the promise of marijuana, Berenson's book represents a return to scare tactics from the "Reefer Madness" era, which were used to deny access and maintain the criminalized status of cannabis.

No one is denying health risks around cannabis use and the need to study them. The better way to think about cannabis access is parallel to how we think about alcohol. Alcohol addiction is a problem. Alcohol has extensive risks and related social harms. As we learned in the Prohibition Era, however, the bottom line is that we are better off as a society when we decriminalize it, apply standards to its production and marketing, and focus on limiting access for kids and expanding public health education and awareness. ironically, cannabis appears to be distinguishable from alcohol, both for its extensive therapeutic potential and for a lower level of harm. As with alcohol, the rational path forward for cannabis involves (a) expanding access; (b) opening up research; and (c) putting into place controls to prevent use by children, and (d) education campaigns to increase awareness of risks, and (e) developing treatment resources for people with use disorders.

For more on this topic, please check out The United States of Opioids