Pot vs. Pills: Will Cannabis Help End the Opioid-Abuse Epidemic?

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With the election of Donald Trump and Republican majorities in Congress, the GOP has vowed to move forward with its longtime pledge to undo the Affordable Care Act. While it remains to be seen what approach the Republicans will take to replace the ACA, overhauling the country’s health-care system presents a timely opportunity to address an epidemic gripping the nation: the explosive growth in opioid addiction and abuse.

The numbers are staggering. The total number of opioid pain relievers prescribed in the United States jumped from 76 million in 1991 to 207 million in 2013. In that time, Americans accounted for nearly 100 percent of the hydrocodone sales in the world and 81 percent of oxycodone sales. This explosive growth in opioid use has resulted in a surge of opioid-related deaths. In 2015, opioids were involved in 33,091 deaths, a fourfold increase since 1999 that accounted for 63 percent of all drug-related deaths. As a result of this increase, drug-related deaths for the first time exceeded the number of deaths from car crashes in the United States.

With over two million Americans addicted to prescription painkillers and an additional 600,000 addicted to heroin, there’s a growing urgency to find alternative therapies that can slow or reverse this epidemic.

Cannabis presents a significant alternative. It’s been found to be beneficial in treating chronic pain, neuropathic pain and the spasticity associated with multiple sclerosis—conditions for which opioids are commonly prescribed. Additionally, researchers are investigating whether its neuroprotective properties also help reduce the likelihood of becoming dependent on opioids when both are used together.

More research is essential, but the substitution of cannabis for painkillers has already begun. A recent analysis of the Medicare program found that drug prescriptions fell significantly in states where medical marijuana was legal. Doctors in legal-marijuana states prescribe an average of nearly 1,800 fewer doses of painkillers per year than those in states without medical cannabis.

Patients suffering from pain are the biggest drivers of the demand for medical marijuana. Analysis by New Frontier found that chronic-pain patients accounted for the largest proportion of medical marijuana patients in states that allow pain as a qualifying condition. In the five states analyzed, chronic-pain patients accounted for well over half of medical marijuana patients. In Arizona alone, pain sufferers account for 81 percent of registered patients, the most in any state.

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Pharmaceutical companies are watching these developments closely; the increased substitution of medical cannabis for opioids could significantly impact their bottom line. The top three pain medicines in the Medicare program—Oxy-Contin, hydrocodone and Fentanyl—accounted for $1.96 billion in prescriptions in 2013 alone.

With so much revenue at stake, it’s not surprising that opioid manufacturers are investing money in preventing the expansion of legal cannabis. In 2016, Insys Therapeutics, the manufacturer of Subsys—one of the most potent and expensive opioids on the market—donated $500,000 to oppose adult-use legalization in Arizona. The donation made Insys the third-largest funder of the opposition campaign, and it was a key contributor to the failure of the legalization ballot measure.

Insys claimed that it opposed the measure “because it fails to protect the safety of Arizona’s citizens, and particularly its children.” However, the company’s motives may not have been entirely altruistic: Insys admitted in a filing to the Securities and Exchange Commission that legal marijuana poses a direct threat to its product lines, including a product under development called Dronabinol Oral Solution, which uses synthetic THC to treat the nausea and vomiting associated with chemotherapy.

The tension between pharmaceutical companies and legal marijuana will likely continue for many years to come. However, at a time when tens of thousands of Americans are dying from opioid overdoses and millions more are dealing with the scourge of opioid addiction, it’s imperative that lawmakers, drug manufacturers and health-care providers find ways to solve this catastrophic epidemic. A solution may be as close as your nearest dispensary.

John Kagia is executive vice president of industry analytics for New Frontier Data.

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