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Link Between Medical Marijuana and Fewer Opioid Deaths Is More Complex Than Previously Reported

February 11, 2018

“The association between medical marijuana and lower levels of opioid overdose deaths—identified previously in several studies—is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve, according to a new RAND Corporation study.

The report—the most-detailed examination of medical marijuana and opioid deaths conducted to date—found that legalizing medical marijuana was associated with lower levels of opioid deaths only in states that had provisions for dispensaries that made medical marijuana easily available to patients. Opioid death rates were not lower in states that just provided legal protections to patients and caregivers, allowing them to grow their own marijuana.

In addition, the association between medical marijuana dispensaries and fewer opioid deaths appears to have declined sharply after 2010, when states began to tighten requirements on sales by dispensaries.”

Read more at: https://www.rand.org/news/press/2018/02/06.html

Source: Rand.org – February 6, 2018

Categories: Addiction, Heroin, News Updates, Opioid Abuse/Addiction, Opioids, Overdose
Tags: marijuana, Overdose

Marijuana Could Be Huge for Treating HIV

November 29, 2017

marijuana“For too long, conducting legitimate research on the medical benefits of marijuana was all but impossible. Kept out of the hands of doctors and scientists by an overzealous DEA, pot is still classified by the federal government as a Schedule I drug under the Controlled Substances Act—the strictest category available. This makes funding and access to research-grade, federally legal cannabis hard to come by; even in states where marijuana is legal, studies on the drug are still subject to approval by multiple boards, and samples must be procured from the only lab in the country approved to dispense research-grade marijuana.

Robert L Cook, professor of epidemiology at the University of Florida, recently announced he is leading a 400 person study to scrutinize marijuana’s effects on people living with HIV. The five year, $3.2 million study is believed to be the largest of its kind, and will look not only at marijuana’s impact on the brains of HIV patients, but also whether the drug is able to help suppress the virus. Cook will also account for the specific amount of marijuana consumed or inhaled by participants, as well as the amount of THC and cannabinoids in those doses—something he said other researchers haven’t been able to do.”

Read more at: https://www.vice.com/en_us/article/59ya48/marijuana-could-be-huge-for-treating-hiv

Source: Vice.com – November 16, 2017

Categories: News Updates
Tags: HIV/AIDS, marijuana

Two Thirds of Pain Patients in a New Study Used Cannabis to Get Off Opioids

November 13, 2017

marijuana“Two out of three pain patients were able to replace opioids with cannabis in a new study, further illustrating the dire need for drug policy reform in those states hardest hit by the country’s ongoing opioid epidemic.

The study by Aclara Research surveyed more than 400 patients and 500 pharmacists on medical marijuana and opioid addiction.

Among polled patients, 67 percent said they were able to quit opioids once they had access to a state medical marijuana program. Another 29 percent said they were able to reduce their opioid use thanks to cannabis. That means only four percent of those surveyed did not have their opioid use affected by cannabis.

Moreover, 30 percent of the patients polled by Aclara said they were able to quit all prescription drugs after they started using cannabis.

Among pharmacists, 87 percent of those surveyed said medical marijuana should be legal, and 69 percent said they believe pharmacists should dispense the drug and provide guidance to patients.”

Read more at: https://www.civilized.life/articles/pain-patients-cannabis-opioids-two-thirds/

Source: Civilized.Life – November 6, 2017

Categories: Addiction, Heroin, News Updates, Opioid Abuse/Addiction, Opioids, Prescription Drugs
Tags: Addiction, Heroin, marijuana, Prescription Opioids

Policies Limiting Rx Opioids Aren’t Working; It’s Time to Expand MAT and Evaluate Other Options

August 11, 2017

By Barbara Goodheart, ELS

Prescription opioids are still getting much of the blame for the current opioid overdose crisis, yet heroin and synthetic opioids—fentanyl, carfentanil, and tramadol—have become the leading causes of opioid overdose deaths. The death rate from heroin and synthetic opioids other than methadone rose by more than 72% from 2014 to 2015, while overdose deaths linked to prescription opioids have leveled off or declined since 2011.

What would be a better way to deal with the opioid crisis? Three groups offer suggestions.

The Research-Oriented Approach

An article by Drs. Nora Volkow and Francis Collins in the New England Journal of Medicine urges stepping up research in three areas: overdose reversal: additional interventions and better formulations of naloxone; addiction treatment: new medications and technologies aiming at novel molecular targets; and pain management: safe, effective, nonaddictive treatments for chronic pain.

marijuanaA Less-Conservative Approach: Legalizing Marijuana

Most states and Washington, D.C. have legalized marijuana use for medical purposes. But lacking substantial data to support medical marijuana’s effectiveness and safety, the broader medical community is calling for well-designed studies before lending its support.

In the Middle: The Drug Policy Alliance

The Drug Policy Alliance (DPA), a national nonprofit organization, describes itself as supporting drug reform and seeking to promote drug strategies “grounded in science, compassion, health and human rights.”

The focus of this AT Forum article is a policy paper the DPA released in April. Only 12 pages long, the paper includes dozens of recommendations, presented as suggestions for consideration.

The authors begin their policy paper by emphasizing patients’ legitimate need for access to pain medications, pointing out that “over 87 percent of people who used prescription opioid pain relievers in the past year did not misuse them.” They caution that “we must not widen the net and criminalize legitimate medical use of opioids, overstate the potential dangers of prescription opioid use and reduce access to needed pain medications, or stigmatize the people who use them.”

Some believe that the DPA overly favors marijuana, heroin, and harm-reduction interventions. As for marijuana and heroin, the DPA policy paper calls for safe drug consumption services, specifying “a pilot program” to clarify the heroin issue, and “additional research” to help resolve the marijuana question. It takes a stronger position on harm reduction.

Harm Reduction

(In harm reduction, individuals who have a substance use disorder but are not ready for rehab find ways to minimize the risks they incur.)

The DPA policy paper recommends setting up safe injection facilities (SIFs) and safe drug consumption services through local health departments or community organizations. While the paper was being written, proposals or legislation to establish such sites had already been introduced in California; Maryland; Ithaca, New York; and King County in Washington State.

The policy paper points out that studies in other countries have shown that SIFs reduce overdose deaths; provide an entry to treatment, even abstinence; reduce risky injection practices and disease transmission; reduce public injection practices; are cost effective; and do not increase the incidence of local crime, or encourage additional drug use.

Bottom line: some health care providers consider harm-reduction programs extreme; others believe they have potential benefits, and favor learning more about them, with well-designed clinical studies a necessary first step.

Medication-Assisted Treatment

The DPA covers medication-assisted treatment (MAT) at length, and includes many recommendations opioid treatment programs (OTPs) will favor. Among them: increasing access to MAT by such means as providing office-based treatment.

Establish an Expert Panel on Treatment Needs. A panel in each state would address treatment needs and opportunities, while considering the following tasks:

  • Evaluate existing barriers to treatment
  • Identify ways to address gaps in treatment
  • Make recommendations to the state legislature
  • Set evidence-based standards of care
  • Identify treatment components and recovery services to include

The paper notes that access to MAT is limited in U.S. treatment facilities.

Increase Insurance Coverage for MAT. Plans in some states do not cover methadone or buprenorphine,
and only about a quarter of patients treated for opioid use disorders at Veterans Health Administration (VHA) facilities are treated with methadone or buprenorphine.

Provide Office-Based Opioid Treatment for Methadone. Several states have limited the availability of methadone by establishing moratoriums on new OTPs. Office-based methadone would help make treatment broadly available, and could help reduce the stigma still associated with MAT.

Offer MAT in Hospitals, Jails, and Prisons. About 25% of incarcerated people are opioid-dependent. They are up to 130 times more likely to die of an overdose soon after release from incarceration than are opioid-dependent people in the general population. For the newly incarcerated, continuation of MAT should be mandated, the DPA believes; and for those who lack MAT, but need it, MAT should begin before their release from confinement.

Other Options: Helping Those Refractory to Treatment

The DPA suggests considering two options:

▬ A heroin-assisted pilot

▬ A program evaluating marijuana as an opioid substitute, or as an adjunct, in patients with chronic pain

Naloxone

The document provides good coverage of naloxone. It notes that great progress has already been made to increase access to this opioid overdose antidote—although access and protections vary widely among the states.

Criminalization, Syringe Sales, Diversion Programs, Decriminalization

The publication also recommends ending criminalization of syringe possession; lowering barriers to over-the-counter syringe sales; and allowing direct prescriptions for syringes (some states have already taken such steps); establishing an expert panel on prescribing practices, by states; mandating specific educational courses for degree-granting institutions; and developing an evidence-based curriculum for schools.

Two additional key recommendations found in the report: establish programs to help individuals with substance use disorders meet their basic needs; and decriminalize drug possession—that is, remove criminal penalties for possession of small amounts of controlled substances for personal use.

Conclusion

Although its approach is not as conservative as some would like, the paper offers many timely recommendations concerning MAT and naloxone. It also emphasizes a key requirement, sometimes overlooked—the need for policymakers to evaluate the benefits of “potential harm reduction, effective treatment, and prevention interventions—all backed by rigorous science—and to shift the focus of their efforts to implementing policies that actually have the power to save and improve lives [emphasis added].”

# # #

References

Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths— United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. doi: http://dx.doi.org/10.15585/mmwr.mm655051e1.

Centers for Disease Control and Prevention. Opioid Overdose Data. Opioid Data Analysis. Categories of Opioids. https://www.cdc.gov/drugoverdose/data/analysis.html#contentArea. Accessed August 10, 2017.

Volkow N, Collins F. The role of science in addressing the opioid crisis. N Engl J Med. 2017; [Epub ahead of print]. May 31, 2017. doi: 10.1056/

The Drug Policy Alliance. A Public Health and Safety Approach to Problematic Opioid Use and Overdose. April 18, 2017. http://www.drugpolicy.org/resource/public-health-and-safety-approach-problematic-opioid-use-and-overdose. Accessed August 10, 2017.

Categories: Addiction, Buprenorphine, Drug Courts & Criminal Justice, Heroin, Medication-Assisted Treatment (MAT), Methadone, Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids, Overdose, Prescription Drugs
Tags: Addiction, Buprenorphine, Health Insurance, Heroin, marijuana, Methadone Treatment, Opioid Treatment Programs, Overdose, Prescription Opioids, Substance Abuse Treatment

Federal Agency Admits That Marijuana Could Curb Opioid Addiction

May 8, 2017

marijuana“As first reported by MassRoots political correspondent Tom Angell, the National Institute of Drug Abuse (NIDA) now states on its website that three recent studies, two of which it funded, suggest “medical marijuana products may have a role in reducing the use of opioids needed to control pain.”

Marijuana advocates see this as a significant admission from NIDA, which has insisted in the past that marijuana’s potential benefits are outweighed by its negative side effects and stated that its use may “cause problems in daily life or make a person’s existing problems worse.”

Legalization advocates and certain lawmakers such as Sen. Elizabeth Warren (D-Mass.) have touted marijuana reform as a way to curb opioid abuse in the midst of a national epidemic. But the federal government has been slow to respond to mounting evidence that doctors prescribe fewer opioids and there are less opioid-related overdoses in states where the plant is legal. The website update is one of the first signs of a shift in the federal government’s view on the issue.

Read more at: https://www.attn.com/stories/16906/federal-agency-admits-marijuana-curbs-opioid-use

Source: Attn.com – May 1, 2017

Categories: Addiction, News Updates, Opioid Abuse/Addiction
Tags: Addiction, Heroin, marijuana, Prescription Opioids

Research Results: Cannabis Use May Increase Risk of Failing Methadone Tx in Women

April 18, 2017

marijuana“According to researchers from McMaster University and St. Joseph’s Healthcare Hamilton, the use of cannabis may affect treatment in women being treated with methadone. Findings from the study are published in Biology of Sex Differences.

Researchers reported that about 60% of men and 44% of women undergoing methadone therapy also use cannabis. The study included 777 participants from 16 Canadian Addiction Treatment Centre Sites across Ontario. The results indicated women undergoing methadone treatment who used cannabis were 82% more likely to continue using opioids. Cannabis use appeared to be a “predictor for continuing opioid use despite treatment with methadone.”

Read more at: http://www.empr.com/news/methadone-opioid-cannabis-addiction-treatment/article/647557/

Source: EMPR.com – March 30, 2017

Categories: Addiction, Methadone, News Updates, Opioids
Tags: Addiction, marijuana, Methadone Treatment, Substance Abuse Treatment

Would Legalizing Medical Marijuana Help Curb the Opioid Epidemic?

April 18, 2017

“In states that legalized medical marijuana, U.S. hospitals failed to see a predicted influx of pot smokers, but in an unexpected twist, they treated far fewer opioid users, a new study shows.

Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes, the analysis found. Hospitalization rates for opioid overdoses dropped 13 percent on average.

At the same time, fears that legalization of medical marijuana would lead to an uptick in cannabis-related hospitalizations proved unfounded, according to the report in Drug and Alcohol Dependence.”

Read more at: http://www.huffingtonpost.com/entry/would-legalizing-medical-marijuana-help-curb-the-opioid-epidemic_us_58dac0f8e4b0cb23e65c061a

Source: HuffingtonPost.com – March 28, 2017

Categories: Addiction, Heroin, News Updates, Opioid Abuse/Addiction, Opioids
Tags: marijuana, Overdose

Marijuana Testing: Advice From SAMHSA and the Joint Commission

October 11, 2016

By Alison Knopf

marijuanaIn this day of medical marijuana in some states, and recreational marijuana as well, what is a treatment program to do when it comes to testing for the drug. We checked with the Joint Commission and with the Substance Abuse and Mental Health Services Administration (SAMHSA). Both say the same: test at admission, and from then on, it’s up to you.

The requirements for opioid treatment programs (OTPs) cited in the Joint Commission Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC) do not specify that marijuana must be tested for, except at admission. Megan Marx-Varela, associate director of the Joint Commission’s behavioral health care program, replied to our question about this by citing Standard CTS 02.020.09, element of performance 4 (for OTPs), which states: “On admission the program tests the patient for opiates, methadone, amphetamines, cocaine, marijuana, and benzodiazepines. The need for testing for additional substances is determined by individual patient circumstances and local drug-use patterns.”

As for SAMHSA, in 2014, a Dear Colleague letter to OTPs noted that marijuana is still listed as a Schedule I controlled substance (and it still is in 2016). In accordance with federal law, SAMHSA still views marijuana as an illicit drug in all OTPs, regardless of the state they operate in. This means SAMHSA, as a federal agency, does not accept medical marijuana or recreational marijuana.

As for drug testing, however, marijuana testing is required only at admission.

Joint-CommissionBoth SAMHSA and the Joint Commission specify that admission to an OTP requires running the following toxicology tests: opioids, methadone, buprenorphine, amphetamines, cocaine, marijuana, and benzodiazepines. SAMHSA states that if there is a history of prescription opioid analgesic abuse, “an expanded toxicology panel that includes these opioids should be administered.”

However, any additional testing, beyond admission, “is based on individual patient need and local drug use patterns and trends,” states SAMHSA.

Alcohol vs. Marijuana

We asked specifically what the difference is between recreational marijuana and recreational alcohol use in OTP patients. SAMHSA’s response: “Using methadone and alcohol together is particularly dangerous because of the interactions between the two substances. According to the National Institutes of Health (NIH), when used at the same time, alcohol can increase the risk of experiencing serious and life-threatening side effects from methadone.”

Using alcohol and methadone together “can create health concerns that are more severe based on the combined use of these two substances,” added SAMHSA. “Individuals who mix methadone and alcohol may be more likely to experience respiratory depression, irregular heartbeat, drowsiness, and coma.

We also asked about the effects of combining marijuana with methadone. “Illicit drug use, specifically cannabis, is common among opioid-dependent individuals and has the potential to impact treatment in a negative manner,” SAMHSA responded. “Studies demonstrate that rates of cannabis use were high during methadone induction, dropping significantly following dose stabilization.”

Problems With Marijuana

SAMHSA offered the following evidence of the harms of marijuana, including citations.

Approximately 9% of people who experiment with marijuana will become addicted to it; among those who start using the drug in their teens, the number goes up to about 1 in 6, and among daily users to 25-50%. (Lopez-Quintero C, Perez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2011; May 1;115(1-2):120-130. doi: 10.1016/j.drugalcdep.2010.11.004. Epub 2010 Dec 8.)

Early (animal) studies show that early THC exposure can weaken the dopamine system in the reward areas of the brain—an effect that, in humans, would explain why early and chronic marijuana use may increase the likelihood of developing other substance use disorders later in life. Agrawal A, Neale MC, Prescott CA, Kendler KS. A twin study of early cannabis use and substance use and abuse/dependence of other illicit drugs. Psychol Med. 2004; Oct;34(7):1227-37.) “This potential risk factor could further complicate the treatment course among those already struggling with substance abuse disorders,” stated SAMHSA.

Marijuana significantly impairs coordination and reaction time and is the illicit drug most frequently found to be involved in automobile accidents, including fatal ones. The recognition of this effect along with known methadone induced sedation is a major concern among OTP clients that drive. (Brady JE, Li G. Trends in alcohol and other drugs detected in fatally injured drivers in the United States, 1999-2010. Am J Epidemiol. 2014; Mar 15;179(6):692-9. doi: 10.1093/aje/kwt327. Epub 2014; Jan 29.)

The takeaway from all of this information: you do not have to test OTP patients for marijuana once they are admitted, but you may want to provide education about the deleterious effects of combining marijuana with methadone. Even more important, however, you may want to bring up alcohol–which just about nobody tests for because it doesn’t show up in urine tests. SAMHSA and the Joint Commission wisely leave testing decisions up to clinicians.

References, and for Further Reading

SAMHSA  2014 Marijuana Dear colleague letter.   http://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/dear_colleague_letters/
2014-colleague-letter-marijuana-use.pdf
.

Federal Guidelines for Opioid Treatment Programs. http://store.samhsa.gov/product/PEP15-FEDGUIDEOTP.

Scavone JL, Sterling RC, Weinstein SP, Van Bockstaele EJ.  Impact of cannabis use during stabilization on methadone maintenance treatment. Am J Addict. 2013;Jul-Aug;22(4):344-351. doi: 10.1111/j.1521-0391.2013.12044.x.

Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs: Chapter 9. Drug Testing as a Tool. https://www.ncbi.nlm.nih.gov/books/NBK64151/.

Categories: Addiction, Medication-Assisted Treatment (MAT), Newsletter, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Opioids
Tags: alcohol, Buprenorphine, marijuana, Methadone Treatment, Opioid Treatment Programs

Current News Update

News & Updates – April 6, 2018; Issue 292

Current Newsletter

AT Forum Volume 29, #2 February/March 2018

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