TALKING POINTS / MESSAGE TO MEMBERS OF THE HGO COMMITTEE (MD GENERAL ASSEMBLY) OPPOSING SB 893 AS AMENDED (cannabis for Opioid Use Disorder). 
Hearing in HGO committee scheduled for 3-27-2019

Members of the Health Government & Operations Committee (HGO) should vote against SB 893 (Sen Zirkin)
("Medical Cannabis - Provider Applications - Opioid Use Disorder") which was passed with amendment by the Senate Judicial Proceedings (JPR) Committee and will return to the HGO Committee on 3-27-2019.     
 
Unfortunately the JPR amendment will not protect Marylanders from the harms resulting from this bill.  
The bill as amended is opposed by the Maryland DC Society of Addiction Medicine and others.

One of the authors of the study showing decreased opioid overdoses in states with medical marijuana spoke out against the use of cannabis as a treatment of opioid use disorder (OUD), below:

‘Overdoses Fell with Medical Marijuana Legalization’ by Colleen Barry PhD, April 26, 2016. New York Times.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/
Excerpt, emphasis added:

. . . my colleagues and I found that the annual rate of opioid overdose deaths decreased substantially — by 25 percent on average — following medical marijuana laws, compared to states that still had bans. . .
Our study should not be used to tout the use of marijuana to treat opioid addiction, a particularly upsetting misinterpretation, as the limited evidence available points to the opposite being true: Quitting marijuana may strengthen recovery for individuals with opioid use disorders. Further research is needed. . . .
If the opioid crisis has taught us anything, it should be that careful regulation, stringent oversight and ongoing evaluation are all absolutely essentially to establishing an environment that protects the public’s health.
~ (Colleen Barry is a professor at the Johns Hopkins Bloomberg School of Public Health and co-director of the Johns Hopkins Center for Mental Health and Addiction Policy Research).

There is no convincing evidence that cannabis is effective in improving outcomes for the treatment of OUD. Widespread use for OUD treatment is predicted to increase opioid overdose deaths due to less use of treatments proven to save lives.
 
The decline in overdose deaths in states with medical cannabis laws is consistent with effectiveness of medical cannabis for pain (it is overwhelmingly used for pain), which might indeed reduce opioid prescriptions and might prevent overdose by that mechanism, which is very promising.  
 
Cannabis’ effectiveness to treat pain should not be confused with its effectiveness for the actual treatment of OUD.
 
By listing OUD as a qualifying condition for cannabis, the General Assembly would be endorsing and encouraging its use for this condition, likely leading to widespread use for OUD treatment, in the absence of any evidence of effectiveness.
 
The FDA-approved OUD treatments have the important benefit of protecting individuals from overdose.  Cannabis offers no such protection in the event of slips or relapses that are extremely common in early recovery. 

 

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"A comprehensive review of existing medical literature shows that there is no credible scientific evidence backing up the claims that cannabis is beneficial in treating addiction, and that there is some evidence suggesting that it may exacerbate substance use and dependency issues."

Source:  Statement from the 2018 Maryland Medical Cannabis Commission Legislative 
Report: Treatment of Opioid Use Disorder with Medical Cannabis

 

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"To date, no prospective evidence, either from clinical trials or observational studies, has demonstrated any benefit of treating patients who have opioid addiction with cannabis."

Source: Humphreys K,  Saitz R. 'Should Physicians Recommend Replacing Opioids With Cannabis?'
JAMA: Journal of the American Medical Association, February 19, 2019 Volume 321, No. 7

Authors:
Keith Humphreys,PhD;  VA Health Services Research & Development Ctr; and Stanford University
Richard Saitz,MD,MPH Dept of Community Health Sciences, Boston University School of Public Health; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, and Grayken Center for Addiction, Boston Medical Center; Associate Editor, JAMA

 

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At the JPR hearing, one article was referenced which may have given the impression that cannabis may be useful for OUD treatment:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/

This was in a journal devoted exclusively to cannabis, written by a psychologist and an anesthesiologist, suggesting that the use of cannabis for OUD was "promising."  

Evidence for this claim were animal studies and human studies with indirect endpoints. 

The indirect endpoints cited were some (but not all) studies indicating greater retention in treatment, and some (but not all) studies indicating effectiveness for opioid withdrawal symptoms. (We have many drugs that are effective for withdrawal symptoms but that are not effective for OUD treatment).   

Possible effectiveness for reduction in cravings by cannabidiol was cited, but this is not cannabis and is also an indirect endpoint.

 

For more information contact Joseph Adams, M.D. 
Chair, Public Policy Committee, MD-DC Society of Addiction Medicine
This email address is being protected from spambots. You need JavaScript enabled to view it..  mobile:   410-812-1447.         March 20, 2019

 

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