Would Legal Medical Marijuana in Virginia Reduce Opioid Addiction?

Courtesy of AmericanMarijuana.Org

By DJ Rippert

The lesser of two evils. The ongoing 2020 Virginia General Assembly session has generated a lot of debate over gun control. Proponents of stricter firearms regulation cite reduced gun violence as a goal. While gun-related deaths (including murder) are a real problem, those deaths are less frequent than fatal opioid overdoses. In 2017, there were 455 murders in Virginia versus 1,241 drug overdose deaths involving opioids. The number of fatal opioid overdoses in Virginia rose from about 500 in 2010 to over 1,200 in 2018 while the number of gun related deaths (of all types) rose from 868 to 1036 over the same period. While it’s fair to say that Virginia has taken many steps to deal with the opioid crisis there is one step that has not been taken: legalization of medical marijuana. Recent studies point to the fact that most states adopting legal medical marijuana see an immediate reduction in opioid prescriptions after medical marijuana is legally available.

The road to hell … is paved with good intentions. While illegal opioids like heroin have been used and abused in America for years the recent spike in opioid abuse has a legal genesis. In the early 1990s pharmaceutical companies held out a new generation of opioid medicines almost as a panacea for pain relief. It was said that these new medicines would relieve pain without becoming addictive. Based on these assurances, opioids were legally prescribed for a spectrum of relief from significant pain. Once used almost entirely to treat cancer-related pain, by 1999 86% of patients using opioids were using them for non-cancer pain. In some communities opioid prescriptions became the rule, rather than the exception, for pain relief. Two Virginia localities, Norton and Martinsville, topped the list for per capita opioid pain pill distribution from 2006 to 2012. Over those seven years Norton saw a distribution of 306 pills per person while Martinsville checked in at 242. The “average” resident of Norton was taking one pain pill every eight days for seven years. In reality, the distribution was skewed to a subset of the population which was taking pain pills at a much faster rate. People started to overdose. People started to die.

As the problems with opioid prescriptions became obvious the pills were made harder to legally obtain. This caused the second shoe to drop when it became obvious that opioids were, especially for some people, highly addictive. An illegal secondary market for legally prescribed pills started as opioids were transferred from those to whom they were prescribed to others. After that secondary market dried up, the opioid-addicted turned to heroin — an illegal opioid-based drug. Deaths due to heroin-related overdose increased by 286% from 2002 to 2013.

The latest chapter in this tragedy involves illegally manufactured fentanyl, a potent synthetic opioid that is 50 to 100 times stronger than morphine. Fentanyl is sometimes sold on the black market as fentanyl and sometime mixed with heroin or cocaine to increase potency. This mixing is very unscientific and can result in extremely potent doses. Deadly doses. Starting in about 2006, accidental fatal overdoses of illegal fentanyl spiked in the U.S.

Ganja to the rescue? Opioids are still being legally prescribed. The peak prescription rate for prescribed opioids was 81.3 per 100,000 Americans in 2012. By 2017 that number had been cut to 58.7. However, that’s still almost 200 million prescriptions. In some places it’s much worse. Lee County, Va had a per capita prescription rate of 132.6 in 2017 (whereas Fairfax County had 24.9). People still suffer from chronic pain and doctors still prescribe opioids. The search for alternatives has led, in many cases, to medical marijuana. Chronic pain relief is the most common qualifying condition for the prescription of medical marijuana. The online marijuana journal American Marijuana undertook a study of the 19 states that both legalized medical marijuana and had sufficient data to study opioid prescription rates. Fifteen of the 19 states showed a drop in opioid prescribing from one year before medical marijuana was legally available to one year after. Opioid prescriptions in Ohio dropped by almost 20% during the study period.

Implications for Virginia. In 33 states medical marijuana (including THC) is legal. Virginia is one of 17 states where medical marijuana is illegal. The 2020 General Assembly session seems likely to decriminalize marijuana but unlikely to legalize medical marijuana. This delay will have deadly consequences for some number of Virginians who are taking (or will soon start taking) opioids for pain relief under a doctor’s supervision. Over a thousand Virginians die each year from opioid overdoses. Nobody has ever died from a marijuana overdose. But Virginians will not be prescribed medical marijuana instead of opioids because medical marijuana is illegal. Someday Virginia will join the majority of American states by legalizing medical marijuana. Until then, our General Assembly’s dithering on medical marijuana will add to Virginia’s opioid body count in 2020 and beyond.

Finally, some will say that medical marijuana has not gone through the rigorous approval process required by the FDA. Tell that to the families of the thousands of dead Virginians whose loved ones lost their lives in a fatal process that started by taking FDA-approved opioid pain killers. Once again: Nobody has ever died of a marijuana overdose.

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19 responses to “Would Legal Medical Marijuana in Virginia Reduce Opioid Addiction?

  1. Your article is really quite excellent and several you have done on this subject have been non-partisan and thought-provoking.

    But someone recently said here something about the government telling you how to live and I would ask – is this an example?

    If Marianna is a way to wean those on opioids off of them and/or divert them from using opioids – what is the proper role of government?

    To allow it? To incentivize it? To criminalize it?

    • Decriminalizing marijuana possession is easy. Implementing a medical marijuana regime is hard. It has to be grown in state. Doctors have to know what they’re allowed to prescribe it for. There has to be marijuana stocked dispensaries where the prescriptions can be filled.

      I think the state government should exercise control over legal marijuana (medical or recreational) at about the same level as alcohol. I don’t think it should be dispensed or sold in state run stores (like the ABC stores) but it must be reasonably regulated.

      The good news is that the regulatory costs will be a small fraction of the amount of new state money that will be derived from taxing marijuana. Usually regulation adds to the tax burden. In this case it more than pays for itself.

      The libertarian view is easy – don’t want to pay a marijuana tax? Don’t buy, possess or use marijuana.

      The issue of driving while high remains. However, I wonder how many people drive after having taken legally prescribed opioid medications. If a policeman stopped a motorist for a broken taillight or for speeding would they even know the driver was using Vicodin? I don’t know but I doubt it. At least you can smell leaf marijuana. You can see red eyes and piles of Cheeto wrappers on the floorboards. However, a reliable marijuana breathalyzer is needed.

  2. I actually think people screwing with their cell phones is a bigger issue than drugs…

  3. Do a word search on cannabis on the bill tracking for 2020, and after excluding failed bills there are close to 20 measures still alive. At some point somebody needs to sort that out, but in two weeks more may be gone. I see studies laying the groundwork for more medical access….

    Not sure I accept your premise that with grass available, fewer will move to opiates, and once hooked moving to marijuana is no cure. But any sales pitch in a pinch…..

    • I did that word search and there is a lot in flight. I maintain my prediction that decriminalization will pass, medical marijuana will be put under study until 2021 and recreational marijuana legalization will be indefinitely deferred. I have not looked at the proposed expungement legislation.

      As for marijuana being prescribed for pain relief instead of opioids – there’s no doubt that will happen. In 2017 Lee County, Va was still prescribing opioid medicines at a 132.6 rate per 100,000 people. That’s 1.32% of the population. If medical marijuana was legal some of those opioid prescriptions would be medical marijuana prescriptions. While this won’t help people hooked on opioids it will prevent some people from being prescribed opioids and starting down the path to addiction.

      As the US population ages there will be more and more cases of non-cancer chronic pain. At some point for many patients aspirin and ibuprofen won’t cut it. The next stop today is opioid based medicine. But there’s a big gap between aspirin and Vicodin. Medical marijuana fills that gap for many people without opening the door to opioid addiction, overdose and death.

  4. I support full legalization with the same status and controls as distilled spirits.

    • and that has not happened and probably never will if Conservatives control the GA in Richmond. True?

      • True. One reason the conservatives (aka Republicans) in Virginia have fallen apart is their unwillingness to change. Run a poll in very conservative SouthWest Virginia regarding whether medical marijuana should be legalized. Remember, this is Trump Country. My expectation is that even the Republicans’ own constituents want to see medical marijuana legalized. Yet the Republicans elected to the General Assembly were (overall) doing everything in their power to thwart any movement on marijuana reform. Some say “elections have consequences”. I agree. But even more “Mis-governance has consequences”. The Republicans were mis-governing Virginia for a long time. That caught up with them. Then they lost the election. That has consequences.

        • More to the point – if elections do have consequences – do those “consequences” changes that voters do want?

          when we say elections have consequences, it’s almost as if things went awry and were not intended or supposed to be.

          I maintain – that the will of the voters – has consequences that DO get reflected in elections – what people want – what a majority of people want – not some unintended adverse event – only that in the eyes of the minority who were outvoted.

          When there are polls in Virginia that show numbers in the 70% for change in laws – that’s not an anomaly to be dismissed. It’s a warning to those who govern with the opposite views.

      • True.

        But while I support legalization I do not care enough about it to make it one of the key issues upon which I base my choice of which candidates get my vote.

    • I agree. If you don’t agree with smoking marijuana, don’t smoke it. If you don’t believe in gay marriage don’t marry somebody of your own sex. Some of these things are just not that hard.

  5. Black market will still rule.

    • To about the same extent as moonshining and bootlegging still exist.

      • There is an entire culture that goes with the dope black market. Government run dispensaries simply will not be able to compete with the black market tax free prices.

        • I respectively disagree, and I think the bootlegging analogy is apt.

          While there will always be a certain number of people who enjoy the cultural aspect and the thrill associated with breaking the rules, I think the majority of marijuana users simply want to be able to legally purchase and enjoy a consistent-quality product without the risk of being arrested.

          I will admit to occasionally enjoying a bit of moonshine on occasion (when a certain friend makes it available to me); but my standard practice is to legally purchase bourbon of consistent and good quality.

          If marijuana is legalized, I think its black-market will shrink dramatically, in much the same way the boot-leg liquor market was essentially gutted at the end of prohibition.

  6. Anyone think that growing Marijuana would be an economic benefit to rural Virginia?

  7. Pingback: Would Legal Medical Marijuana in Virginia Reduce Opioid Addiction? – Topshelf News

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