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Is marijuana a viable replacement for opioids in managing chronic non-cancer pain?

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The facts are clear; patients with legitimate chronic pain who are cared for by boarded pain or addiction specialists do not abuse their opioid pain medication. In fact, recent data reveal that only between 4 and 10 percent of these patients will ever misuse or abuse their medication. Most of these individuals could not work, achieve self-efficacy, or have any quality of life without the pain relief opioids provide them. We all wish that alternatives were available—but they are not. As the baby boomers are living longer and have more wear and tear and injuries that require expert pain management, there is a legitimate need for these medications—until some alternative to opioids are found. Understandably, many pain patients and their doctors are afraid that government overreach, designed to stop drug dealers and drug addicts, will rob them of the little quality of life they have because opioids provide a temporary respite from severe pain.

In truth, the DEA has done a good job of shutting down the pill mills and most states now allow physicians to access each patient’s pharmacy records online. This process has also shut down “doctor shopping” for controlled substances and takes less than a minute to review all prescriptions for controlled substances for a single patient. Perhaps the epidemic of chronic pain should be the focus of our research efforts.

So why are people still dying from opioid overdose? The CDC report reveals part of the answer. As the pill mills shut down, the price of illicit prescription opioids increased substantially. In response, the Mexican cartel, which was losing billions due to legalized marijuana, flooded the US with cheap, powerful heroin. It was cheap and powerful because the cartel was spiking it with homemade fentanyl, which is approximately 100 times more potent that morphine. It is heroin and fentanyl that are killing thousands of Americans each month.

Cannabis and Pain

Is marijuana really a reasonable alternative to opioids for opioid addicts or for chronic pain? Maybe, but the science is woefully silent on the topic. What little science exists remains inconclusive. The recent JAMA article shows epidemiological trends among Medicare Part D recipients and state Medicaid recipients. The analysis attempts to statistically correlate states with liberal marijuana laws and a decrease in the number of opioid prescriptions written between 2010 and 2015.

Why Does This Matter?

Correlation is not causation. The conclusions reached by this investigation suggest that merely the decline of filling prescriptions for opioids by elderly infirmed adults is due to liberalized, legal access to cannabis, which is quite a reach in logic. This conclusion assumes these same adults voluntarily switched from their opioids to medical marijuana for pain control. In truth, there are hundreds of variants, including hordes of untrained and anxious physicians who live in fear that prescribing opioids sends a red flag to licensing boards and invites increased scrutiny and potential retribution. Plus, any physician who believes in evidence-based medicine is unlikely to prescribe medical marijuana for pain. At present, the research does not support this practice.

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