Would Easier Access to Medical Marijuana Reduce Opioid Deaths in NJ?

Andrew Kitchenman | September 5, 2014 | Health Care
Study in 10 states with established programs suggests steady decline in overdose rates, but other factors may come into play

Colleen L. Barry, associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
States with laws allowing medical marijuana had reduced rates of opioid overdose deaths, according to a study cited by advocates who say New Jersey should expand access to its own program.

The 10 states that introduced medical marijuana programs from 1999 to 2010 saw a combined 24.8 percent drop in opioid overdose death rates compared to states without such programs, according to a research paper published recently in the journal JAMA Internal Medicine.

New Jersey’s program wasn’t included in the research, since it wasn’t in effect during the time period studied.

The research backs up the argument that the state should eliminate its restrictions on medical marijuana access, said Roseanne Scotti, New Jersey director for the Drug Policy Alliance, a leading advocate for the program.

By offering people suffering from chronic pain a less-dangerous alternative to prescription opioids like oxycodone, medical marijuana could reduce the state’s rising opioid death rate, Scotti said.

However, the study’s authors cautioned that it is too soon to say that the medical marijuana programs caused the reduction in overdose deaths. They said other factors could affect the death rates, although they accounted for some additional potential causes. For example, the study factored in whether states had prescription-monitoring programs or allowed pharmacists to check patient IDs before dispensing medicine.

“All states have been passing various measures to try to address the painkiller epidemic and those measures might affect” the opioid death rate, regardless of whether a state has a medical marijuana program, according to study coauthor Colleen L. Barry, associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Barry noted that during the time period studied, all states saw an increase in opioid overdose deaths, as the number of prescriptions given out for these drugs also rose.

But the states with medical marijuana programs had smaller increases, and the deaths rates dropped more for each year that programs were in place. By the sixth year of a medical marijuana program, the study found, states had a 33.3-percent lower death rate than states without programs.

Some other factors were not taken into account by the study. For example, states with more restrictions on access were put in the same category as states with easier access. The study also focused only on deaths from prescription opioids and not illegal narcotics, like heroin.

Barry said several important areas merit further study.

She said people who live in states with medical marijuana laws need to be followed over a period of time.

And the study, which used death certificates compiled by the Centers for Disease Control & Prevention, didn’t track the impact of the laws on patterns of substance abuse — for example, whether the availability of medical marijuana affected the use of other legal and illegal substances.

Barry noted that medical science hasn’t answered many questions about medical marijuana, including which patients benefit most from using it; how it interacts with other prescription medications; the effects of switching entirely to marijuana from opioids versus using prescription drugs to supplement medical marijuana; and, perhaps most importantly, the effects of medical marijuana on individuals with different conditions, ranging from various cancers to multiple sclerosis.

“We don’t understand what’s going on in that black box,” Barry said.

Barry said there could be important policy implications for New Jersey. If fully functioning medical marijuana programs reduce overdose deaths, then New Jersey’s relatively restrictive approach may be mitigating those benefits.

“To the extent that very few people are availing themselves of the opportunity of the program, then that would suggest that the impact of the program would be far less than in other states,” said Barry. “Our study suggests that those laws may have unintended benefits as well,” and that states with more restrictive programs may miss out on those benefits.

“We think of states as a laboratory of policy making, so I think that one thing for New Jersey legislators to think about is drawing experiences from other states in terms of benefits,” Barry said.

She added that she understands that medical marijuana programs are controversial in “that they in particular may encourage cannabis use among children — and as a parent of a 5-year-old I get that – but it’s potentially a missed opportunity.”

Scotti said the study has sparked much conversation within the Drug Policy Alliance.

“I certainly agree with the authors that while additional research needs to be done, it is certainly a very significant and interesting finding,” she said.

“It certainly makes intuitive sense,” Scotti said. “When we worked with patients on the medical marijuana bill we heard over and over and over again” that marijuana provided a better quality of life than opioids, allowing better focus and more time with family members.

She noted that opioid overdoses have become the leading cause of accidental death in the state.

“Certainly marijuana has much safer side-effects profile than most opioids,” she said. “I think it just highlights why New Jersey needs to fully implement its medical marijuana program.”

Scotti and other advocates have complained that only three of the six medical marijuana alternative treatment centers allowed under the New Jersey law have opened. They have also complained about New Jersey’s unique requirement that marijuana prescribers have their names listed on a public registry, saying that discourages doctors from joining the program.

“There are no doubt thousands of people out there who would rather use medical marijuana than opioids, and they can’t because the program isn’t fully implemented,” she said.

State officials have said they have worked to have the companies approved for alternative treatment centers open their doors.

Gov. Chris Christie has opposed further easing of restrictions, expressing concerns about less-restrictive approaches taken by other states, such as California.