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venerdì 7 aprile 2017

Marijuana could be the cure for the opioid epidemic


“Three million people have chronic pain in this country and it’s a thing where they normally will diagnose you open opioids, and there’s this amazing opioid addiction as a result. In America, since they’ve (allowed) medicinal marijuana, in some states opioid deaths have gone down by one-third, so it is saving lives,” Anderson said on The “Project,” reports News.com.au.

Rio Arriba County, just north of Santa Fe, New Mexico, has long struggled with some of the highest rates of drug overdoses in the United States. Between 2010 and 2014, at least 78 people died from overdoses for every 100,000, compared with 24 instate and 14 across the nation. Heroin and other opioids – highly effective painkillers that include oxycodone, hydrocodone and fentanyl – have been consuming the small, high desert communities in the Southwest. The state has introduced harm-reduction efforts – like syringe exchange services, overdose training and the distribution of naloxone, an injection that can reverse the effects of an overdose – but New Mexicans are searching for ways to cut ties with opioid abuse altogether.


The author of the petition is Anita Willard Briscoe, a psychiatric nurse practitioner with a private practice in Albuquerque. Briscoe grew up in Espanola, a largely Hispanic and Latino city in Rio Arriba, settled by the Spanish in 1598 and more recently taken over by devastating drugs. "Heroin took over this area starting in the 1940s with the Lowrider culture and then in the 1970s with Vietnam veterans," says Briscoe. "I saw it absolutely ravage my hometown. I had a lot of high school classmates who died." Briscoe became a registered nurse in 1977 and a psychiatric nurse in 1992. In 2005, she became a nurse practitioner because she saw medical professionals "misdiagnosing people, over-prescribing pills, and patients were suffering as a result." After the state legalized medical marijuana in 2007, a colleague showed her its ability to help patients with PTSD and she started referring patients to the state Medical Cannabis Program in 2009.
Last year, Briscoe teamed up with her "cannabis prescribing colleagues" – two other psychiatric nurse practitioners and one psychiatrist – to collect self-reported data from 400 patients, and they found that many were "successful at quitting opiates using cannabis." Between 2015 and 2016, Briscoe observed that 25 percent of her patients reported being able to "kick" opioids with marijuana. "They state it calms down their cravings, relaxes their … anxiety and is helping to keep them off opioids," Briscoe wrote in November to the Department of Health's medical advisory committee, which approved the petition and passed it onto Gallagher. "If they are in pain, cannabis is helping relieve their pain, often to the point that they don't need opiates anymore." 
A 2014 study published in JAMA Internal Medicine, which examined data between 1999 and 2010, found that states with medical marijuana laws had 25 percent lower annual opioid overdose death rate compared to states without such laws. Briscoe's team is not looking to replace the use of methadone and Suboxone with marijuana completely, but rather to use cannabis as "an adjunct to treatment."
New Mexicans are not the only people searching for alternative ways to ward off opioid-related deaths. Last year, the Maine Department of Health and Human Services denied a petition drafted by a medical marijuana caregiver requesting to add opioid addiction to the state's list of qualifying conditions, citing the "lack of rigorous human studies" and the "lack of any safety or efficacy data." Advocates admit direct evidence is needed, but they contend that funding is limited since marijuana is federally listed as a Schedule 1 drug, on par with LSD and heroin. In the meantime, they turn to a Centers of Disease Control report to make their point on the safety of marijuana, comparing the 33,000 Americans who died from prescription painkillers and heroin overdoses in 2015 to the number of people who died that year from using cannabis: zero.
Earlier this year, the National Academy of Sciences, in a 395-page report, refuted the "gateway drug" theory that using marijuana can lead to opioid addiction and instead found evidence of cannabis having therapeutic and health benefits. Joe Schrank, a social worker who worked at various detox centers and clean houses, is now practicing the report's findings at High Sobriety treatment center in Los Angeles, where he offers clients medical and therapeutic sessions, and daily doses of marijuana to treat a variety of addictions. 
Schrank, who has been sober for 20 years and doesn't smoke marijuana, says his most recent efforts started with the death of his friend Greg Giraldo, the comedian who died in 2010 in after accidentally overdosing from prescription drugs in a hotel. As Schrank tells it, he suggested that Giraldo use pot instead of cocaine or painkillers weeks before his death – unpopular advice in the rehab world. "I think Greg's death was the moment I said, 'Fuck this, if people can get better smoking pot rather than using cocaine and Valium, I'm going to help,'" says Schrank. After Giraldo's death, Schrank began working with addiction psychiatrist Dr. Scott Bienenfeld and former Drug Policy Alliance law and policy expert Amanda Reiman, who lectures at her alma mater UC-Berkeley on marijuana issues. Schrank has found success since opening the treatment center in January 2017. "Having worked in rehab for many years, my first thought is, 'Why didn't we do this years ago?'" says Schrank. "One of the barriers in entry to treatment is detox. Many people are afraid of it. It's difficult to break this step. But when they're told, 'Hey, you can smoke pot.' It softens the blow."
According to Bienenfeld, heroin, morphine, Oxycontin, oxycodone and Vicodin activate the opioid system in the brain, causing a sense of extreme pleasure, sedation, numbing and euphoria – well above and beyond what normal pleasure feels like from food and sex. Side effects of opiates include analgesia and respiratory depression. "Opiates kill you in overdose by cutting off the brain's sense that it needs oxygen, thus the reflex to breathe is cut off and people die of respiratory failure," says Bienenfeld. "Combining opiates with other drugs like alcohol and sleeping pills makes it easier to overdose." Still, opioids seem to have a profound ability to reduce anxiety and depression in some people. These drugs rapidly induce a physical dependence and users become hooked quickly and need more of the drug to get high, and if they stop the drug abruptly, they experience withdrawal, which contrary to its uncomfortable feeling is usually not life-threatening. Marijuana stimulates cannabinoid receptors in the brain and causes mild psychedelic effects and a range of other feelings such as calmness, paranoia, anxiety and hunger – which can alleviate the symptoms of withdrawal.
As Bienenfeld notes in an email, "There are no actual data or studies that prove marijuana treats opioid addiction, but there are studies to suggest it may be a viable option."
Though marijuana is not fatal in overdose, Bienenfeld notes that people can have intense reactions. "There seems to be an association between cannabis use and psychotic mental illness in people who either have an underlying psychotic disorder, or a strong family history of schizophrenia, therefore it can be risky," says Bienenfeld. Yet he believes that's no reason to stop their treatments. 
Schrank and Bienenfeld believe their position is controversial because established addiction treatment programs like Alcoholics Anonymous are against using any intoxicants in sobriety. "The 12-step advice to fight the opiate epidemic is to go to more 12-step meetings and programs," says Bienenfeld. But, he notes, the statistics show that approach isn't working. "People are dying by the tens of thousands per year due to the opiate epidemic. If this was Zika Virus, the National Guard would be called in and it would be panic in the streets. Nobody would oppose trying experimental approaches based on research trends and medical anecdotes."
The established medical community is less sure. The position of the Philadelphia-based Treatment Research Institute, a nonprofit organization focused on substance abuse treatment reform and policy, is that until there is research to conclusively prove the connection, the experimental treatment is too risky. "Until there is research that deems safe and successful outcomes for the use of FDA-approved, marijuana-derivative medications to treat a substance abuse disorder it does not align with the currently available FDA-approved Medication Assisted Treatments for Opioid Use Disorders," writes TRI spokeswoman Debra Snyder in email. (Snyder declined to comment on the High Sobriety treatment protocols specifically.) 
Thomas McLellan, founder of TRI and a former deputy drug czar under the Obama administration, believes that the pending New Mexico bill is misguided: "The United States has the safest, most effective medications in the world," writes McLellan. "We should not approve something as serious and important as medications by voice vote." But such beliefs are not helping existing opioid addicts clean up, according to Bienenfeld, who adds that marijuana is already preventing new addictions from forming.
Even though there is a lot of support, New Mexico's bill is going to face problems since Governor Martinez seems uncertain on the potential benefits of marijuana. Earlier this year, she supported legislators killing a measure seeking to join Colorado, Nevada, California, Washington, Alaska, Maine, Massachusetts and the District of Columbia in the legalization of recreational marijuana. In New England, where lawmakers are reviewing cannabis regulation in the wake of legalizing recreational use in two of four states last year, legislators are also trying to figure out how to reduce high rates of opioid-related deaths
As thousands of people in Massachusetts have already been using cannabis as a replacement to prescription opioidsIntegr8 Health, a Maine-based medical marijuana physicians practice, has reporting an uptick in patients using marijuana to manage chronic pain. A 2016 study published in Health Affairs Journal supports the trends, finding that Medicare patients received fewer prescriptions for pain and other conditions between 2010 and 2013, as states adopted medical marijuana laws. "We're finding strong evidence that approving medical cannabis can be effective in preventing people from using opiates," says W. David Bradford, a health economist at the University of Georgia, who published the findings with his daughter, a master's student Ashley C. Bradford. The research duo expects to publish a follow-up study in the summer that has "promising results" supporting marijuana's replacement of prescription drugs among Medicaid patients.
"The clinical community has passed the Reefer Madness stage," adds W. David Bradford. "Opioid addiction is killing over 600 people a week. That's more than two 747 planes crashing every week. There's no single solution to that problem, but we haven't really seen the beginning of the deaths that are rooted in this country and anything we can do to slow that down we just have to take advantage of."
Correction: A previous version of this article stated that opioid addiction is killing 6,000 people a week. The correct number is 600. 

How Medical Marijuana Could Help End the Opioid Epidemic Eric Killelea March 29, 2017


PORTLAND, Maine (NEWS CENTER) -- 91 Americans die each day from opioid abuse. Is there hope for the Opioid epidemic? After legalizing recreational Marijuana in January, Mainers may have a pot to stand on.
A professor of emergency medicine at Oregon Health and Science University in Portland was fascinated by the study because it shows a link between access to weed and lowered opioid hospitalizations.
"It is becoming increasingly clear that battling the opioid epidemic will require a multi-pronged approach and a good deal of creativity," Dr. Esther Choo, who was not involved in the study, said in an email. "Could the liberalization of marijuana be part of the solution?
NBC News reports, Legalized Marijuana Could Help Curb the Opioid Epidemic, the study analyzed hospital records from 1997 through 2014 for 27 states, the data shows a decline in opioid use or deaths in states that allow medical marijuana.
On average, hospitalizations dropped by 23 percent for opioid painkiller dependence, and opioid overdoses dropped by 13 percent in states where medicinal cannabis was permitted.
Fears that legalizing marijuana would lead to a surge in weed-related hospitalizations proved unfounded, NBC News reports.

"Instead, medical marijuana laws may have reduced hospitalizations related to opioid pain relievers," said study author Yuyan Shi, a public health professor at the University of California, San Diego.
"This study and a few others provided some evidence regarding the potential positive benefits of legalizing marijuana to reduce opioid use and abuse, but they are still preliminary," Shi wrote. 

However, she said, "There is still much we need to understand the mechanisms through which marijuana policy may affect opioid use and harms. But we don't know who it works best for, at what dosage, for how long."

As the opioid epidemic continues to rise, many are still skeptical about legalizing pot.  U.S. Attorney General Jeff Sessions weighed in on the topic:  "I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana," he told law enforcement officers in Virginia, "so people can trade one life-wrecking dependency for another."


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