Obama: Opioids Solution Missing Cannabis

byPerry Solomon, MD5 minutes

The focal point of President Obama's final State of the Union address -- the opiate epidemic -- appeared to highlight the urgency with which the administration regards the problem. Yet when I took a closer look at the way the issue was framed, I noticed the discussion was clearly meant to focus my attention on a specific aspect of this complex issue.

In the end, Obama's solution offers a narrow approach to the larger problem. The proposed solution? Prescribing more synthetic opiates. Yes, I'm afraid this new war on drugs involves drugs and more drugs. Meanwhile, those suffering from chronic pain are left without effective remedies, despite the fact that a safe, natural and effective treatment for chronic pain already exists. Why is the Obama Administration not reclassifying cannabis as part of the solution, when it is documented to have helped thousands of people, without the debilitating side effects and impaired quality of life that comes with prescription opiate use?

The facts on opioid addiction

How did so many Americans become addicted to opiates? The answer boils down to pain relief: These people were in pain, and they sought relief from a doctor. Heroin grabs a lot of sensational headlines, but it is not the greatest part of substance abuse. According the American Society of Addiction Medicine, of the 21.5 million Americans who faced substance abuse and addiction in 2014, only 586,000 used heroin. About 1.9 million Americans were addicted to prescription drugs. Four in five heroin users got their start using prescription painkillers, and they only turned to street drugs when they could no longer obtain prescription drugs.

In 2012, doctors wrote 259 million prescriptions for opiates, enough to give each American a bottle of narcotics. It comes as no surprise to me to learn people are now dying in record numbers from unintentional overdoses. This number has spiraled steadily upward since 1999; in 2014 there were 47,055 drug overdose deaths in the United States due to prescription opioids.

Treating pain with more pain

President Obama released his first National Drug Control Strategy in 2010, which emphasized the need for action to address opioid misuse and overdose, while also promising that individuals with pain would receive safe, effective treatment. While the new CDC prescribing guidelines do recommend limiting and monitoring opiate prescriptions, they are unclear about the effective, proven solutions for patients suffering from chronic pain.

Monitoring, limiting and controlling prescription opiates may help prevent overdoses and future abuse, but it begs a few questions about what the problem really is. The biggest initiatives circulated by the administration ignore the scope of the problem entirely and promote other synthetic drugs such as methadone and buprenorphine.

Buprenorphine, approved in 2002, is similar to methadone, but it can be prescribed privately in a doctor's office. One key measure to the administration's approach to the opiate epidemic is the mandate to double buprenorphine prescriptions.

A new class of addict

According to their proponents, these drugs work to ease and mediate opiate addiction by providing a less dangerous alternative once a user is already ensnared in the opiate trap. In reality, though, methadone and buprenorphine are still dangerous and additive drugs, and both can lead to abuse and overdose. Such an approach seems more like a defense of our national prescription drug habit than an attack on it.

Prescription opiates were never a good solution for chronic pain, since they formed a recipe for addiction. While the medical community belatedly embraces this insight, it is unclear which remedies doctors will have to relieve pain and suffering. In the face of such a crisis, the reclassification of marijuana might help millions of Americans who cope with chronic pain, but this solution is conspicuously absent from the solution. I ask you, Why isn't this natural plant, known to be non-addictive and not linked to a single death, part of the conversation?

Patient survey

HelloMD conducted a survey of medical marijuana patients in January 2016, as one of the largest and most comprehensive studies of its kind. Chronic pain topped the list of conditions from which people sought relief, and 84 percent of respondents strongly agreed that medical marijuana effectively treated their symptom. In addition to relief from their primary condition, respondents named many beneficial side-effects, including improved mental state, relaxation and better sleep patterns. There were few to no reports of negative consequences.

According to the National Institute on Health, pain impacts more Americans than diabetes, heart disease and cancer together, and it is a top reason why people access the health care system. Pain is a leading cause of disability and has a major impacts on productivity and quality of life.

Furthermore, pain demands action. If people are unable to access effective treatment for their pain, they may turn to heroin and other illegal substances to find relief, and we may witness an even worse epidemic.

How federal funds should be used

The federal government is asking Congress for $1.1 billion in funds to fight the opiate epidemic. This money could help doctors prescribe marijuana to sufferers of chronic pain, and it could support growers and labs and help produce an important body of research on this natural remedy.

Instead, most of the new funding is earmarked to "expand access to medication-assisted treatment for opioid use disorders." I'm sure this funding will effectively function as a subsidy to the same pharmaceutical interests that produced the drugs that created this epidemic in the first place.

Does this circular solution really make sense?

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