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Langham: Some Marijuana Findings Reconsidered

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Recently in Science and Doubt, the credibility of opinions was discussed. I was reminded of that recently when the Associated Press headline proclaimed Medical Pot Laws No Answer for US Opioid Deaths, Study Finds.

Judge David Langham

Judge David Langham

See, when states began decriminalizing marijuana (pot is not "legal" in any of these United States), there were many who hypothesized (guessed) and advocated that pot could be the answer to pain. 

In February 2018, there were reports in the news of a connection between "medical marijuana" (an oxymoron) and opioid deaths. Without question, the volume of opioid deaths in this country is a crisis. The 2018 discussion was centered upon the results of "several studies," according to Science Daily. Those resulted in an "association between medical marijuana and lower levels of opioid overdose deaths." So, science was bringing proof (or indicia) that pot use as an alternative could relieve the burden of all the opioid complications. 

At that time, the Rand Corp. had released a report, described as the "most-detailed examination of medical marijuana and opioid deaths conducted to date." That report concluded that "legalizing" pot was seen as associated with fewer opioid deaths "only in states" that made "medical marijuana easily available to patients."

The states that merely afforded protection to "patients and caregivers" who grew their own medicine did not experience any decrease in opioid death. That may be curious in itself. 

In June 2019, the Associated Press reported, however, that researchers have now repeated the analysis "that sparked excitement years ago." The new study "shoots down the notion that medical marijuana laws can prevent opioid overdose deaths."

Apparently, the "original authors speculated" that some patients might be substituting marijuana for painkillers," and upon that premise some states may have "begun to rethink marijuana." 

However, the new research analysis included additional data. It concluded that "states passing medical marijuana laws saw a 23% higher than expected rate of deaths involving prescription opioids." Note that the focus here is specifically upon prescriptions.

There is ample evidence that most opioid deaths are related to heroin, fentanyl or other street drugs. The author there advocates that efforts to monitor prescriptions and dosage are misplaced. The author urges more focus on street drugs. 

According to the Associated Press story, in explaining the results of the latest marijuana report, the authors noted that "it's unlikely" that "medical marijuana laws caused first one big effect and then the opposite." Instead, they conclude that "any beneficial link was likely coincidental all along."

A Rand publication in February 2018 explained that the coincidence was that states that had adopted decriminalization early had "loosely regulated marijuana dispensary systems." As dispensary regulation tightened, and as the opioid death causes shifted to "illicit opioids, mainly heroin and then fentanyl," the "association between medical marijuana dispensaries and opioid harm" diminished. 

Therefore, according to the Associated Press story, the "experts agree" now that "evidence doesn’t support marijuana as a treatment for opioid addiction."

The Associated Press contends that the authors of the original report are pleased with the new analysis. One noted, "We weren’t happy when a billboard went up saying marijuana laws reduce overdose deaths." One of the original study authors noted in this latest story that when she "was told my paper helped change the law in New York. I was appalled.”

In the end, there is some support for marijuana relieving pain. There is "suggestion" that medical marijuana "may reduce opioid prescribing." Therefore, for "some people, marijuana can substitute for opioids as a pain reliever." However, the "evidence doesn’t support marijuana as a treatment for opioid addiction."

And if those arguing that the main opioid issue is not prescription — but street drugs — are correct, then changing what and how much physicians prescribe or recommend may not be as impactful on the death and overdose issues as one might otherwise hope.

A lesson here is that coincidence can happen. Trends and results do not necessarily correlate to causation. And the practice of repeating analyses and studies likely has merit. Speculation and supposition are not the foundation upon which to risk lives. 

David Langham is deputy chief judge of the Florida Office of Judges of Compensation Claims. This column is reprinted, with his permission, from his Florida Workers' Comp Adjudication blog.

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