Medical Marijuana — A COMBAT Series Part 5

Medical marijuana is there a connection with overdose deaths or is it merely a coincidence?
MONDAY, JULY 22, 2019

State With Total Marijuana Ban
Led The Nation In OD Death Rate

Joe Loudon • COMBAT Communications Administrator

Dr. Kelvin Walls understands some people will abuse or misuse medical marijuana.

“We’ll have the same problems with medical marijuana that you can have with any prescribed medication,” Dr. Walls said. “You’ll have people try to sell it after they’ve had a prescription filled. People will get it—and this is something we’ve seen people do for years—give some to their family members to help them with whatever condition they might have.”

Those problems aside, Dr. Walls believes Missourians made the right decision in 2018 when they amended the State Constitution to legalize medical marijuana. People who might benefit from using the drug shouldn’t be denied its therapeutic benefits, he insists, because others might try to sell marijuana illegally or use it merely to get high.

“For some people it is the correct medicine to prescribe,” stressed Dr. Walls, who serves on the COMBAT Commission.

Prescription pad covered in pain killers and medical marijuana
'THE CORRECT MEDICINE TO PRESCRIBE' — The correct medicine to prescribe varies from patient to patient.

'Spiraling Out Of Control'

Healing House, Inc. founder Bobbie Jo Reed doesn’t’ dispute that marijuana might be the best medicine for “certain conditions.” As someone whose non-profit provides transitional housing in Kansas City for people who’ve been in drug treatment—and who is, herself, a recovering addict—Reed worries the state’s medical marijuana regulations will prove ineffective at preventing marijuana from becoming more readily available for recreational use.

Reed leaves little doubt about whether or not she believes increased marijuana use might lead to more widespread drug addiction: “My concern as a person in long-term recovery is that we are going to end up like Colorado, where everybody is being written prescriptions for marijuana and addiction is spiraling out of control.”

A Google search for data about drug addiction in Colorado will generate links to a myriad studies and articles. Separating hyperbole from fact is not easy. Some stats appear contradictory, depending on the source: “Colorado Ranks 12th In Drug Addiction” vs. “Colorado Has Nation’s 3rd Highest Drug Addiction Rate.” And bias is likely an issue, with some organizations perhaps cherry-picking information to fit within an agenda to sway public opinion against or in favor of legalizing marijuana.

Increased Overdose Deaths

COMBAT only references surveys and studies that have clearly explained methodologies and/or were released by official state or federal agencies.

 • A Substance Abuse and Mental Health Services Administration (SAMSHA) survey in 2016 did reveal that Colorado was the only state reporting heavy consumption rates in all four of these major categories:

1) opioid painkillers for non-medical purposes
2) medical or recreational marijuana
3) alcohol
4) cocaine

SAMSHA surveyed individuals 12 or older. 

 A 2017 Colorado Department of Public Health & Environment (CDPHE) survey, however, concluded underaged—and, therefore, still illegal—marijuana use in the state had dropped since 2014. (Colorado legalized the drug’s recreational use in 2014 for adults over 21.)

The survey revealed Colorado adolescents actually used marijuana at a rate below the national average for teenagers.

 Drug overdose death rates have risen practically every year in Colorado since 2000, the year the state legalized medical marijuana. Between 2000 and 2015, overdoses claimed 10,552 lives in Colorado, the CDPHE reported. 

“In nearly every year, Colorado’s rate of drug overdoses was significantly higher than the national rate,” the CDPHE stated. However, while Colorado’s drug overdose rates showed signs of leveling off in 2015, the U.S. rates continued increasing. 

Missouri Higher OD Death Rate

What the CDPHE numbers don’t explain is whether or not there’s any correlation between marijuana legalization in Colorado and the state’s overdose death rate. Across the nation—and among all age groups—OD death rates have been on the rise since the turn of the century, according to the Centers For Disease Control & Prevention (CDC). 

Map Depiciting Overdose Death Rates By State
STATE OD DEATH RATE STATS — Click on the map to view an enlarged version and for a chart rating states from those with the highest overdose death rates in 2017 to those with the lowest. Is there a correlation between marijuana legalization and the states' death rates? 

The overdose death rate in the United States was 21.7 per 100,000 population in 2017. Colorado, California, Oregon and Washington—four states allowing medical and recreational marijuana use—had OD death rates lower than the national rate. Meanwhile, 20 states exceeded the national rate: two with fully legalized marijuana use, 12 that allowed its use medically and six—Missouri among them—that, in 2017, still outlawed the drug entirely.

West Virginia, a state with a complete prohibition against marijuana, had the worst overdose death rate in America two years ago at 57.8 per 100,000—266% higher than the national rate.

“So, we have six states in ’17 that still had total bans on marijuana but still had a higher overdose death rate than the nation as a whole,” observed COMBAT Director Vince Ortega. “When you look at those CDC numbers, it’s a stretch to say there’s a direct cause and effect with marijuana legalization and the increase in overdose deaths since 2000. 

“The biggest factor in overdose deaths increasing is the opioid crisis, which just happens to have overlapped the last 20 to 25 years with a lot of states legalizing marijuana.”

Has Legalized Marijuana Saved Lives By Reducing Opioid Use?

In its special “Marijuana: The Medical Movement” edition published this spring, TIME cited numerous studies showing an apparent relationship between medical marijuana availability and reduced opioid use—and fewer opioid overdoses:

 Patients in a University of Michigan study used medical cannabis to control pain and reduced their opioid use by 64%.

 A 2014 study published in the Journal of the American Medical Association concluded opioid overdoses were 25% less frequent in states with legalized marijuana use.

But a more recent study published just last month in a National Academy of Sciences journal found that, while the 2014 study was accurate at the time, the “association between medical cannabis laws and opioid overdose mortality has reversed over time.”

The new study’s lead author, Stanford University researcher Chelesa Shover, told NBC News data collected in 2017 pointed to states “that enacted a medical cannabis law actually [having] higher opioid overdose deaths after the laws took effect.”

Marijuana As A Substitute For Pain PillsPAIN TREATMENT — In states where its use has been legalized, marijuana has often be prescribed to treat pain, an alternative to opioid medications. 

But she and other researchers have cautioned against drawing any conclusions based on the opioid death rates in states with legalized medical marijuana versus states that still completely ban the drug. Other factors, she stressed, play a role in opioid overdose rates and fatalities, including access within a state to addiction treatment and medications used to reverse the effects of an overdose.

“We don’t think cannabis was saving lives… 10 years ago,” Shover said, “and we don’t think it’s killing people now. We think these two factors are separate issues.”

To illustrate Shover’s point, compare the opioid overdose death rates in Colorado and Missouri from 2017: 

 That year Colorado had 578 overdose deaths involving opioids—10.0 per 100,000 people, well below the national rate (14.6).

 Meanwhile, in Missouri the opioid overdose death rate was higher at 16.5. Opioid overdoses killed 952 people in Missouri that year.

 Synthetic opioids, primarily fentanyl, accounted for 56 deaths in Missouri in 2012. That number jumped to 618 in 2017.

Could Legalized Marijuana Use Be
The 'Gateway'  To  Another Crisis?

Prescription pad for opioids

UPDATE: Friday, November 1, 2019

Will people “doctor shop”—make appointments with one physician, then anotheruntil they find somebody willing to prescribe them medical marijuana?

“This is just my opinion, but I think we are going to see the same thing with medical marijuana that we did with prescription painkillers,” said a legal official from Eastern Jackson County. “People who don’t need the drug to treat a medical condition are going to try and find someone who’ll prescribe it for them anyway.

“We have to remember the opioid crisis started with prescriptions for legal drugs.”  
Nothing New

Dan Cummings, Officer-In-Charge of the Jackson County Drug Task Force, has no doubt his detectives and other law enforcement officers in Missouri will begin seeing medical marijuana being resold illegally, after dispensaries open in the state next year. 

“I don’t know if you can say that’s something new,” he said, “because people have been selling their prescription painkillers and other medications for years. Medical marijuana is just going to be a new way for people who sell pot illegally to get their hands on it and re-sell it.

“That’s what happened in Colorado when all they had was medical marijuana,” he continued. “People would go to a doctor, say they needed it for this or that. If one doctor turned them down, they’d find another one who’d give them a prescription. These people would then turn around and either sell their medical marijuana or just use it to get high.”

Medical Marijuana Being Sold Illegally
ACQUIRED WITH A PRESCRIPTION & RESOLD ILLEGALLY — Jackson County law enforcement officials can expect medical marijuana that is acquired legally to be resold illegally, just like in other states and with other prescription medicines.

The ‘Gateway’ Debate

Whether or not marijuana is a “gateway drug” that can lead to someone using more dangerous narcotics has been debated for decades. The National Institute on Drug Abuse (NIDA) addresses the subject on its website and points to studies in rodents that reached seemingly clear conclusions—“these findings are consistent with the idea of marijuana as a ‘gateway drug’”—before turning murky. 

 Is marijuana a gateway drug? (NIDA)

Animal experiments have indicated that THC, the psychoactive component in marijuana, can “prime” the brain for “enhanced responses to other drugs.” Rodents given THC, the NIDA notes, displayed a heightened response to not only further exposure to THC but other drugs such as morphine.

Yet, the NIDA added, “The majority of people who use marijuana do not go on to use other, ‘harder’ substances.” Furthermore, similar to THC, “alcohol and nicotine also prime the brain for a heightened response to other drugs and are, like marijuana, also typically used before a person progresses to other, more harmful substances.”

During his 30-year career with the Kansas City Police Department, COMBAT Director Vince Ortega repeatedly saw how drug dealers "would try to get the people buying pot from them to try harder, more expensive drugs."

"There's a reason we called drug dealers pushers," he said. "If you're buying marijuana from them for personal use, you're participating in the illegal drug trade at what might be considered a fairly low level. There's probably going to be pressure or temptation, at least, to take it to another level—to maybe try narcotics, something more addictive." 
Addiction On The Brain Graphic, depicting individual lots of drugs, drink and cigerettes inside thei
‘Is Marijuana Addictive?’

The NIDA posted another question on its website: Is marijuana addictive

About 30% of marijuana users will develop “disorders” associated with a dependency on the drug. When people with these disorders attempt to quit using marijuana, the NIDA points out, their symptoms include irritability, mood swings, difficulty sleeping, decreased appetite, cravings and other physical discomfort that can last two weeks.

In only 9% of all marijuana users does a disorder reach the point of what the NIDA defines as an addiction—“when the person cannot stop using the drug even though it interferes with many aspects of his or her life.”

The NIDA warns that figure jumps to 17% among those who began using marijuana in their teens.