Across the country, states desperate to prevent opioid addiction are considering medical cannabis as a solution.
Citing the opioid crisis, lawmakers in several states are looking to initiate or expand their medical marijuana programs including , , and . And in Illinois, where opioids have claimed over the past decade, the legislature is considering a measure that would allow patients with an opioid prescription to get .
Some providers and patients think such a policy could make a difference. In 2001, Springfield resident Larry Lenkart awoke one night in severe pain. He thought it was a bad flu, but it turned out to be diverticulitis 鈥� an infection that required four major stomach surgeries followed by years of crippling pain.
鈥淚n the beginning, it was like life wasn鈥檛 worth living,鈥� Lenkart said. 鈥淲hen you鈥檙e in your forties, it鈥檚 way too young to be thinking about death everyday.
Lenkart, now 60, was placed on high doses of two different opioids, which he took around the clock. The drugs helped him manage his pain well enough to hold down a job and raise his daughter. He said he never abused them, but he hated the constant worry about when he would get his next dose.
Then last summer, with his doctor鈥檚 guidance, he weaned himself off Vicodin and began tapering off Oxycontin as well. To make the process easier, he smoked marijuana every night.
鈥淚t would help me forget about [the pain] to the point where I wouldn鈥檛 take that last dose of pain meds,鈥� Lenkart said. 鈥淚 was all for it.鈥�
Expanding access to cannabis
Though Illinois has a medical marijuana program (along with 28 other states and the District of Columbia), Lenkart got the drug from a dealer. In Illinois, chronic pain does not qualify a patient for the program. And Lenkart couldn鈥檛 find a doctor to qualify him for his fibromyalgia, even though that is one of the 40 conditions Illinois allows.
Now two separate efforts in Illinois might make it easier for patients with chronic pain to get access to medical cannabis.
In January, a Cook County judge ordered Illinois officials to expand the state鈥檚 medical cannabis program to include intractable pain 鈥� that鈥檚 pain that can鈥檛 be effectively treated with other therapies. But the move is on hold, as the state鈥檚 public health department . A spokesperson said the department is unable to comment on pending litigation.
Meanwhile, Illinois state senator Don Harmon is pushing for a similar change. Last fall, he introduced a bill that would allow anyone with an opioid prescription to apply for a one-year marijuana card and receive approval in 14 days instead of the usual two to three months. He hopes to move the bill through the legislature early in the spring session, which began on January 30. On February 7, the bill with a 16-1 vote and heads now to the full Senate for consideration.
鈥淭he ravages of opioids and the subsequent use of heroin is killing scores and scores of people in our community,鈥� Harmon said. 鈥淸Medical cannabis] seems like a very low-cost, low-risk alternative.鈥�
Harmon joins a growing cohort of state politicians who鈥檝e gone on the record lately in support of medical marijuana as a tool to fight opioid addiction, despite the of Obama-era protections for states that legalized medical marijuana. When Indiana Republican lawmaker Jim Lucas proposed a medical marijuana bill in the fall he mentioned In Kentucky, in January, secretary of state Alison Lundergan Grimes cited the opioid crisis when she spoke in favor of a bill proposed there to legalize cannabis, as the .
Cannabis science vs. policy
While politicians are embracing cannabis, the concept of treating pain with marijuana is still controversial among clinicians.
Aaron Weiner, the director of addiction services at Linden Oaks Behavioral Health and Edward-Elmhurst Health in Chicago鈥檚 west suburbs, staunchly opposes it. He fears that a drug that could be helpful for some could and lead to increased incidence of car accidents, ER visits, and accidental poisoning.
鈥淚n my business, I clean up people鈥檚 lives when they fall victim to this stuff,鈥� he said. 鈥淭hat鈥檚 part of reason I鈥檓 concerned about how we roll this out. It has the propensity to send people to my clinics.鈥�
Of all the uses of medical cannabis, there is a good case for pain, he said, citing findings from a that found substantial evidence to support cannabis for treating chronic pain.
But, Weiner is worried that there鈥檚 little evidence in support of the varied cannabis products available. With our current understanding, he said doctors are unable to give medical guidance, leaving patients to resort to trial-and-error.
鈥淎re you using an oil? Are you eating it? Are you smoking it or vaping it? These things actually matter in terms of whether or not a substance is efficacious,鈥� he said.
Some proponents of medical marijuana cite a 2014 study that found a decrease in fatal opioid overdoses in states that permitted medical cannabis. But Weiner said the study does not establish a cause-and-effect relationship; the decline could very well be explained by concurrent efforts to get doctors to prescribe fewer opioids.
When it comes to the proposals to include pain treatment in Illinois鈥� medical marijuana program, Weiner worries that doctors may be too quick to deem a patient鈥檚 pain 鈥渋ntractable鈥� and recommend marijuana before exhausting other possible treatments, including physical and occupational therapy, injections, and cognitive behavioral therapy.
In short, Weiner fears the policy is getting ahead of the science.
鈥淭hat鈥檚 always a recipe for disaster because we don鈥檛 know what we鈥檙e getting into,鈥� he said.
Cannabis as harm reduction
Dr. Leslie Mendoza Temple, a family medicine physician in Chicago鈥檚 north suburbs, takes a different view. She has helped more than 400 patients get access to medical cannabis for approved illnesses.
For patients who qualify for Illinois鈥� pilot program, Temple said she considers cannabis when she finds that other treatments, including non-addictive ones, are not working.
鈥淚鈥檇 love that nobody needed anything addictive, that would be really great,鈥� she said. 鈥淎nd then I would have to wake up and realize that鈥檚 a dream.鈥�
She agrees that there is not the kind of high-quality data and randomized trials on medical marijuana that exists for FDA-approved drugs. But with opioid death rates climbing every year, she said her approach is harm reduction.
鈥淚 don鈥檛 think we have the time to wait for those beautiful trials to come out in ten or twenty years,鈥� Temple said. 鈥淲e have people dying now.
鈥淚 can鈥檛 just throw up my hands and say, 鈥業鈥檝e got nothing... come back in ten years,鈥� she said.
She said she鈥檇 like to see better research but the problem is that medical marijuana is classified as a Schedule 1 drug, considered, along with heroin and LSD, to have no medical use and high abuse potential. That makes it .
鈥淚t鈥檚 a Catch-22,鈥� Temple said. 鈥淥ur hands are tied as a scientific community for studying this in people.鈥�
High hopes for medical cannabis
Temple understands Weiner鈥檚 concern over patients having to use trial and error to determine what works for them. But she鈥檚 optimistic medical cannabis can work because she has seen so many patients do well once they鈥檝e figured out their regimen.
鈥淚 think being doom and gloom about it is wrong if you haven鈥檛 seen patients and gotten the story,鈥� she said.
For many of Temple鈥檚 patients, and for Lenkart, cannabis has been a game-changer.
Lenkart finally got a medical marijuana card after his diagnosis of stage 4 pancreatic cancer, but he wishes he鈥檇 had it sooner.
鈥淚t took me basically a death sentence before I could have a chance of getting a marijuana card,鈥� he said. 鈥淚 truly believe if I would鈥檝e had access to medical marijuana five years ago, by this point I would鈥檝e been off of opioids, or very minimal.鈥�
Lenkart is concerned about the widespread unwillingness of providers in central Illinois to help even qualifying patients access medical cannabis. He hopes shifting attitudes about marijuana will make it easier for other patients to find relief.
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