Can Marijuana Ease the Opioid Epidemic?
Sabulski is among nearly 14,000 patients in
Nationwide, an estimated 1.4 million patients in 28 states and the
In the midst of an opioid crisis, some medical practitioners and researchers believe that greater use of marijuana for pain relief could result in fewer people using the highly addictive prescription painkillers that led to the epidemic.
A 2016 study by researchers at
In December, the
Advocates for greater use of medical marijuana argue that including chronic pain as an allowable condition could result in even further reductions in dangerous opioid use.
But some physicians remain cautious about recommending the botanical medicine as a pain management tool.
Dr.
"There is no doubt marijuana is much safer than opiates. So we don't discourage its use." But in general, she said, "non-drug treatments are far more helpful than any drug treatment, and marijuana is a drug."
At
In January, the
Historically, research on marijuana has been hamstrung by the Controlled Substances Act of 1970, which classifies marijuana along with heroin and LSD as illegal substances with "no currently accepted medical use and a high potential for abuse." As a result, the supply of legal marijuana that can be studied and federal funds to pursue academic research are limited.
Slow and Cautious
Since 1996, when
Enacted in 2014,
In the fall, after two years of operation, the state health agency declared its medical marijuana program a success and expanded its rules to allow nurse practitioners to certify patients for marijuana use. The state also approved home delivery for patients too ill to travel and announced it would certify more manufacturers of marijuana extracts to increase the supply of tinctures, liquid capsules, sprays and vape cartridges available for patients who rely on them.
Remarkable Results
Sibulski's physician, Dr.
Technically, doctors can't prescribe marijuana for their patients because federal law prohibits it. But under
As a primary care doctor who takes a holistic approach to medicine, Shapiro said trying medical marijuana was a natural for him. But he said he worried that "a bunch of druggies would start showing up." Instead, he said the patients he began seeing were all very sick and none of them appeared to be seeking drugs for fun. The improvement he saw in those first patients was remarkable, he said.
"I really think medical marijuana is the drug of the future," Shapiro said. "We're going to find out that it does a lot of things we already think it can do, but don't have scientific studies to prove it."
Out of 109 patients he's seen over the past year, all but a handful reported substantial improvement in their pain and other symptoms within a month or two of using medical marijuana, he said.
For Shapiro's patients, the cost of marijuana treatment ranges from
"I urge my patients to purchase only a two-week supply at first, so they don't waste money on a dose that may not be effective," Shapiro said. Most patients start out with a 1-to-1 ratio of THC, the intoxicating component of marijuana, to CBD, the second major component, which has proven to be medically effective for a range of conditions.
Patients typically need to work with the dispensary to adjust their ratio so that the medication alleviates their symptoms but doesn't get them too high to function, Shapiro explained. It's a trial-and-error process, he said.
Most marijuana patients take a tincture or liquid capsule every four to six hours during the day and use a vape pen to inhale a faster-acting dose of marijuana extract when they have breakthrough symptoms. Sibulski said she uses a vape pen before she gets out of bed in the morning, because it almost instantly wards off her abdominal spasms. She then takes an oral dose, which kicks in within one to two hours.
At 36, when she quit her job last year, Sibulski said she feared she would be permanently disabled and never be able to return to work. She had seen multiple specialists and tried a medicine cabinet full of prescribed drugs, including OxyContin and muscle relaxers, to relieve her pain and abdominal spasms, but nothing worked.
Once she was unemployed, Sibulski said she experimented on her own with street-purchased marijuana and found that it worked better than anything else she had tried. But she couldn't control the potency of what she was smoking, so sometimes it worked and sometimes it didn't, and sometimes it made her too high to function.
Still, she felt well enough to return to work and started applying for jobs. That's when she realized she couldn't pass a drug test, which she said most employers she spoke to required.
In December, Sibulski found Shapiro through a Yelp listing and brought him her medical files so he could consider certifying her to use pharmaceutical-grade marijuana. Working with him and a pharmacist at a dispensary in
"It's been life-changing," she said. As a certified marijuana patient, she's hoping potential employers will waive that part of the drug test.
Dr.
"Many marijuana patients are what we call the 'intractables.' They try everything the medical system has to offer, and they finally find relief from medical cannabis," he said.
Dahmer says he agrees with the state's cautious approach. "We physicians take an oath to 'do no harm.' " But unfortunately, he said, it means a lot of patients who could benefit from marijuana aren't getting access to it. "It's my hope that the door will open wider in the future and medical marijuana will become a first-line treatment."
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