July 16, 2016

"There's a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws."

"These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that's always been just an assumption. Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses...."

From "One striking chart shows why pharma companies are fighting legal marijuana" in The Washington Post.

ADDED: I'd like to see the analysis extended to states that have legalized marijuana beyond the medical/"medical" use. If we're talking about painkiller abuse, then it's not just about whether "medical marijuana" can replace doctor-prescribed drugs, but which drugs people are choosing on their own for whatever use they feel they have.

45 comments:

rp said...

The only number I really care about, as a tax-payer, is whether, once a state passes a medical marijuana law, the percentage of folks holding down a full-time job increases. I still wonder if those using pain pills and not working are just being replaced by those using medical marijuana and not working. If medical marijuana can improve the work force participation rate without raising the overall accident rate, then that would be quite interesting.

Ann Althouse said...

We were just in Colorado for a week and we did a lot of driving and interacted with many people, and I didn't notice anyone seeming different from people in other states where marijuana is not legal. People in cars were driving just fine, and everyone we spoke to seemed to be alert and healthy.

Matthew Blaine said...

Christopher Ingraham cherry-picks data to shill for marijuana. In this case, he is using prescription drugs prescribed to Medicare Part D beneficiaries. I doubt there is much substitution between "medications" among those beneficiaries and pot users.

Chuck said...

Does this say anything about marijuana's pharmacological utility as an analgesic? Or does it tell us more about human behavior in using recreational and prescription (ostensibly, presecription) drugs?

Put another way, is this representative of marijuana being a kind of methadone for the oxycontin set?

I've encountered a number of people in medicolegal litigation who had (State of Michigan) medical marijuana cards. In every single case, the cardholder was known to have been a heavy marijuana user before any medical diagnosis. They liked smoking marijuana, and got a card as soon as they could legally do so. I've also never known of anyone who wanted a "medical" marijuana card and could not get one, with the assistance of a willing prescriber.

Yancey Ward said...

Ann, did you and Meade partake?

Carol said...

I asked one of our legislative candidates her position on a new medical marijuana initiative, and the rest of the R's the room looked at me like I had three heads. No one respectable wants to be associated with the issue.

But I do wish there were legal pain alternatives to opioids and alcohol. At some point one's liver or stomach won't be able to take either. I really don't like the psychedelic part but fear that the medical-legal establishment will ultimately cut us off from everything. .for our own good of course.

SukieTawdry said...

Aren't there bodies of research showing almost any and everything? I don't think this particular study has established a "causal link" as the article implies.

I've been a cannabis user for some 50 years now. In my experience, while it has been helpful with nausea, I've not noted any particular effect on pain, particularly not on a level of pain that necessitates opiates. But, of course, that's just me.

I Have Misplaced My Pants said...

How many people who who spend their days in basements with Netflix and their bongs did you interact with?

I Have Misplaced My Pants said...

Major league stoners don't do energetic things like hike, is what I'm saying.

Michael K said...

The stoners who frequent the pot shop around the corner from where my daughter works in Venice must all be in pain.

They do look a bit odd.

"But I do wish there were legal pain alternatives to opioids and alcohol."

There is a lot of work going on about opioids and endorphins.

The chronic pain patients are really getting lost on the government's war on drugs. I was a chronic pain patient after my back surgery for about 15 years. Eventually, the pain got tolerable and I take some ibuprofen for it.

There are a lot of people whose pain never gets better,

West Texas Intermediate Crude said...

Free persons should be free to use or abuse any substance they please.
They should also be free to suffer or benefit from the consequences of their choices.
Taxpayers should not be required to bail their sorry asses out if said free persons choose poorly.
Those of you who object to this policy are free to contribute to the care/rehabilitation/resurrection of those who have chosen poorly.

traditionalguy said...

Pot is used by introverts to feel good all alone. And the chronic pain people are introverts most of the time. So it definitely cuts a chunk out of Big Pharma prescription drugs.

The down side of Pot as a recreational use or as an aphrodisiac is that Pot slows the users down to the point it makes working a job harder.

Ergo: Pot is like Golf.

ALP said...

Sukie Tawdry:

40+ years of cannabis use here - with a boring, solid, "normal" life to go along with it. Never had a medical card as we never felt comfortable being on a list. My partner swears by it for his migraine nausea (no MMJ card) and I recently tried high CBD/low THC oil concentrates - as a skeptic. My family went organic/vegetarian when I was about 10 - by the time I graduated from HS I had swallowed tons of herbs/vitamins at their behest. Never did a damn thing so I've always been the odd person out in the family with regards to using anything non-pharmaceutical to cure anything. I struggle to develop a "pill habit" just to take vitamin D.

Damn, that high CBD stuff relaxes the muscles in a way "normal" weed doesn't. For the type of pain that is exacerbated by tight muscles, it does work. Getting out of bed with less back ache and starting a long ass day pain free? I'll take it. Very short, mild high that is gone by the time my 2+ hour commute to work is over.

StephenFearby said...

Most recent large scale study on the effect of marijuana on the brain:


Neuroimage Clin. 2016 Jun 8;12:47-56.

Recreational marijuana use impacts white matter integrity and subcortical (but not cortical) morphometry

"...Despite a trend of de-criminalization and softening societal views, the scientific literature on the effects of marijuana on the brain has not yet reached a consensus. Work with adolescents has consistently shown that heavy marijuana use leads to disruptions in the integrity of white matter...However, work investigating the effects of marijuana on the morphometry of gray matter and subcortical regions has yielded inconsistent findings..."

"...The current study...[used] multi-modal neuroimaging approach on data from almost 500 participants reporting varying levels of recreational marijuana use."

Conclusion: "...Examined from multiple perspectives including white matter integrity,
subcortical shape, and brain volume, our parametric analyses suggest that an early onset of marijuana use may be associated with subtle changes in brain regions implicated as being altered in substance abuse. These findings provide for the possibility that marijuana use during adolescence, which is a time of rapid brain development, might, at least in some individuals, have long-lasting effects..."

Comment: The experience of Michael Brown comes to mind.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925620/pdf/main.pdf

Michael K said...

"Very short, mild high that is gone by the time my 2+ hour commute to work is over."

Where is your commute ? I hope not the 405 south bay curve.

Michael K said...

"Work with adolescents has consistently shown that heavy marijuana use leads to disruptions in the integrity of white matter."

Yes. I'm OK with adult use but worry about adolescents up to 21.

There is a significant (not 5% but some) risk of schizophrenia in adolescent use.

Cocaine and methamphetamines are too dangerous to legalize. Opioids would be OK with me.

Jupiter said...

Michael K said...

"Cocaine and methamphetamines are too dangerous to legalize. Opioids would be OK with me."

What about automobiles? Do you think they should be legal? A lot of excess mortality there, plus non-fatal but still debilitating injuries. Of course, people who drive automobiles think the benefits outweigh the risks. But what do they know?

Michael K said...

How often do you do coke and meth, Jupiter ?

ALP said...

Michael K:

Go forth knowing that you and yours are safe. I commute by either bus or train - roughly 90 minutes, in the state of WA. I am fuzzier headed arriving at work if I SLEEP that long and wake up only to go to work mere minutes later.

I had to think about posting that - I sacrificed the fun of thinking about your panties in a bunch over nothing. But now that I know, I just might make a trip down to CA and use the 405 south bay curve all day long, smoking a big old fattie. I have time this summer.

I have spoken with owner/operators of large mmj dispensaries in Humbolt county. They are all aware that a segment of their mmj card holders are plain old stoners. However, those people generally pay full price, allowing dispensaries to offer mmj at a low price, or free, to the really sick ones that clearly need it - and have huge medical bills to worry about. Thus the stoners support the truly sick and financially strapped.

Birches said...

Aren't most doctors skeptical of medical marijuana because there is no formulary for it? Pharmaceuticals are the same every where, not so with pot. I know some doctors who know there are benefits to pot for some people, like those with seizures, but don't outright advocate it because it's all the wild west.

Why shouldn't we do real clinical trials on this stuff and stop legalizing medicinal marijuana on anecdotes? Cat's already out of the bag, let's do it right.

Michael K said...

I am OK with marijuana for pain and nausea.

I knew one guy with cancer of the esophagus who found smoking a joint worked better for his chemotherapy nausea that the oral THC pill.

I just think that recreational users are a road hazard like alcohol and I'm glad to gear that ALP commutes by train.

Rhythm and Balls said...

Imagine that, lady.

"I'd like to see the analysis extended to states that have legalized marijuana beyond the medical/"medical" use. If we're talking about painkiller abuse, then it's not just about whether "medical marijuana" can replace doctor-prescribed drugs, but which drugs people are choosing on their own for whatever use they feel they have."

It doesn't matter, goofball. The risks are inordinately less. Prescription opioids killed almost 20,000 in 2014 - that's 400 per state per year. Marijuana OTOH has never resulted in a single recorded lethal overdose. Ever.

There are non-prescription products that can't even match that safety record. Foods, even.

You're fighting a losing battle. Why are you so invested in this? What's up with the fuddy duddy-ism? What are you so afraid that you or the state or whomever will lose out on, if these things are known and/or if a rational policy was implemented to align the regime to the actual reality? What is it in your mind that forces you to impulsively assume that marijuana must have always been dangerous enough to merit a Schedule I classification?

Face it, for all your faux-sympathizing with the right-wing and anti-government rhetoric, here's a case that the state actually got massively wrong. For many reasons that we can all look into, but I assume that the one that appeals best to you is pro-conformity and pro-mental rigidity appeal.

Rhythm and Balls said...

Aren't most doctors...

Most doctors are practical and autonomous enough to not begrudge the experts in their field a right to investigate and develop their own practice standards. Orthopedic surgeons tend not to feel a need to infringe on what the endocrinologist is doing, etc.,

Terry said...

Journalists are the worst at confusing correlation with causation. Well, next to sociologists.

Rhythm and Balls said...

There is a significant (not 5% but some) risk of schizophrenia in adolescent use.

This is controversial. It may just decrease the delay to an otherwise inevitable onset.

coupe said...
This comment has been removed by the author.
Bob said...

Huh?

Mike said...

As a Colorado resident, it is much easier for me to get marijuana for pain relief than it is to get Vicodin or Oxycontin. There is no doctor visit required. I don;t have to hand carry a prescription to the pharmacy.

Fernandinande said...

People in cars were driving just fine, and everyone we spoke to seemed to be alert and healthy.

That's because you were in Vail, where people can afford lawyers. And stoned on some epic earwax.

Around here - ranchers, farmers and small towns - we've been besieged with "pot zombies" who randomly drive between 20 and 120 mph in both lanes regardless of the road, shooting out through their pickup windows at their hallucinations, and when they're not driving and shooting like crazy they're half-passed out in their moms' basements, and when they're not half-passed out or driving crazy they're running amok and killing things - usually deer and cattle because they're too stoned to catch a human and too weak to hold onto one. On the other hand, they're too lazy to steal, so the burglary rate is about the lowest in the country.

I know it's all true because I see the deer and cattle skeletons when I run the dogs. It's been going on for years.

madAsHell said...

The stoners who frequent the pot shop around the corner from where my daughter works in Venice

Stoners? Venice Beach is an open air insane asylum. It's really quite frightening walking south from the Santa Monica pier, and into Venice. The concentration of mental health issues seems to be related to the availability of marijuana in Venice.

Michelle Dulak Thomson said...

R&B, two people died in Colorado right after legalization. One, IIRC, fell off a deck while stoned.

Pot is way less dangerous than other intoxicants, but it isn't risk-free. And that you can't OD on it doesn't mean that it can't kill you.

Achilles said...

Michael K said...

"Where is your commute ? I hope not the 405 south bay curve."

Stoners are safer on the road stoned than sober. They are the people who drive too slow and look everywhere before turning. In every study run so far the amount of THC they had to pump into a stoner to impair their driving was obscene. Pot DUI laws are like most traffic violations: a brazen money grab by lawyers and municipalities.

Achilles said...

Michelle Dulak Thomson said...
"R&B, two people died in Colorado right after legalization. One, IIRC, fell off a deck while stoned."

This is pretty desperate. Alcohol is several orders of magnitude more likely to cause an accident like this.

Achilles said...

Mike said...
"As a Colorado resident, it is much easier for me to get marijuana for pain relief than it is to get Vicodin or Oxycontin. There is no doctor visit required. I don;t have to hand carry a prescription to the pharmacy."

Pot is cheaper, more effective, and not physically addictive. The drug industry is of course jealous of threats to their patented drugs.

Rhythm and Balls said...

Pot is way less dangerous than other intoxicants, but it isn't risk-free.

Neither is life. What's your point? Where is the compelling government interest justifying telling you what not to put in your body or how not to modify your mindset?

And that you can't OD on it doesn't mean that it can't kill you.

This is not what the E.R. physicians sending 20,000 corpses per year to the morgue care about. Opioids cause accidents also. Your point is moot.

tim in vermont said...

Stoners are safer on the road stoned than sober. They are the people who drive too slow and look everywhere before turning. In every study run so far the amount of THC they had to pump into a stoner to impair their driving was obscene.

I would love to see some links. From what I have read, pot is less impairing that alcohol, in small doses, but if you mix the two, and I have only smoked pot socially, and have never smoked it without alcohol, that I can remember anyways, if you mix the two, small doses of both, creates a very deadly combination.

Maybe you can tell me what is wrong with snippet below?

Accident-involved drivers with THC in their blood, particularly higher levels, are three to seven times more likely to be responsible for the accident than drivers who had not used drugs or alcohol. The risk associated with marijuana in combination with alcohol appears to be greater than that for either drug by itself.

I don't have a problem with people using pot, but don't kid yourself that you are OK to drive. Seriously, just don't.

Fernandinande said...

tim in vermont said...
Maybe you can tell me what is wrong with snippet below?


The snippet comes from here (.gov): Does marijuana use affect driving?, and they say:
"However, a large case-control study conducted by the National Highway Traffic Safety Administration (NHTSA) found no significant increased crash risk attributable to cannabis after controlling for drivers’ age, gender, race, and presence of alcohol.16"

The reference[#7] for the snippet says:
"Studies that have used urine as the biological matrix have not shown an association between cannabis and crash risk."
and
"Combining cannabis with alcohol enhances impairment, especially lane weaving."

Almost all the "marijuana contributes to accidents" studies include alcohol + pot.

The ones that say "% of drivers in accidents with THC in blood is increasing" nearly always omit the fact that the accident rate has gone down. As a Gedankenexperiment, imagine that everyone drives high, but the accident rate decreases (it's gone down more in legalizing states that other states). 100% of the drivers in crashes have THC, but there are fewer crashes. Does the THC cause crashes or reduce crashes?

"Landmark [NHTSA] Study Finds Marijuana Is Not Linked to Car Crashes"
"This analysis shows that the significant increased risk of crash involvement associated with THC and illegal drugs...is not found after adjusting for these demographic variables. This finding suggests that these demographic variables may have co-varied with drug use and accounted for most of the increased crash risk. For example, if the THC-positive drivers were predominantly young males, their apparent crash risk may have been related to age and gender rather than use of THC."

ndspinelli said...

Althouse used to talk out of her ass scoffing and denying the pain relief qualities of cannabis. Now she is reading what I have been saying for years here. I think she might have brought home a stash. Good for her.

Bob Loblaw said...

From the stoners I've known over the years I'd say pot is far less of a problem when it comes to driving. People who are high tend to realize they're high and get anxious over the idea of driving. People who are drunk either don't realize they're impaired or they think they'll still be able to drive safely.

Robert Cook said...

"The only number I really care about, as a tax-payer, is whether, once a state passes a medical marijuana law, the percentage of folks holding down a full-time job increases. I still wonder if those using pain pills and not working are just being replaced by those using medical marijuana and not working. If medical marijuana can improve the work force participation rate without raising the overall accident rate, then that would be quite interesting."

The number of people holding down full-time jobs will increase when the economy improves enough that more smalll employers begin hiring for full-time jobs...and when the large employers and major corporations decide to bring back to America the hundreds of thousands of jobs they have shipped overseas...which will happen never...or only when it is more expensive or otherwise troublesome for them to maintain their jobs overseas than to bring them home.

How do you suppose states passing medical marijuana laws will have any effect on the conditions driving high unemployment in the USA? Or do you hold onto the fantasy that drug-users are primarily jobless layabouts who avoid applying for the thousands of full-time jobs--that you must also fantasize are going unfilled--in order to spend their days drugging? (There are druggies like this, but the majority of drug-users in this country are working people.)

Bruce Hayden said...

I think the official number of CO deaths is three. Not ODs, but probably linked to hallucinations. Two apparent commonalities. First, they were fairly new users. And, second, they involved edibles. As most everyone probably knows here, the high from edibles comes along more slowly than smoking pot. And, that the first time you get high, you may not have detected it as quickly as you do later. So, the theory is that these were newbies, maybe even virgins, picked edibles because that didn't involve inhaling possible bad stuff into their lungs, didn't detect that they were coming on, took more, still didn't, etc, and when they did, they were completely wasted. Something like that. So, the state solution seemed to mostly revolve around packaging and labeling. Selling a tin of magic brownies is illegal - I think each piece has to be individually wrapped and marked. Something like that.

Oh, and I think the guy jumped off the balcony. If I remember right, first confirmed pot death was from a guy who had ingested edibles, and had little if any experience with pot. It was in a hotel by the old airport that had an atrium inside all the way up, maybe 6-8 or so floors. The rooms open on walkways on each floor around the atrium, that have railings high enough that you aren't going to accidentally fall off to your death. You can see all the way down, and there used to be a nice cafe on the main floor that we would on occasion meet on occasion. Esp before 9/11 security, for people flying into Stapleton. In any case, the original reports had the guy talking a bit crazy before he jumped/fell, which is part of why they thought it was hallucinations and not an accident.

One other thing about regulation - CO was in the lead in regulating blood THC levels. If you are going to get stoned, and drive down the road at 20 in a 55, I think that in much of the state you can expect to possibly get pulled over, tested, and end up in jail, for DUI.

Bruce Hayden said...

@Dr K (in particular)

One of the interesting/unfortunate problems with pot legalization and pain, combined with prescription drug misuse is that the Feds (esp DEA) are making it harder and harder for those with (true, injury caused, not pot induced) chronic pain to try pot. The problem is that a lot of this treatment has moved to specialized pain management doctors. If you get lucky enough to get with a good one, who isn't burning and churning his clientele in order to get rich quick, he is likely going to require a contract with you that requires you to promise to inform them of any other use of pain meds (including in the hospital), requires periodic drug testing, and that you will be terminated as a patient if you have anything in your system besides what they have prescribed. at least some of these specialized docs practice zero tolerance here. They find pot in your blood, you are out as a patient. Ditto, of course for unprescribed narcotics, amphetamines, etc. It is because the Feds keep tightening up the system, and these pain doctors need to keep their licenses to prescribe schedule 2 drugs. And, yes, a good pain management doctor can be worth the hassle. And after getting "fired" as a patient, it is hard to find a quality replacement pain doc. (I know one person who was "fired" for what their surgeon prescribed in the hospital after surgery - the surgeon who had recommended the pain doc in the first place). Pot may be legal in CO and WA generally, and in a bunch of other states with a prescription, but is still a schedule 1 drug according to the FDA, without any recognized medical advantages (which, of course, involves self-induced blindness).

Fernandinande said...

Bruce Hayden said...
If you are going to get stoned, and drive down the road at 20 in a 55 ...


You know what's really strange? Nobody actually does that.

In fact, here's an example of nobody driving too slowly:

"...24 miles per hour in a 35 mph zone, according to the Mountain View Police Department -- with traffic apparently backing up behind it.

'As the officer approached the slow moving car he realized it was a Google Autonomous Vehicle,' a police department post said.
...
In a Google Plus post, the Google Self-Driving Car Project pled guilty to slow driving."

mikee said...

As pointed out by a statistician commenter over at reddit, where I saw this posted yesterday, the statistically significant difference is about one or two patients per day per doctor choosing pot over painkillers.

While statistically significant, this is not necessarily that great a loss for big pharma, who typically give that much medication away through free doctor samples as advertising for their brand (usually given to poor patients or those without good prescription coverage - at least by my spouse/physician).

Pot normalization will last until it is legal enough to destroy the same way tobacco was destroyed in the US. And don't think there aren't a lot of lawyers who want a chunk of that class action lawsuit when it happens, which it will when the reward seems big enough.

ALP said...

RE: driving and toking.

My partner and I are night/day on this issue. He loves to drive, is an engineer, and really gets into the "oneness" of driving a well designed car. I have no issues riding with him after he's had a few tokes, as it appears to make him utterly absorbed in the task and I have no worries.

Me? I fucking hate driving, my object-spacial perception sucks totally sober, getting stoned makes it worse. Driving is on my list of things I don't do stoned (along with handling chemicals or doing anything requiring speed/precision). Driving an extended cab pickup* through a city street with cars parked along the curb is white knuckle ride - I'm positive any minute my vehicle will start taking side view mirrors off every car I go by.

That's my confirmation bias: if you like driving and are already good at it, moderate cannabis use probably doesn't impact your performance. If you suck at it, its not going to improve things.

* Not my normal car; drove a truck as a rental when my car was rear-ended by an elderly woman mistaking the gas for the breaks - now SHE was probably hopped up on painkillers!