Had it been approved, Connecticut would have been just the third state after New Jersey and Pennsylvania to sanction cannabis as a treatment for opioid addiction. But several board members said the research simply wasn’t there to support one of the more unorthodox proposals to fight the country’s runaway opioid crisis.
“In terms of curtailing cravings, we just don’t have the evidence,” said Jonathan Kost, director of Hartford Hospital’s pain treatment center. “It’s just too open; it’s just too unknown.”
Vincent Carlesi, a Stamford pain management specialist, said he’d seen some of his patients with other conditions qualifying them for medical marijuana use the drug to whittle down their opioid intake. But Carlesi admitted it was unclear whether marijuana had actually helped ease withdrawal symptoms, or if it had relieved their pain and reduced the need for painkillers.
“I’d rather do this as a chronic pain issue than a chronic use issue,” said William Zempksy, head of pain and palliative medicine at Connecticut Children’s. “The longer I’m involved in medical marijuana,” Zempsky added, “the more I shift towards [adding] all chronic pain.”
The board took far less time deliberating over whether to add degenerative spine disease as a qualifying condition. After narrowing the condition to “chronic neuropathic pain associated with degenerative spinal disorders,” the panel approved it for adults; the spinal condition now joins six others in the regulations process which, if approved, will bring the number of qualifying conditions in Connecticut to 29.
In written testimony, several people told the board that marijuana helped them quit opioids where no other treatment plan or medication had worked. Cannabis, they said, had saved them from opiatic “zombie” hazes, addiction, even death.
But several doctors submitted clashing testimony, warning there was little, if any, research showing marijuana helps overcome powerful opioid addictions.
Samuel Silverman, director of addiction services at Hartford HealthCare’s Rushford facility in Avon, cautioned against “recommending something we really don’t understand.”
“To suggest that marijuana plays any role in sustained recovery is bewildering,” he wrote.
“The anecdotal evidence is compelling,” said Linda Barry, a board member and professor at UConn Health. But “it’s single stories,” she added, “rather than a large pool of people that shows a trend, a trend that’s repeatable and substantiated.”
The Connecticut State Medical Society also opposed using marijuana to treat opioid addiction. If someone trying to kick an addiction used only cannabis instead of buprenorphines, which can satiate opioid cravings without producing a high, the result “could be disastrous,” the group warned, “leading to relapse, overdose and even death.”
Several board members also worried that prescribing cannabis to people with opioid addictions could reroute them out of treatment regimens that use buprenorphines or methadone — regimens that research has shown to work.
The board’s decision dealt a blow to the state’s marijuana vendors, the four growers and nine dispensaries that sell all the state’s legal cannabis. Adding opioid withdrawal to the list of conditions would likely have grown the state’s patient count — and the vendors’ customer base — considerably. There are currently 26,501 medical marijuana patients in Connecticut, 12 times the number when the program began in 2014. Employees from several dispensaries submitted testimony supporting the measure.
Advocates of medical marijuana will likely request the board weigh chronic pain as a qualifying condition — a broad diagnosis that would increase the state’s patient count dramatically.
Eight states currently subscribe marijuana to people suffering from chronic pain. In 2016, the Marijuana Business Daily reported that among the states that disclose patient count by condition, 64 percent of patients listed chronic or severe pain as their qualifying condition.
Marijuana does not hit the Opioid receptors, there’s no pharmacologic reason for it to help, but if you’re stoned enough, anything is more tolerable…