Physician Board Rules Against Adding Opioid Withdrawal As Condition For Medical Marijuana

A board of physicians that acts as gatekeeper to the state’s medical marijuana program rejected a proposal on Monday to add opioid use disorder and withdrawal as a qualifying condition, scrapping one of the country’s first attempts to combat opioid abuse with cannabis and dealing a blow to patients who say the drug blunts withdrawal symptoms.The nine-person board, made up of Department of Consumer Protection commissioner Michelle Seagull and eight physicians, said that while cannabis anecdotally seemed to help some patients wean themselves from opioid painkillers, they could not disentangle the drug’s effect on withdrawal symptoms from its ability to relieve pain. Absent a larger discussion on whether to treat chronic pain with cannabis, the board ruled against adding opioid withdrawal as a condition that qualifies patients for a marijuana prescription.

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.”