Gwen Moritz

The Question That Must Not Be Asked

Gwen Moritz Commentary

The Question That Must Not Be Asked

Let me tell you, there are some questions one simply must not ask. One of them is whether there’s any real evidence that legalizing marijuana reduces abuse of opioids.

I know because I made the mistake of asking this question on Twitter a few weeks ago, and I was inundated with responses that fell in a very narrow range between questioning my intelligence and asserting my lack of intelligence. I was encouraged to learn to use Google, presumably because Google always delivers only the highest quality information.

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It started like this. Rex Chapman, the former NBA player who overcame a debilitating opioid addiction, tweeted a comment about a U.S. senator from his home state of Kentucky, Damon Thayer, opposing medical marijuana — which Chapman favors. Chapman’s tweet asked how much in campaign donations Thayer had taken from the Sackler family, whose Purdue Pharma dishonestly promoted OxyContin as a safe painkiller with little likelihood of addiction or abuse.

I responded: “Is there any evidence that legalized marijuana, medical or otherwise, reduces abuse of opioids? I certainly want it to be true, but we have more legal marijuana than ever in the US ... and also more overdose deaths than ever.”

To my astonishment, Chapman replied: “Yes. Jesus. Seriously?” I then became fair game for scores of his million-plus Twitter followers.

But here’s the thing: Chapman pointed to no specific evidence, nor did most of the people who piled on. Several did point to various articles available online, and sometimes it seems like people stop reading at the headline. For instance:

► A 2018 CNN article headlined “Marijuana legalization could help offset opioid epidemic, studies find” is very popular. The studies referenced, however, are actually about whether the availability of legal marijuana is associated with a reduction in prescribing of opioid painkillers. And while opioid prescriptions have certainly resulted in a heartbreaking number of addicts — including Chapman — a reduction in prescriptions is not the same as a reduction in abuse.

► A 2019 review of 16 separate studies that appeared in the medical journal Injury Epidemiology was cited repeatedly, including by an anonymous coward who called me a liar. Yet here’s what the authors of “State marijuana laws and opioid overdose mortality” concluded:

“Legalizing marijuana might contribute to a modest reduction in opioid prescriptions. Evidence about the effect of marijuana legalization on opioid overdose mortality is inconsistent and inconclusive. If any, the effectiveness of state marijuana laws in reducing opioid overdose mortality appears to be rather small and limited to states with operational marijuana dispensaries. It remains unclear whether the presumed benefit of legalizing marijuana in reducing opioid-related harms outweighs the policy’s externalities, such as its impact on mental health and traffic safety.”

► “Legalized Marijuana Linked to Decline in Opioid Emergencies,” a news release issued last July by the University of Pittsburgh Medical Center, appears to be holy writ among people who didn’t actually read it. What it found was that during the first six months after recreational (not medical) marijuana was legalized in four states, the number of opioid-related emergency room visits declined by 7.6% — and then went back to the previous level. The UPMC did offer this faint praise: Recreational cannabis doesn’t increase opioid-related ER visits.

And so on and so on. There is certainly anecdotal evidence that some pain patients can get the relief they need from marijuana rather than opioids, and marijuana — now legal in some form in 37 states — is unquestionably safer. But 100,000 Americans died of drug overdoses, about three-quarters of them from opioids, between April 2020 and April 2021. The popular hope that legal marijuana will mitigate the opioid crisis has not yet materialized — at least not in any evidence I could find on Google.

The Arkansas Center for Health Improvement has won a $1.3 million research grant from the National Institute on Drug Abuse to study medical marijuana use in Arkansas, where medical marijuana became available in 2019. Among other things, this research will look at emergency visits and opioid use.

Gwen Moritz is a contributing editor at Arkansas Business Publishing Group.