State Approaches to Treating Opioid Use Disorder With Medical Marijuana
Association of State and Territorial Health Officials / February 08, 2018
With the opioid overdose death rate continuing to rise and an estimated 2.1 million people with opioid use disorder (OUD), the effective treatment of opioid addiction and dependence remains essential. Research shows that medication-assisted treatment (MAT)—the combination of counseling and behavioral therapies with one of three medications approved by FDA (i.e., methadone, buprenorphine, and naltrexone)—is an effective treatment. However, even with the development of a successful treatment, barriers to MAT access (e.g., insurance coverage and provider availability) remain. While efforts to increase access to MAT are being made—by expanding the types of providers who can administer MAT (e.g., through physician waivers for buprenorphine and waivers for nurse practitioners and physician assistants) and ensuring health insurance coverage for OUD treatment (e.g., both private and public payers)—attempts to add OUD to the list of qualifying conditions for medical marijuana are taking place in some states.
In January 2016, a petition was submitted to the Maine Medical Use of Marijuana Program to add opioid addiction to the list of medical conditions that qualify for the medical use of marijuana. In addition to a public hearing and consultation with physicians, the state’s Medical Marijuana Advisory Committee identified and reviewed several studies on the relationship between the use of marijuana or cannabidiol (CBD) and opioids. Based on the review and “[g]iven the lack of rigorous human studies on the use of marijuana for the treatment of opioid addiction . . . and the lack of any safety or efficacy data,” the committee could not conclude that the use of medical marijuana for opioid addiction was safe and the petition was denied. Efforts to add OUD to the list of qualifying conditions in Maine are continuing through the state’s legislature (LD 411).
In 2017, the New Mexico legislature passed HB 527, which included the addition of OUD to the list of qualifying conditions for medical marijuana. Ultimately, Gov. Susana Martinez vetoed the measure, noting in her message to the legislature that the addition of OUD as a qualifying condition was problematic since “the bill does not define what ‘treatment’ for opioid dependence entails.” In November 2017, the state’s Medical Cannabis Advisory Board recommended for the second time the addition of OUD as a qualifying condition for medical marijuana use. The recommendation is now in the hands of the health secretary, who has already declined to add OUD as a qualifying condition once before. Meanwhile, in the New Mexico legislature, memorials (i.e., expressions of legislative desire) were introduced in each chamber (HM 67 and SM 55) in support of allowing medical marijuana use for OUD, with lack of access to MAT as one of the stated reasons.
In Hawaii, HB 1893 would allow for the use of CBD products for the treatment of OUD. On Feb. 1, written testimony was submitted by several stakeholders, including the state’s health agency, and the measure was deferred. Testimony was also provided on a bill in Maryland to allow treatment of OUD with medical marijuana. On Jan. 30, the sponsor of HB 268 testified before the bill’s assigned legislative committee in support of the measure. Toward the end of the hearing, one of the committee members noted that written testimony from medical and substance use organizations indicated how the only approved medications for OUD treatment are methadone, buprenorphine, and naltrexone. A companion bill was also introduced in the senate chamber but has not yet had a hearing (SB 181).
Bills to allow medical marijuana for the treatment of OUD have also been introduced this year in New York (SB 7564 and AB 9016) and Arizona (HB 2508). Also of note is a 2017 Massachusetts bill (H 1050) that directs the department of public health to establish a pilot program for veterans to use medical marijuana to treat OUD.
Proponents of using marijuana to treat OUD point to a potential reduction in harm by allowing marijuana as a substitute for opioid use, claiming that marijuana can be used as an adjunct therapy for those receiving MAT and that its use can increase treatment success rates. While evidence on the relationship between marijuana and OUD is still emerging, recent research calls into question whether a positive relationship exists. For example, a study published in the September 2017 issue of the American Journal of Psychiatry concludes that “cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.” Another recent publication, in the February 2018 issue of Addictive Behaviors, concludes that “cannabis use strengthens, rather than weakens, the relationships between pain and depression and pain and anxiety.”
Another argument cited for allowing medical marijuana as a treatment for opioid addiction and dependence is MAT unavailability. As noted, efforts to increase access to evidence-based MAT are continuing and a focus on these efforts, rather than adding an unknown, untested factor into the mix, may prove a more instructive course of action when it comes to treating OUD.
With several state and territorial health agencies responsible for approving the addition of qualifying conditions for the use of medical marijuana, it is key to recognize this emerging topic and the concerns surrounding it. ASTHO will continue to monitor these issues and provide support as needs arise.
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