Potential medical marijuana crisis could mirror opioids, doctors warn

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The parallels between how the opioid crisis began and medical marijuana’s quick rise as a candidate on the pain-management roster has some experts concerned due to the lack of studies on such issues as cannabis dosing and addiction.

Doctors interviewed for a study on the infancy of the current opioid crisis pointed to four top reasons opioid prescriptions became so prevalent in U.S. health care: Opioids were assumed to be nonaddictive; the drugs were the preferred option in curing pain; there was a lack of knowledge about opioids in addiction science; and undetermined dosage concerns, according to a paper released Monday by the Boca Raton, Florida-based National Council on Compensation Insurance.

“None of it is surprising; it is pretty much in the literature now, how we got to this place (with opioids),” said Dr. Suzanne Novak, a 37-year practicing physician in Austin, Texas, who wrote the pain management section for the Official Disability Guidelines and who was among the six physicians interviewed for study.

What hasn’t been dissected is whether medical marijuana poses those same dangers, said Dr. Novak. “We don’t really know enough about marijuana to know about pharmaceutical reactions, or any of the other polypharmacy (issues),” she said, referring to side effects when marijuana is combined with other medications. “There are not a lot of studies out.”

Now legal for medical uses in 29 states and the District of Columbia, marijuana remains illegal at the federal level — its Schedule I drug classification keeping it from being accurately studied, experts have said.

Meanwhile, Democratic Senate Minority Leader Chuck Schumer, of New York, announced recently that he would be introducing a bill to decriminalize marijuana.

Issues around marijuana dosing have pain experts concerned, said Dr. Steven Feinberg, a pain expert and founder of the Palo Alto, California-based Feinberg Medical Group, which helps injured workers manage pain.

“If an injured worker comes in here and says I am using X amount a day (of medical marijuana), I don’t know what that means … I don’t know what kind. Is it tainted with anything?” he said, adding that the forms of medical marijuana keep growing as the substance becomes legal recreationally in more states. California was the most recent state to legalize the drug for recreational purposes, bringing the total to nine states.

Dr. Feinberg said the parallels between opioid’s infancy in modern medicine and how marijuana is touted as a pain management drug of choice are tough to ignore.

“(Opioids were) so promoted and they said it was so positive to receive these drugs, they worked so well and so on,” Dr. Feinberg said. “I see lots of problems on the horizon (with medical marijuana.)”

While sitting down with Business Insurance magazine at the Risk & Insurance Management Society Inc.’s annual conference in San Antonio on April 17, Brian Allen, Salt Lake City-based vice president of government affairs for Mitchell International Inc., a technology firm that manages pharmacy transactions, raised similar concerns while discussing the state of affairs in workers comp, with opioids and medical marijuana at the top of the list.

“We don’t know where we’ll be,” he said in regard to the future of medical marijuana and whether the industry will be grappling with its unknown dangers.

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