Maine knows all too well the potential dangers of narcotic painkillers. Many a journey down the dark path of addiction begins with a prescription for Vicodin, oxycodone or similar medications, though heroin has taken center stage in Maine’s battle against drug abuse.
But could another drug hold answers to preventing overdose deaths?
In Maine and a dozen other states that passed laws legalizing medical marijuana between 1999 and 2010, 25 percent fewer people died each year from prescription opioid overdoses, according to a new study published in the Journal of the American Medical Association.
“States that implemented medical marijuana laws still experienced an increase in overdose mortality after they passed the law. It’s not that mortality went down, rather it increased more slowly than in states that didn’t pass laws in the time period,” said Brendan Saloner, a study co-author and assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
While the reasons for that link require further study, patients with chronic pain may be substituting medical pot for prescription painkillers, or at least using pot to lower their dose, the authors speculate. Nationally, the number one reason patients take medical cannabis is to manage pain, Saloner said.
“These are all possibilities that we have yet to fully understand,” he said.
Maine legalized medical marijuana in 1999, but it wasn’t until 10 years later that patients’ access to pot took a leap forward, with a ballot initiative allowing dispensaries and additional qualifying medical conditions.
The study found a slowing of opioid overdose deaths that strengthened each year after medical marijuana laws were passed. The effects showed up almost immediately, within a year after enactment, according to the study.
In Maine, however, deaths from prescription drugs began a dramatic spike in 2000, a year after medical pot became legal, and largely held steady or rose over the following decade. (Note that this chart reflects deaths from all prescription medications, not just opioids.)
Would the number of drug deaths have climbed even higher without Maine’s medical marijuana law? It’s impossible to say but sobering to imagine.
We could use the 2009 law as a benchmark, since that’s when more Mainers actually started using medical marijuana as a result of improved access. Here’s a more recent snapshot of drug deaths in Maine, showing a drop in pharmaceutical overdoses from 2010 to 2013, but then an increase in 2014.
A number of factors might account for these trends, beyond medical marijuana laws. I suspect one is the remarkable drop in use of prescription painkillers among MaineCare beneficiaries.
But the study’s authors accounted for a couple of other likely culprits, finding no effect on the association between medical pot laws and lower opioid overdose deaths. For example, they examined state prescription monitoring programs, such as Maine’s, finding those programs didn’t change or explain the association.
When they included deaths from heroin, even those involving no narcotic painkillers, the link persisted, indicating that the reduced opioid deaths weren’t offset by higher rates of heroin deaths.
The timing of medical marijuana laws drove the link, Saloner said.
But one expert isn’t convinced. Dr. Andrew Kolodny, chief medical officer at Phoenix House, a national addiction treatment nonprofit, told Newsweek the slowing of overdose deaths likely has nothing to with medical marijuana laws. Only a small subset of doctors offers medical pot to patients to begin with, and most don’t suggest it in place of Vicodin or other painkillers, he said.
“Addressing this epidemic of opioid overdose is going to require a lot of different kinds of strategies,” Saloner said. “We’re looking at one that may be promising, but it’s going to require, among other things, getting people into treatment programs, which is a serious concern in a state like Maine.”