Thursday, April 12, 2018

Prescription Nation 2018: Facing America's Opioid Epidemic

Improving Medical Cannabis Programs Will Help Combat The Opioid Crisis

Credit: NSC

In a report released this month by the National Safety Council, which provides research showing just 13 states and Washington, D.C., have implemented comprehensive, proven actions to eliminate opioid overdoses and help protect their residents. Despite widespread acknowledgement of the severity of the opioid crisis, most states have been slow to respond, according to this recent report from the National Safety Council.

The 2018 report did not conduct research into states with medical cannabis programs and the impact there on reducing use of opioids and other painkillers but the National Safety Council has plans to do so in the 2019 Prescription Nation Report. Despite this years report not taking medical cannabis programs into consideration, there are some strong correlations revealed in the NSC Prescription Nation White Paper.

Only 13 states and the District of Columbia have implemented comprehensive, proven measures to address what NSC calls “the worst drug crisis in recorded U.S. history” in Prescription Nation 2018. The report, which analyzes how states are battling the opioid crisis, has been released annually since 2013.

“While we see some states improving, we still have too many that need to wake up to this crisis,” said Deborah A.P. Hersman, president and CEO of the National Safety Council. “For the last five years, the Council has released Prescription Nation reports to provide a roadmap for saving lives across the country. We hope states adopt the recommended actions laid out here so we can eliminate preventable opioid deaths and stop an everyday killer.”

NSC identifies six actions that “could have immediate and sustained impact” in combating the opioid epidemic – which claimed more than 42,000 American lives in 2016 – as well as the number of states employing them:

  • Mandatory prescriber education (34 states and D.C.)
  • Implementing opioid prescribing guidelines (33 states and D.C.)
  • Integrating prescription drug monitoring programs into clinical settings (39 states and D.C.)
  • Improving data collection and sharing (seven states)
  • Treating opioid overdose (37 states and D.C.)
  • Increasing availability of opioid use disorder treatment (36 states and D.C.)
In Prescription Nation, a digest analyzing how states are tackling the worst drug crisis in recorded U.S. history, the Council assigned its highest mark of “Improving” to Arizona, Connecticut, Delaware, Washington, D.C., Georgia, Michigan, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Rhode Island, Virginia and West Virginia. 

All of these states, except three; Georgia, North Carolina, and Virginia - the rest are all states with a comprehensive medical cannabis program that allow treatment of ‘chronic pain’ or ‘severe pain’.

The eight states receiving a “Failing” mark – Arkansas, Iowa, Kansas, Missouri, Montana, North Dakota, Oregon and Wyoming – are taking just one or two of the six key actions identified in the report as critical and life-saving. 

All of the states receiving failing grade, except Oregon, are all states with no medical cannabis programs or states that allow use of "low THC, high cannabidiol (CBD)" products for medical reasons in limited situations or as a legal defense. Those programs are not counted as comprehensive medical cannabis programs.
[Related Article: ‘Improving Medical Cannabis Programs Will Combat Opioid Crisis’]

Medical cannabis is a proven alternative to treat chronic pain. Medical professionals and researchers have released studies demonstrating its positive effects and overall benefits to public health. However, medical cannabis programs are serving just 2 percent of the population in most of the thirty states, Washington, D.C., Puerto Rico and Guam that have so far passed laws (another sixteen have passed more limited laws). One-third of the U.S. population is living with chronic pain, and they all deserve access to medical cannabis. The blueprint lays out the specific barriers to access contributing to this disparity and provides lawmakers with the legislative means to reduce those barriers.

Americans for Safe Access released “Medical Cannabis as a Tool to Combat Pain and the Opioid Crisis: A Blueprint for State Policy.” The blueprint outlines legislative and regulatory solutions related to medical cannabis that states can utilize to combat the opioid epidemic.

Using medical cannabis to treat chronic pain is an approach that is supported by research and medical professionals, and has demonstrated positive public health outcomes. Thirty states in the US have passed medical cannabis laws and another sixteen have passed more limited laws. Medical cannabis programs on average are serving 2% of the population despite a potential addressable market of 1/3 of the population that are living with chronic pain.

Americans for Safe Access and their advisors have examined current medical cannabis programs and have identified many barriers for medical professionals, patients, and their caregivers that prevents them from utilizing medical cannabis as a tool to combat pain and opioid use disorder. The following report takes a public health approach to defining enrollment issues and offers a blueprint for legislative and regulatory bodies to resolve these issues. We have concluded that improvements in state medical cannabis legislation and regulations could increase program enrollment and save lives.


The report features model legislation, an emergency proclamation, and flow charts that help lawmakers identify barriers to access that medical cannabis patients in their states are facing.

New Mexico and Nevada are the only two states to meet all six indicators, giving those two states the highest marks in the NSC Prescription Nation White Paper. This is great news for those states and for New Mexico this shows how further expansion of the states medical cannabis program with result in a continued decline in opioid & painkiller drug abuse, overdose, and even death.

Despite having a 10 year old comprehensive medical cannabis program and a medical cannabis law on the books for over 40 years- the New Mexico Department of Health mentions nothing of how medical cannabis contributed to the reduction seen in the state.

“We are working hard to reduce drug overdose deaths in New Mexico, including from prescription opioids,” said Lynn Gallagher, NMDOH Cabinet Secretary. “It is clear that we still have work to do, and we are committed to reducing the loss of life to opioid overdose and ending the tragic impact that these drugs have on our families and communities.”

The New Mexico Department of Health reports that, Governor Susana Martinez has made drug overdose prevention a major priority of her administration and has implemented comprehensive solutions to fight drug abuse in New Mexico. Under her administration, New Mexico:
  • strengthened Prescription Monitoring Program (PMP) laws to require health care providers to check the database when prescribing opioids, leading to fewer opportunities for someone addicted to opioids to go from doctor to doctor for drugs;
  • became the first state to require all local and state law enforcement agencies to provide officers with naloxone, a medication that reverses opioid overdoses;
  • expanded legislation allowing both pharmacists and law enforcement to dispense naloxone without a prescription -- expanding access to the life-saving drug;
  • and removed prior authorization for Suboxone, expanded the number of methadone clinics, and the number of these clinics accepting Medicaid.
As a result of these measures, prescriptions of opioids are down across New Mexico:
  • The total volume of opioids (measured in morphine milligram equivalents or MME), dispensed in New Mexico fell by 11% between the 4th quarter of 2016 and the 4th quarter of 2017.
  • The number of patients receiving high-dose prescriptions fell by 15% over the same period.
  • The number of patients receiving concurrent benzodiazepines and opioid prescriptions for 10 days or more in the quarter (making them at higher risk of overdose) fell by 17%.
  • Approximately half of all drug overdose deaths in New Mexico involve prescription opioids.
The National Safety Council released their report last week at the National Rx Drug and Heroin Summit in Atlanta, where NMDOH officials participated in a national discussion about effective prevention and treatment tools and resources.

Additionally, the NMDOH site has more information on Prescription Opioid Safety, Harm Reduction, and Substance Abuse Epidemiology.

The New Mexico Department of Health makes no mention of how the medical cannabis program has rapidly grown over the last two years. Nor does NMDOH mention how treatment of severe Chronic Pain in the medical cannabis program is benefiting over 17,000 New Mexicans and is the second most used qualifying condition into the program. Patient enrollment has been accelerating over the past 24 months. Enrollment increased by
more than 14,400 patients between the end of January 2017 and the end December 2017. Each day, the Medical Cannabis Program receives between 150 and 600 patient applications.

[Related Article: ‘Study Finds Medical Cannabis Is Effective At Reducing Opioid Addiction’]

Then in the late fall of 2017, we saw a new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use cannabis and significant reductions in opioid use.

The study titled, “Associations between Medical Cannabis and Prescription Opioid Use in Chronic Pain Patients: A Preliminary Cohort Study,” and published in the open access journal PLOS ONE, was conducted by Drs. Jacob Miguel Vigil, associate professor, Department of Psychology and Sarah See Stith, assistant professor, Department of Economics. The results from this preliminary study showed a strong correlation between enrollment in the New Mexico Medical Cannabis Program (MCP) and cessation or reduction of opioid use, and that whole, natural Cannabis sativa and extracts made from the plant may serve as an alternative to opioid-based medications for treating chronic pain.

The UNM researchers used Prescription Monitoring Program opioid records over a 21-month observation period (first three months prior to enrollment for the MCP patients) to more objectively measure opioid cessation – defined as the absence of opioid prescriptions activity during the last three months of observation, with use calculated in average daily intravenous [IV] morphine dosages. MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.

By the end of the observation period, the data showed MCP enrollment was associated with a 17 times higher age- and gender-adjusted odds of ceasing opioid prescriptions, a 5 times higher odds of reducing daily prescription opioid dosages, and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10 percentage points in the non-enrolled patient group.

Survey responses in the UNM study indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few negative side effects from using cannabis one year after enrollment in the MCP.

The researchers’ findings, which provide clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrant further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.

As a result of those measures by the NM Health Department, how the state’s comprehensive medical cannabis program has more than three-fourths (83%) of the program participants listing Post-Traumatic Stress Disorder (49.1%) or Severe Chronic Pain (33.3%) as a qualifying condition and rapid growth of the program for over two years- all resulted in prescriptions of opioids being down across New Mexico resulting in:

The total volume of opioids (measured in morphine milligram equivalents or MME), dispensed in New Mexico fell by 11% between the 4th quarter of 2016 and the 4th quarter of 2017.

The number of patients receiving high-dose prescriptions fell by 15% over the same period.

The number of patients receiving concurrent benzodiazepines and opioid prescriptions for 10 days or more in the quarter (making them at higher risk of overdose) fell by 17%.

Approximately half of all drug overdose deaths in New Mexico involve prescription opioids.

New Mexico did not pass any legislative or regulatory improvements to the medical cannabis program in 2017. However, research from the University of New Mexico showed a strong correlation between use of medical cannabis and reduction of opioid use, making the state more poised to adopt opioid use disorder in 2018, despite a veto from Governor Martinez on this condition in 2017. New Mexico remains a strong program for patients; however, the state still needs to add civil protections for patients including housing, employment, parental rights, and organ transplants.

“Medically Necessary” is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.

At the November 2017 medical cannabis Advisory Board Hearing, Doctors recommended to add Substance Abuse Disorders into the New Mexico Medical Cannabis Program with 5-0 Vote. The final decision rest with Secretary Lynn Gallagher at the Department of Health and is expected at the next hearing on May 11th 2018. View the Petition Here:

Lawmakers in the Roundhouse and the Governor need to address the neglected medical cannabis program and follow the recommendations by the Doctors on the advisory board. The State’s Medical Cannabis Program expansion is now “Medically Necessary” and the State needs to allow the Department of Health to open the application process, the State needs to increase the Licensed Non Profit Producer plant count, add more licensed non-profit producers, in conjunction with other measures to ensure safe access to medicine.