Authored By: William F. McDevitt, Esq.
The cover story of the January/February issue of The Pennsylvania Lawyer proposed “Medical Marijuana as One Solution to the Opioid Epidemic in Pennsylvania.” The authors posit that medical marijuana might serve as a tool in curbing the high numbers of opioid users and resultant fatalities in the Commonwealth by bringing about
(1) A reduction in deaths.
(2) Prevention of addiction.
(3) Relief from withdrawal.
The article’s central premise is that cannabis may prove to be a viable alternative to opioids, which would result in a reduction in the rate of over-prescription of opiates and a reduction in the rate of sharing or improper distribution of the excess amounts of prescribed painkillers.
While every Pennsylvanian should hope for and work toward an end to the suffering and death caused by this crisis, it is unlikely that Pennsylvania’s Medical Marijuana Act (MMA) will immediately provide a large-scale resolution.
The idea that marijuana is a less-toxic, non-addictive replacement for opiates is based in part on outdated beliefs. Cannabis is not a narcotic. While it is classified as a Schedule I substance under federal law, research has established that its active ingredients bind to different receptors than opiates. There is anecdotal support for marijuana as a painkiller, but far less clinical evidence. Clinical evidence does conclusively establish that the human body processes cannabinoids and opiates differently. Therefore, proposals that marijuana could be a “replacement” for opiates are misplaced, premature and may fuel the misconception that cannabis is just as dangerous as heroin or other opiates.
We also must remember that the MMA was not designed with the goal of resolving the opioid epidemic. The MMA defines 17 “serious medical conditions” for which cannabis may be prescribed by a certifying physician. “Opioid withdrawal” is not one of these 17 conditions.
Some of the statutorily defined medical conditions are not treatable with opiates, including human immunodeficiency virus, acquired immune deficiency syndrome and autism. Chronic pain is associated with many of the MMA’s “serious medical conditions,” but most of those conditions, including cancer, Parkinson’s disease, inflammatory bowel disease and sickle cell anemia, have not been specifically linked to opiate abuse.
With respect to the treatment of pain, the MMA limits the prescription of medical marijuana to patients with “severe chronic or intractable pain in which conventional therapeutic intervention and opiate therapy is contraindicated or ineffective.” Arguably, this restriction also might apply to two of the MMA’s overlapping conditions – “neuropathies” and “severe chronic or intractable pain of neuropathic origin.” The Pennsylvania Department of Health likely will be required to provide guidance to further define which patients experiencing chronic neuropathic pain can be certified to receive medical marijuana prescriptions.
Medical research may support revising the MMA to allow marijuana to be prescribed generally for the treatment of pain, including pain caused by accidents and physical trauma. Until that revision occurs, the ability of medical marijuana use to stem the opioid crisis will be limited to preventing possible addiction in a strictly defined class of patients.
About the Author
William F. McDevitt is a partner in the Philadelphia office of national law firm Wilson Elser, where he is a member of the firm’s Cannabis Law practice. He can be reached at firstname.lastname@example.org.