One way for states to curb the opioid crisis might be to completely legalize another drug: marijuana.
According to a report set to run in November’s edition of the American Journal of Public Health, the amount of opioid-related deaths dropped by 6.5 percent in Colorado during the two years following the legalization of recreational marijuana in 2014.
“This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado,” the researchers wrote in the report. “Legalization of cannabis in Colorado was associated with short-term reductions in opioid-related deaths.”
The researchers — from the University of North Texas, University of Florida and Emory University — analyzed opioid-related deaths in Colorado from the start of 2000 to the end of 2015. To determine whether it was recreational or medicinal marijuana that was potentially impacting opioid death rates, researchers compared data from Colorado with data from Nevada and Utah — states where only medicinal marijuana was legal during the time periods considered for the study.
They also tried to account for changes in Colorado’s prescription-drug-monitoring program, which in 2014 began requiring those prescribed opioids to sign up for, but necessarily use, the program.
While results showed a 6.5 percent reduction in opioid-related deaths — about one less death per month than in previous years — the researchers cautioned that further research is needed before drawing any strong conclusions.
“Although we found an apparent public health benefit in a reduction in opioid-related deaths following recreational cannabis legalization in Colorado, we note that expanded legalized cannabis use is also associated with significant potential harms,” the authors wrote. “For policymakers to balance the potential beneficial and deleterious effects of these laws, researchers must continue to examine the full range of health effects in both clinic- and population-level research.”
It’s not the first study to look at the interaction between marijuana and opioids at the state level. A 2014 report showed that states that legalized medicinal marijuana had lower opioid-related deaths, and other research has shown that medicinal marijuana is effective at mitigating chronic pain. But the new report offers the first glimpse of how the accessibility of recreational marijuana might affect opioid abuse rates.
Still, some experts are wary of the conclusions people may draw.
“The whole thing is so convoluted, with so many different things going on in the marketplace,” said Robert Valuck, professor at the University of Colorado-Denver’s School of Pharmacy and Pharmaceutical Sciences and director at the Colorado Consortium for Prescription Drug Abuse Prevention, to the Denver Post. “It’s virtually impossible to assign cause and effect or credit and blame to any one thing.”
Valuck noted other factors in 2014 that could have contributed to the reduction: increased public education about the dangers of opioids, and “wider distribution of the overdose-reversing drug naloxone.”
Another explanation for the downturn in opioid deaths is that people could be simply switching from one substance to another, namely heroin: deaths by heroin overdose doubled from 2011 to 2015, and the amount of heroin seized by police jumped by 1,562 percent during the same period.
The opioid crisis nationwide
The data on opioid-related deaths is startling. According to death rates released by National Center for Health Statistics, 59,520 people have died from opioids from September 2015 to September 2016. That’s enough people to fill Chicago's Soldier Field, as the Washington Post notes. Opioid abuse kills about 100 people every day in the U.S., accounting for about six out of every 10 drug overdose deaths.
The future doesn’t look any better. Most projections say opioid abuse will claim about 500,000 lives over the next decade, and that death rates won’t begin to curb until at least 2020.
“It took us about 30 years to get into this mess,” Valuck said to health news website STAT. “I don’t think we’re going to get out of it in two or three.”
After consulting public health experts at 10 universities nationwide, STAT compiled a worst-case projection for opioid deaths over next decade that assumes doctors will continue freely prescribing the drugs.
The publication also offered a best-case scenario, but cautioned that reaching those numbers “would require a major public investment in evidence-based treatment options and a concerted push among medical providers to control pain with non-narcotic therapies before trying prescription opioids.”
The recent report on Colorado may have stirred excitement, but most seem to agree that more evidence is needed before other states decide to legalize recreational marijuana for the purpose of reducing opioid abuse.
“Everybody wants the answer now because we want to know if this is a good idea or not,” Valuck said to the Denver Post. “But the truth is we don’t have the answer, and it’s going to be a while until the jury comes back in.”
Melvin Livingston, a co-author of the Colorado report, echoed that sentiment:
“Policy change shouldn’t be based on the results from a single study of a single outcome.”
Seattle has a heroin epidemic. More people in the city and its surrounding county enter detox for heroin than alcohol, according to the Seattle Times. Heroin overdose deaths are climbing, especially among homeless people. That’s why the city created a task force to address the problem.
Its solution? Letting addicts shoot up legally.
It’s not as crazy as it sounds. Giving addicts safe, clean places to shoot up decreases the risk of infection, contamination, and death. Those places will be called safe consumption facilities. Drugs will not be provided, but addicts will receive clean needles and syringes. They will also be able to “take other addictive drugs under the supervision of trained authorities,“ reports The New York Times.
The idea isn’t new. Vancouver has had a safe-injection site since 2003, and it was also opened to help stem an overdose epidemic. Cities in Australia and the Netherlands have also had similar programs. Seattle already has a needle exchange program, so a safe consumption facility is a natural next step. That’s most likely why the task force endorsed the plan today.
Another benefit to safe consumption centers is that they could become a gateway for addiction treatment and even primary medical care. They are better options than methadone clinics, as University of Washington researcher Caleb Banta-Green explained to the Seattle Times: “Methadone-treatment centers are limited to 350 total patients by state law. Doctors may prescribe [buprenorphine] in their offices, but they need a special license and the number of patients any one doctor can treat is capped at 100.”
While all of these benefits seem theoretical, Seattle does actually have a real-world example to follow: Portugal. 16 years ago Portugal decriminalized possession of all drugs, including heroin, as
VICE News reports. Critics of the plan expected overdoses to spike. They did not. 1% of Portugal’s population abused heroin in the late 1990s. Today, only 0.50% are abusing heroin, and most of them are seeking treatment. Better yet, overdose deaths decreased from 80 people per year to 16. That makes Portugal’s drug-induced death rate only 3 per million residents, almost 6x less than the EU’s. That’s also far less than America’s, where 14,000 people died from prescription overdoses in 2014 alone, according to the Center for Disease Control and Prevention.
Those results are staggering. While Portugal’s free healthcare system and smaller population make that kind of plan too simplistic to replicate wholesale in the US, there are still valuable lessons. “In a society where drugs are less stigmatized, problem users are more likely to seek out care,” VICE concludes. “Police, even if they suspect someone of using drugs, are less likely to bother them.” Seattle’s Mayor Ed Murray agreed with that sentiment, speaking a press conference earlier this year: “We can make a significant impact on homelessness if we make an impact on addiction.”
Both of these statements reveal the same conclusion: addiction is the real problem. Not the addict. And it can be overcome. Neuroscience journalist Maia Szalavitz explains how:
