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Medical Marijuana vs. Prescription Opioids – Misplaced Perceptions and Priorities

Medical Marijuana, Opioids and a Deeply Confused Public 

Friday, July 19, 2019
Vicodin tablet more dangerous than medical marijuana

English: Vicodin tablet Italiano: Pillole di Vicodin. (Photo credit: Wikipedia)

Medical marijuana is mostly prescribed for pain in the 18 states and District of Columbia that allow it. Yet it continues to provoke adolescent snickers and inevitable bong jokes.

And addiction to opioid painkillers is anchored in concern about its abuse leading to addiction.

Common to both is public fixation on the illicit and the seamy rather than the humane and the responsible.

Opioid addiction is a serious concern. But it pales in contrast with the potentially toxic consequences for the millions who take opioids for chronic pain with no hint of abuse. Which suggests we’re more concerned as a society that someone may be getting high from medical marijuana than someone may be needlessly dying from overuse of opioid medications like Vicodin, Oxycontin and Percocet.

Opioid prescribing was originally limited to acute pain – generally for cancer and post-surgical patients. Their use has expanded over the years, however, to the much larger population of chronic pain patients (see this recent post on “Understanding Chronic Pain and How Best To Manage It“). According to the IMS Institute for Healthcare Informatics, Vicodin is by far the single best-selling drug in America with over 136 million prescriptions filled in 2011.

The adverse effects of these potent drugs multiply, of course, the longer they’re used. This is why they were initially prescribed only for short-term episodes of acute pain.

There’s also evidence that opioids, like all medications, lose their effectiveness over time. This means their risk-to-benefit ratio quickly turns against patients taking them for chronic pain.

As a result, it also increases doctors’ risk of potential malpractice lawsuits. You’d think a profession as obsessed with legal liability as America’s medical profession would be more cautious about prescribing these dangerous medications. As discussed in Our Healthcare Sucks, very often the opposite is the case.

Granted, many physicians feel pressured to provide relief to patients in chronic pain that’s often acute. It’s a real conundrum in medical practice today. Patients with one or more chronic medical conditions account for 75% of our healthcare spending in America. It’s no surprise the chronic pain that often accompanies these conditions has also mushroomed. Pain is the primary reason for doctors’ office visits.

But the Hippocratic Oath doctors take upon becoming doctors clarifies how to reconcile these often competing priorities in patient care. “First, do no harm” is pretty clear and concise advice.

What Would Hippocrates Say?

English: Main side effects of Vicodin (See Wik...

English: Main side effects of Vicodin (See Wikipedia:Vicodin#Side effects). Model: Mikael Häggström. To discuss image, please see Template talk:Häggström diagrams Italiano: Principali effetti collaterali del Vicodin. References > Vicodin Retrieved on April 17, 2009 (Photo credit: Wikipedia)

Opioids have proven to cause plenty of harm, as this illustration of Vicodin’s effects confirms. The ones it omits are addiction and overdose.

A recent report found that opioid overdoses in New York City increased seven-fold over a sixteen year period.

And despite urban stereotypes, this wasn’t a problem for just racial minorities. In fact, it was mostly a problem among Caucasians. From the report:

Whites were much more likely to overdose on analgesics than blacks or Hispanics…the fatality rate among white males was almost two times higher than the rate among Latinos and three times higher than the rate among blacks…

“Deaths were mostly concentrated in neighborhoods with…lower-than-average rates of poverty.”

Nationally, accidental overdoses from prescription opioid painkillers account for almost 2 of every 5 accidental poisoning deaths in the U.S. This has more than doubled since the year 2000, representing over 24,000 deaths annually by 2006.

Deaths from marijuana overdose? Zero.

It gets worse. Studies in animals have confirmed earlier evidence that morphine and other opiate-based painkillers may promote the spread of cancer cells.[1]

The evidence indicating cause for concern was sufficient in 2012 to cause some anesthesiologists to reassess their use of opioids in managing cancer-related treatments and post-surgical pain. To quote from a report on the University of Chicago Medicine website:

“In a commentary in the journal (Anesthesiology), (researchers) summarize results from multiple studies to argue that opioids…appear to have a significant and direct proliferative effect in cancer cells aside from their effect suppressing immunity (emphasis added).”

If anesthesiologists – the medical experts in pain management – are sufficiently concerned to reassess their use of opioids for cancer and post-surgical pain management, the rest of us shouldn’t be too quick to disregard it. In fact, you’d think the rest of the medical profession might pay it more heed.

It’s rather a sick irony that the drugs many patients take for cancer pain may be promoting the spread of more cancer in their bodies.

Don’t Bogart That Painkiller!

But what of medical marijuana – another medication prescribed for pain relief? Isn’t medical marijuana prone to abuse as well and doesn’t it cause mortality risk with chronic use, too?

Well, no and no.

Of course, any substance can be abused by someone intent on doing so, including perfectly legal ones like alcohol and cigarettes. Medical marijuana’s profile for abuse, however, is relatively low, especially compared to alcohol and cigarettes – and opioids.

When I ran a drug rehab program back in the day, we used to laugh at the public perception that marijuana was a “gateway drug” – a perception that persists decades later.

Of course, it can turn out to be such for the very young, but no one’s seriously advocating that it be available to them – except perhaps as medical marijuana for medical treatment purposes.

The facts simply don’t support the public perceptions. We ought to be really worried about the legal opioid drugs that young people are actually overdosing on and not those that absolutely no one overdoses on.

And here’s where it’s important to distinguish between legalizing medical marijuana and marijuana for recreational use. Because this public perception about marijuana easily spills over into the medial marijuana debate – where the emphasis is too much on the “marijuana” and too little on the  “medical”.

Eyeing the Wrong Drugs

Consider it objectively: while opioid overdoses increased by 700% in New York City, heroin overdoses actually declined. Yet American politicians are less concerned about this “new smack” – or “honky heroin” – than they are about comparatively harmless medical marijuana with virtually no mortality effect.

What does it say about our culture when the most dangerous drugs that kill more young Americans than heroin and cocaine combined are also our best-selling medications?

Not only are we not making it more difficult to prescribe these best-selling and most dangerous opioid medications, the FDA is currently considering approval of an even stronger version of Vicodin that’s 100% hydrocodone (Vicodin consists of hydrocodone and acetaminophen found in Tylenol).

And a majority of Americans surveyed favor keeping the current loose restrictions we now have on Vicodin in America.

Of course, a much greater majority favor legalizing medical marijuana and their opinion is routinely ignored.

We’ve been  dragging our feet for decades on legalizing medical marijuana as a far safer alternative that would help at least some of those now taking far more dangerous opioid medications. Actually, it’s now much worse than merely dragging our feet, as made clear in this article in The Huffington Post. The politics of medical marijuana and over-zealous federal prosecutors intent on keeping it a criminal activity read like a bad remake of Reefer Madness.

All-in-all, it’s a fine mess we’ve gotten ourselves into – and there’s no ready solution in sight.

Misguided prosecutors would perform a greater public service by prosecuting real crimes and real criminals. Instead, they go after the easy pickings of those caught in the legal limbo created by conflicts between state and federal laws governing medical marijuana. These are people acting in compliance with the laws of their states. Yet federal prosecutors manage to muster righteous indignation like they’d busted an international drug cartel.

And for its part, the FDA would perform a greater public service by loosening restrictions on medical marijuana and tightening them on far more dangerous opioid medications.

Then again, when has public service – or common sense – ever guided public policy in American politics?

[1] Morphine May Help Tumors Spread in Cancer Patients. 11/18/09.
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15 Awesome Comments So Far

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  1. Name (required)
    January 11, 2014 at 2:52 am #

    The federal government is not going to give up on this issue anytime soon. To do so would be to admit that their foolish war on drugs has failed miserably.

  2. nirvana
    November 25, 2013 at 12:54 am #

    I agree that all medications if used incorrectly can be harmful but I do believe also to educate young people is the best way to avoid abusing medical marijuana by the help of professional doctors.

  3. Tommy
    November 17, 2013 at 8:15 pm #

    One of my very good friends smoked marijuana about a month ago recreationally to try it for the first time. She’s super “by-the-book”.

    After I was chatting with her, she told me about a running injury that she had and that the marijuana cured her for about 3 days afterwards. The docs prescribed all these meds that weren’t even 0.1% effective as the marijuana.

    So, if used responsibly, just like anything else, it can really help people.

    • John Lynch
      November 18, 2013 at 11:00 am #

      This is anecdotal information that frankly dilutes the arguments for medical marijuana. Without knowing the type of injury involved, I find it hard to believe that smoking a joint helped with her injury. It doesn’t have any therapeutic effect on acute injuries like that. It may have temporarily distracted her from her pain, but for three days?

      Let’s just stick what the verifiable evidence demonstrates – you know, the scientific method. All silly claims like this do is play into the hands of those who’d deny it has any legitimate medical uses.

      • Tommy
        November 18, 2013 at 12:26 pm #

        I am in no position to judge your expertise, John, and while my real life example is anecdotal, there is truth behind it. She wasn’t just “smoking a joint” as you so eloquently put it, but something is to be said about a user completely ignorant of it’s uses to be able to tell me how she felt in comparison to all the pills the doctors were pushing on her.

        On the same token, I misspoke and dubbed it a “cure”. It’s not a cure. Whether it’s marijuana, opiods, or Root Beer, proper management is key, and even that can cause harm.

        Personally, I don’t believe in just using science as the “end-all-be-all” to support claims of whether something works or not. While it does substantiate claims, most take it to an extreme (i.e. “Is there a God?”) and I disregard them as much as I do wild conspiracy theorists.

        Again, this is just my opinion and not directed towards you.

  4. marijuana seeds
    October 30, 2013 at 1:33 am #

    The facts simply don’t support the public perceptions. We ought to be really worried about the legal opioid drugs that young people are actually overdosing on and not those that absolutely no one overdoses on.

    • John Lynch
      October 30, 2013 at 6:13 pm #

      Amen, brother, but I think I already said that. I guess I’m not surprised you agree given your handle…:-)

  5. LondonReal
    September 27, 2013 at 8:58 am #

    Thanks for the useful information.I have learned a lot about drugs especially marijuana from this blog. My first encounter with these ideas was Adam Scorgie’s – The Union, he is on London Real this week talking about “The Culture High” have you heard of it!

  6. Greg P. Morrisson
    May 28, 2013 at 8:59 pm #

    I agree.. The number of people who are abusing painkillers is growing which is already alarming. Percocet, for example is one of the medications that are most commonly abused.

    • John Lynch
      November 18, 2013 at 11:14 am #

      You’re vituperative comments are as baseless as Tommy’s claim of marijuana helping with an acute injury. If you read the article, you won’t find the word “cure” anywhere in it. I’m not a big believer in cures for most medical conditions – management is the better mental construct. Forget cures – there’s no cure for cancer and probably never will be. But you can manage it better and, hopefully, keep it in remission.

      Simply declaring “IT IS NOT GOOD 4 YOU” doesn’t make it so, even if you put it all in caps. Show me some evidence. And accusing others who don’t share your bias of lying is, well, pretty lame.

      If opioids are so safe, why are they killing more Americans than heroin and cocaine combined? You say “when used properly”, but the evidence shows they’re harmful even when used properly. I provided evidence of their cancer-promoting properties and of anesthesiologists stopping their use because of this concern. Where’s your evidence to the contrary?

      Of course there are stoners who might justify your stereotype. Apparently you’ve known some. But this post is about medical use, not recreational use. Get off your high horse and do some homework before spouting off like just another internet troll with a bad attitude.

  7. online head shop
    May 2, 2013 at 9:31 am #

    great read, things are improving slowly. wish it would speed up though.

  8. Darian
    February 5, 2013 at 10:19 pm #

    Marijuana and Opioids are like other drugs that can cure but, if abused, their side effects can be severely harmful to individuals. The problem is the public is very aware of the harmful effects of these drugs but has less knowledge about their benefits to human health. I guess others find legalizing marijuana a solution.

    • Randy
      March 26, 2013 at 12:34 am #

      All medications if used incorrectly can be harmful, marijuana is not an exception. It’s always been debated whether to legalize marijuana or not.

      • John Lynch
        March 26, 2013 at 7:05 am #

        Thanks for commenting, Randy. Yes, all medications can be harmful, but not just when used incorrectly. Many can cause harm even when used exactly as prescribed. Opioids clearly fall into that category.

        As for your second comment, this post isn’t about legalizing marijuana – at least not for recreational use. It’s about legalizing it for its proven medical applications. There’s a huge difference that needs to be better understood.

        Merging the two only confuses the public and perpetuates the denial of a potentially helpful medication to millions of Americans while continuing to subject them to the dangers of opioid medications.

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