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Stanford researchers find many dispensaries make harmful, unsubstantiated claims about medical cannabis and opioid use disorder

Jul 16, 2020

“On Suboxone?” asked a web-based advertisement from Pennsylvania’s Compassionate Certification Centers, the Keystone State’s self-proclaimed number-one resource for medical marijuana. “Get off the Suboxone and onto a healthier choice, medical cannabis.”  

The ad, aimed at Pennsylvania’s growing population of persons struggling with opioid use disorder, sought to take advantage of the disease’s new status as a qualifying condition for medical cannabis. But at the time it was released, it caught the ire of medical professionals and the Twitter-verse at-large

There have been no clinical trials proving the effectiveness of medical cannabis as a substitute for or adjunct to Suboxone or methadone, the two life-saving drugs for opioid use disorder, which are considered the gold-standard of treatment. And although there is a rich tapestry of anecdotal evidence showing the benefits of using marijuana as a harm reduction tool for problematic drug use, those in the industry who demonize proven medications are crossing a dangerous line at a time when overdose deaths continue to rise.

According to new research from Stanford postdoctoral research fellows Chelsea Shover and Noel Vest, and a large team of additional researchers, all of whom were from Stanford, with one additional collaborator from Washington State University, in states where opioid use disorder is deemed a qualifying condition for medical cannabis, local dispensaries are more likely to make misleading claims about marijuana as it relates to the problematic use of opioids. These claims, the researchers argue, are largely unregulated and could cause potential harm to patients.

“After I saw [the Compassionate Care Centers ad], I realized online ads would be a way to empirically examine how common that sort of messaging is,” Dr. Shover told the PotNetwork. “And so I convened a team to look at a TON of dispensary content.”

What Drs. Shover and Vest found was disturbing — that, in fact, many bad actors in the medical cannabis space are making unsubstantiated claims as to the effectiveness of the drug’s therapeutic benefits. It’s a particularly concerning situation, as the number of drug overdoses in America has been on the rise for the past few decades — with only a small plateau last year. In 2018 almost 70,000 people died of an overdose, with nearly 50,000 of those involving an opioid of some kind.

The industry has long touted cannabis as a cure for problematic opioid use, an idea which worked its way into the zeitgeist thanks to an oft-cited study by researcher Marcus Bachhuber. His work, which found a positive correlation between medical cannabis states and a decrease in opioid overdose deaths from 1999-2010, became the basis for numerous cannabis industry essays and advertisements.

But last year, a group of researchers from Stanford, led Drs. Shover and Keith Humphreys extended the analysis through 2017 and found that Bachhuber’s trend reversed. In short, the original study became the poster child for proving that correlation is not causation.

Shover, Humphreys, and their team deduced that medical cannabis legalization was not the solution to opioid overdose deaths. However, they stressed that didn’t mean there shouldn’t be medical cannabis in general. By then, however, the cat was out of the bottle, and the genie was out of the bag.

“There is no evidence that cannabis or any of its components can effectively treat OUD,” Dr. Shover said. “There is abundant evidence that FDA-approved medications for OUD reduce mortality. Any time people follow dispensary advice and try cannabis instead of evidence-based treatment for OUD, I'm concerned about increased risks of overdose or death, as well as delaying effective care.”

For the current study, Shover and Vest looked at 167 brands across seven states where opioid use disorder is considered a qualifying condition for medical cannabis. They also examined an additional 123 brands in adjacent states, finding that 39 percent more dispensaries claimed that marijuana could treat problematic opioid use in the former. Additionally, in states where opioid use disorder is a qualifying condition, 14 percent more dispensaries claimed that medical cannabis could replace medications like Suboxone and methadone, while 28 percent more said it could be used as an adjunctive therapy.

New Jersey, New York, and Pennsylvania were the biggest offenders, although the researchers do believe that state legislators did not intend for these outcomes when they made opioid use disorder a qualifying condition. Still, the trend is concerning, as the research claims, because it runs a significant risk of driving patients away from proven treatments. 

According to the research, the Food and Drug Administration has sent out only one warning letter, recorded in July 2019, which stated, “Cannabidiol [CBD] can also be used in conjunction with opioid medications, and a number of studies have demonstrated that CBD can in fact reduce the severity of opioid-related withdrawal and lessen the buildup of tolerance.” The Stanford study, which was conducted three months after the FDA warning, found that the offender still had online content making claims about opioid use disorder.

“Going forward, it seems to be up to the FDA to more strictly enforce the existing rules that prohibit making these kind of unsupported medical claims,” Dr. Shover told The PotNetwork. “And states considering adding OUD as a qualifying condition now have some empirical data on worrisome communication from dispensaries associated with that policy decision to consider alongside the real lack of evidence to support the policy in the first place.”

In the end, researchers warned that this issue was not limited to problematic drug use and runs the gamut of diseases from “Alzheimer’s disease to cancer, depression, diabetes, heart disease, obesity, Parkinson disease, and more.”

And, of course, COVID-19.

“After we'd submitted the study that came out yesterday, Keith [Humphrey’s] and I wrote a brief along the same lines about cannabidiol retailers making claims about curing COVID-19,” said Dr. Shover. “You name a serious illness or condition, and I can probably point to some dispensary claiming cannabis or cannabinoids can treat it.” 

“So this isn't just a problem with OUD,” she continued.

(Header Image from Twitter)

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