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Can expanding the state’s medical cannabis program help curb the opioid crisis?

Glen Stubbe/Star Tribune via AP

As Illinois officials search for new ways to combat an opioid epidemic that continues to claim a growing number of lives, state Sen. Don Harmon, D-Oak Park, is pushing new legislation that would expand the state’s medical cannabis program to give people who have been prescribed opioids a different option for treating their pain.

After hearing testimony last spring from medical cannabis patients, Harmon learned they were experiencing fewer side effects than they had while taking opioids — and that medical cannabis was actually giving them “a pathway out of opioid use.”

Now, new research appears to show that the use of medical cannabis can result in lower rates of opioid prescriptions.

States with legal medical cannabis programs — including Illinois, which has a medical cannabis “pilot program” — had more than 2 million fewer daily doses of opioids prescribed each year under Medicare Part D than in states that hadn’t enacted similar laws, according to a pair of studies published Monday in the journal JAMA Internal Medicine.

The studies also found that prescriptions for all opioids dipped by 3.7 million daily doses per year when medical cannabis dispensaries opened.

Harmon’s bill, called the “Alternatives to Opioids Act,” would expand Illinois’ medical cannabis pilot program to give people who have been prescribed opioids the opportunity to obtain a medical cannabis card that would remain valid for 12 months.

State Sen. Don Harmon (pictured on March 27, 2017) hopes the bill can “limit the problem” of opioid abuse in the state. | Ashlee Rezin/Sun-Times

Last month, the measure passed the Senate Executive Committee 16-1, and “the odds of it passing out of the [full] Senate are excellent,” said Harmon, who is confident the bill can also get through the Illinois House.

Harmon hopes the bill can “limit the problem” of opioid abuse in the state. However, he admits the Legislature hasn’t been proactive enough in reacting to the rising tide of the “calamitous” opioid problem.

In 2016, the state tallied 1,946 opioid deaths, according to provisional data compiled last November by the Illinois Department of Public Health. The rise in synthetic opioids, like fentanyl, and opioid analgesics, such as oxycodone and hydrocodone, has resulted in opioid deaths “rising dramatically” as the state tallied 1,072 such fatalities in 2013, the agency said.

“It certainly does seem to have grown out of control,” according to Harmon, who views the expansion to the cannabis program as a “commonsense solution.” As for critics of legal cannabis use, Harmon said: “I know a lot of people are dying from heroin and opioid overdoses, and I don’t know of anyone who has died from a cannabis overdose.”

Zoë Rosenbaum said she used cannabis to overcome an addiction to opioids that stemmed from serious injuries she suffered when she was ejected from a vehicle in a rollover crash that happened during her freshman year at the University of Colorado-Boulder in 2008.

Rosenbaum, now a graduate student at the Chicago School of Professional Psychology, suffered a traumatic brain injury, broken spine, shattered scapula and multiple cracked ribs. As a result, she was prescribed a cocktail of opioids, including OxyContin, as well as Xanax, a powerful benzodiazepine typically used to treat anxiety.

Zoë Rosenbaum | Provided photo

In 2009, she applied for a medical cannabis card in Colorado, a state that has since legalized cannabis for recreational use. She was almost immediately approved.

Nevertheless, Rosenbaum’s battle with opioid dependency continued until 2012, when she entered a drug rehabilitation center in California in the hopes of finding a better way to manage her pain. During her three-month stay, she was able to kick the opioids.

“Cannabis was really the only substance that truly helped with my residual body aches and pains,” Rosenbaum said. “I have not used any opiates since entering the treatment program in 2012, and I have cannabis to thank for that.”

Rosenbaum was able to obtain a medical cannabis card in Illinois when she returned to complete her graduate studies, but she noted that the process of getting one was far more difficult than it had been in Colorado. She agrees with Harmon’s plan to expand the program.

Cannabis “should absolutely be offered by doctors instead of opiates,” she added.

Dr. Jay Joshi, a nationally recognized anesthesiologist and interventional spine and pain management physician who practices in Vernon Hills, said he agrees with many aspects of Harmon’s bill, but holds that both cannabis and certain opioids are tools that should be used as part of individual treatment plans devised by board-certified, fellowship-trained pain management physicians.

The current opioid scourge, which Joshi dubbed an “epidemic of stupidity,” was in his view initially driven by complicit or unaware health care professionals from major universities who were influenced by certain pharmaceutical companies peddling false information.

The problem has been exacerbated by insurance companies forcing physicians to prescribe cheaper, more dangerous alternatives to brand name medications, Joshi said.

In order to avoid creating a similar crisis, Joshi said the state should continue to strictly regulate its medical cannabis program and require patients to be treated by “true experts.”

“We made the mistake of allowing people who are not experts in pain management, such as family practitioners, surgeons, neurologists, psychiatrists and non-fellowship-trained anesthesiologists, to overprescribe poor opioid molecules and technologies,” Joshi said. “Let’s not make a similar mistake and allow medical cannabis certification for patients who do not need it.”

In addition, Joshi voiced concern about the 12-month medical cannabis card that patients would be granted under Harmon’s proposal, noting that some people prescribed opioids won’t need to take them for nearly that long. He suggested the cards should be offered exclusively to patients who are candidates for extended release opioids.

According to Joshi, medical cannabis in Illinois should be used for the treatment of “pain severe enough to require daily, around-the-clock, long-term opioid treatment, and for which alternative treatment options are inadequate.”

Harmon noted that members of the Senate are considering whether to tailor the card length set forth in the bill. However, he added, anyone who would be looking to get into his proposed program would need a doctor’s approval, so much of the responsibility in determining whether a person should be prescribed cannabis would fall to health care professionals.

Harmon claimed the state’s medical cannabis pilot program has “worked well” despite being hampered by Gov. Bruce Rauner’s “overly cautious” administration, which has rejected many previous proposals put forth by an advisory board to introduce new conditions.

Harmon said he hadn’t spoken to Rauner about his proposed expansion to the program. Rauner’s office didn’t immediately respond to a request for comment on Harmon’s bill.

State Sen. Don Harmon and Dr. Jay Joshi will join a group of experts April 9 for a panel discussion at the Chicago Reader’s “Medical Cannabis 101” event at mHub, 965 W. Chicago Ave. Click here for information about the event.