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Hemp 108: Can CBD help fight the opioid epidemic?

Posted by ROBERT KOSSACK on
In Hemp 108, we discuss how Big Pharma resorted to false advertising and doctor incentives to corruptly flood America with an oversupply of opioids and how CBD can help fight the opioid epidemic.

Marijuana is small potatoes compared to opioids.
Battling marijuana is too small potatoes to be worth anyone's while in consideration of what is really important when it comes to the dangerous drug scene.  Opioids kill . Marijuana doesn’t.  In 2015, the National Institute on Drug Abuse estimated two million people in the United States suffered from a prescription opioid pain reliever substance use disorder.  In 2016, America’s opioid overdose deaths exceeded 59,000.  From July 2016 to September 2017, opioid overdoses increased 30 percent in 52 areas in 45 states.  Opioid related deaths are now this nation’s leading cause of death for people under age 50.  The number of cannabis overdose deaths in 2016 remained constant at 0.  To repeat, marijuana, CBD, and all other cannabis related overdose deaths remained constant at ZERO.

Opioid overdoses are the primary cause of death among young people in America.

Opium is probably the oldest medical remedy.  It’s first known cultivation was in Mesopotamia by the Sumerians in approximately 3400 BCE.  They called it “hul gil” for "joy plant."  Growing hemp in China dates from around 5000 BCE, and by 2737 BCE, the legendary Chinese Emperor Shen-Nung listed cannabis as one of the Chine medicine's 50 “fundamental herbs."  If cannabis-based medical remedies are safe and can replace opioids, then their wide distribution should be highly encouraged.


Chinese Emperor Shen-Nung considered cannabis one of Chinese medicine's 50 fundamental herbs.

As opposed to opioids, cannabis is the safest medical remedy known to man.  As explained in Hemp 102 and 103, cannabis was not outlawed because it was dangerous but because of political and prejudicial reasons.  In nearly 5000 years of use, there have been no confirmed deaths as a result of smoking or ingesting any form of cannabis.

On September 6, 1988, DEA Administrative Law Judge Francis L. Young ruled marijuana cannot induce a lethal response as a result of drug-related toxicity.  Researchers would later discover this is because cannabis does not affect the areas of the brain that control the heart and lungs.

In a 1988 ruling, DEA Administrative Law Judge Francis L. Young found as a matter of fact,

“Nearly all medicines have toxic, potentially lethal effects.  But marijuana is not such a substance.  There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality.

“This is a remarkable statement.  First, the record on marijuana encompasses 5,000 years of human experience.  Second, marijuana is now used daily by enormous numbers of people throughout the world.  Estimates suggest that from twenty million to fifty million Americans routinely, albeit illegally, smoke marijuana without the benefit of direct medical supervision.  Yet, despite this long history of use and the extraordinarily high numbers of social smokers, there are simply no credible medical reports to suggest that consuming marijuana has caused a single death.

“By contrast aspirin, a commonly used, over-the-counter medicine, causes hundreds of deaths each year.

“Drugs used in medicine are routinely given what is called an LD-50.  The LD-50 rating indicates at what dosage fifty percent of test animals receiving a drug will die as a result of drug induced toxicity.  A number of researchers have attempted to determine marijuana's LD-50 rating in test animals, without success.  Simply stated, researchers have been unable to give animals enough marijuana to induce death.

“At present it is estimated that marijuana's LD-50 is around 1:20,000 or 1:40,000.  In layman terms this means that in order to induce death a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette.  NIDA-supplied marijuana cigarettes weigh approximately .9 grams.  A smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about fifteen minutes to induce a lethal response.

“In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity.”

See J. Young, In the Matter of Marijuana Rescheduling Petition, Docket No. 86-22, Opinion and Recommended Ruling, Findings of Fact, Conclusions of Law and Decision of Administrative Law Judge, Sept. 6, 1988, http://www.ccguide.org/young88.php.

Judge Young then required marijuana be reclassified a Schedule II drug.  To be a Schedule I drug there must be “a lack of accepted safety for use of the drug or other substance under medical supervision.”  See 21 U.S.C. § 812 (b)(1)(C).  Judge Young’s decision was overturned in part because “‘recognition of [the drug’s] clinical use in generally accepted pharmacopeia’--rested on a determination that marijuana lacked a known, reproducible chemistry.”  See Alliance for Cannabis Therapeutics v. DEA, 15 F.3d 1131, 1135 (1994).

One could say marijuana remains illegal because the government restricted cannabis research because cannabis was illegal. Meanwhile, the over prescription of perfectly legal opioids has been killing people by the tens of thousands.

The opioid epidemic was caused by false and unethical marketing practices, excessive opioid prescriptions, and an overabundance of opioid medications making their way into the black market.

To generate sales of prescription opioid-based pain relievers, a number of big pharmaceutical companies (Big Pharma) misrepresented their drugs by claiming they were safe and effective for a number of conditions for which their use was neither safe nor effective.  Big Pharma encouraged doctors to prescribe opioid drugs to people who really did not need the extent of the medication the opioid drugs offered.  Bonuses were paid to salespeople who sold the most opioid drugs.  Some doctors were paid off with cash or a variety of perks to recommend opioid-based medications.

Opioids designed for and approved by the FDA for one usage were encouraged to be prescribed for other uses.  For example, when the Oregon Department of Justice investigated the ailments for which the Insys Therapeutics manufactured fentanyl-based drug Subsys was prescribed, it found 78% of all pre-authorization forms submitted by Insys Therapeutics were for off-label uses.  Fentanyl is an extremely powerful, highly addictive, synthetic opioid meant to be prescribed to terminally ill cancer patients where dosages are carefully measured and addiction is not a concern.


Fentanyl is an exceedingly dangerous opioid, is far more potent that heroin, and is responsible for a spike in opioid-related deaths.  Most illegal fentanyl is smuggled in from China.  A small amount of fentanyl is often mixed with a base to make fake OxyContin or fake heroin, but any error in the mixture can result in death.

Most people who die from an opioid overdose first became addicted to opioids by taking prescription medications received from friends or family or as prescribed by their doctor.  According to the National Institute on Drug Abuse, from 2002 to 2012, people who had already begun to take prescription opioid-based pain relievers were 19 times more likely to begin taking heroin.  Interviews conducted from 2008 to 2009 found 86 percent of drug users who were mainlining (injecting drugs directly into their veins using a hypodermic needle) heroin or crushed opioid-based pain pills, such as OxyContin, had previously used prescription opioid-based medications.  In the 1960's, 80 percent of all opioid addicts began with heroin.  By the 2000's, 75 to 80 percent of all opioid addicts began with prescription medications.


OxyContin made by Purdue Pharma was an often prescribed opioid pain reliever that got tens of thousands of people hooked on opioid medications.

Some pharmaceutical wholesalers were shipping opioid prescription drugs to regions of the country where most of the pills being delivered were obviously being disbursed out of the area.  These excessive opioids made their way into the black market as evidenced by the number of drugs delivered being enough to treat an area with a hundred times the population.  This degree of opioid drug distribution was welcomed by Big Pharma because they were only interested in the flow of dollars.  The present opioid epidemic was caused by Big Pharma and the doctors prescribing their opioid-based pain medications, not by the neighborhood heroin pusher who only came into play when the prescription medications ran out, and the habit remained.

The battle against the opioid epidemic has remained at a standstill because of political alliances to Big Pharma.

United States Attorney General Jeff Sessions appears from time to time to gear up the Department of Justice to go after marijuana, but all such threats have petered out to nothing as they should.  Under the Controlled Substances Act, the Attorney General could reschedule a drug if he finds it does not meet the criteria for the schedule to which it has been assigned.  See 21 U.S.C. § 811(a).  This Sessions and every attorney general before him have failed to do for political reasons, but now a vast majority of Americans believe pot should be completely legal.


Attorney General Jeff Sessions will need change his attitude about cannabis if he expects to offer a viable alternative to opioid-based pain medications.

Sessions has used the power of his office to hold up cannabis research.  On August 11, 2016, the DEA finally announced it would no longer require all cannabis for scientific research be grown at the University of Mississippi, and the DEA began to accept applications from prospective private growers.  Twenty-six farmers applied with the DEA to grow cannabis for research purposes, but Sessions intervened in the application process causing none of the applications to be granted causing them to remain in limbo for going on two years.  The DEA refuses to inform the applicants of the status of their applications.  In April 2018, Senators Orrin Hatch (R–UT) and Kamala Harris (D–CA) asked the DEA for a timeline for processing the farmer’s applications, but they received no response.


United States Senator Kamala Harris (D-CA) has signed on as a co-sponsor of the Marijuana Justice Act that would make marijuana legal on the federal level.  Upon announcing her decision, Harris tweeted, “Making marijuana legal at the federal level is the smart thing to do and it’s the right thing to do.”

The Hatch-Harris letter reminded the DEA, "Expanded research [on the medical benefits of cannabis] has been called for by President Trump's Surgeon General, the Secretary of Veterans Affairs, the FDA, the [Centers for Disease Control], the National Highway Safety Administration, the National Institute of Health, the National Cancer Institute, the National Academies of Sciences, and the National Institute on Drug Abuse . . . . In order to facilitate such research, scientists and lawmakers must have timely guidance on whether, when, and how these manufacturers' applications will be resolved."

Apparently the Hatch-Harris letter made no difference to the DEA when Sessions, who said, “good people don’t smoke marijuana” and marijuana is “in fact a very real danger” is in charge.


The Native American Paiute Tribe’s Las Vegas Dispensary is the largest cannabis dispensary in the world, but according to present federal law, not a single gram of cannabis to be found there satisfies the requirements needed for the cannabis to be used in federally approved cannabis research.

One might think cannabis researchers could simply walk into the nearest recreational marijuana dispensary and buy all the marijuana they need, but according to federal law, researchers who experiment with cannabis products for human consumption must comply with federal regulations, and those regulations only allow them to source their cannabis from Mahmoud ElSohly at the University of Mississippi.  ElSohly operates under contract with the National Institute on Drug Abuse (NIDA), and ElSohly’s cannabis does not satisfy every researcher’s requirements.  No other drug research requires all pharmaceutical companies and academic institutions to source their ingredients from one person holding a federal monopoly.  So unless Sessions allows more growers to be approved, researchers are simply out of luck, and the public suffers as a consequence.  At a campaign rally in Sparks, Nevada on Oct. 29, 2015, Trump said, ‘I know people that are very, very sick, and for whatever reason the marijuana really helps them . . .” Trump has come out in favor of medical marijuana and has admitted it helps a lot of people, but Sessions has stood in the way of medical marijuana research.


President Donald Trump has made public his disagreement with Attorney General Jeff Sessions recusing from the Russia investigation, but Trump has not made public his disagreement with Sessions attacking medical marijuana.

As Sessions has stifled medical marijuana and industrial hemp research, the battle against the opioid epidemic has remained at a virtual standstill.  Congress and the President have been slow to take action to fight the opioid epidemic because it was caused by the reckless neglect, if not the intentional misconduct, of Big Pharma who protected themselves through large campaign contributions to corrupt politicians.  In addition to the pharmaceutical industry, Sessions has received campaign contributions from Big Tobacco and the private prison industry, both of whom have a vested interest in keeping marijuana illegal.


The private prison industry has given money to politicians to keep marijuana illegal just so they can make more money locking people up.  In a ten-year period, Corrections Corporation of America spent $17.4 million on lobbying efforts and stated in its 2014 annual report, “. . . any changes with respect to drugs and controlled substances . . . could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities.”

President Trump has failed to lean on Big Pharma.

Donald Trump was sworn in as President on January 20, 2017.  In 2017, another 64,000 people in the United States died from opioid drug overdoses.  Fourteen months after taking office, on March 19, 2018, Trump came up with a simplistic answer which attributed the opioid epidemic to foreign drug cartels and street-side pushers rather than big corporate pharmaceutical executives and their opioid-drug-pushing salesman.  Trump reiterated his support for a southern border wall and proposed the death penalty for “big pushers.”  “If we don't get tough on the drug dealers, we are wasting our time," Trump said, but his speech showed a deep misunderstanding who those drug pushers really were.  Trump inevitably sat among some of them when he met with the Big Pharma CEOs eleven days after taking office.


On January 31, 2017, Trump met with the heads of the major American pharmaceutical companies.  The press was excluded from the actual meeting.  Despite Trump’s tough talk, by all accounts the meeting turned out to be nothing more than a friendly chat.

The stated purpose for Trump’s January 31, 2017 meeting with the Big Pharma CEOs was so he could look them sternly in the eye and pressure them into lowering drug prices.  Trump had previously faulted the law forbidding the government from being able to negotiate the price of drugs purchased by Medicare and Medicaid, and Trump said he was going to change the law if the drug companies failed to voluntarily lower prices.  Trump spoke often about rising drug prices calling them “astronomical,” and he accused Big Pharma of “price-fixing,” but when Trump was elected President and sat down with all the Big Pharma CEOs, he apparently caved.  For more than another year, Trump never mentioned governmental intervention in drug pricing, and then only in passing.  According to Amgen CEO Robert Bradway, all they did at Trump’s meeting with the Big Pharma CEOs was talk “about the need for all of us to work together to address making medicines affordable and accessible to people who benefit from them and need them.”  The overly large release of opioids into the American market by Big Pharma was never discussed.


The mortality rate due to opioid overdoses are not uniform throughout the country.  In this map, the more red the county, the higher the opioid-related death rate.

Trump won West Virginia over Hillary Clinton by a huge margin, 68% to 26%, but he then failed to address West Virginia’s biggest killer.  By February 2018, a congressional investigation found two large prescription drug wholesalers, Miami-Luken and H.D. Smith, had over a period of ten years shipped 21 million opioid prescription painkillers to two pharmacies in William, West Virginia, a town with a population of only 2,900 people.  That equates to a 60 count opioid pain pill prescription for every single person living in William for every single month of the year for ten years.  In Kermit, West Virginia, with a population of only 392 people, a single pharmacy received 9 million hydrocodone pills over a period of two years.  That equates to 31 hydrocodone pills per person per day in Kermit which is more than enough opioid narcotic medication to kill everyone in Kermit every single day before noon if most of those pills did not make their way into the black market to be illegally sold for profit throughout the remainder of state.  According to the Centers for Disease Control and Prevention, in 2016, West Virginia had the highest drug overdose death rate of all the states with 43.4 deaths for every 100,000 residents.  By way of comparison, in 2016,West Virginia suffered 5.9 deaths by homicide and 15.0 deaths from fatal car crashes for every 100,000 residents.


In 2016, the state of West Virginia had the highest opioid death rate at 43.4 deaths per 100,000 residents compared to the national average of 13.3 deaths per 100,000 residents.

No executives at any Big Pharma manufacturer or distributor have been criminally charged with a serious federal crime with the October 2017 exception of John Kapoor, the billionaire founder and former CEO of Insys Therapeutics, and a gang of six other Insys Therapeutics executives who, among other things, were federally indicted for bribing doctors to prescribe a spray version of fentanyl, a highly addictive, highly concentrated opioid designed for terminally ill cancer patents and now responsible for a great number of opioid deaths.  Kapoor and his executives are accused of acting in furtherance of a scheme to bribe doctors to prescribe fentanyl to non-cancer patients.


Former CEO of Insys Therapeutics, John Nath Kapoor, awaits trial on charges of conspiracy to commit wire fraud, conspiracy to violate the federal anti-kickback statute, and a Racketeer Influenced and Corrupt Organizations Act (RICO) conspiracy.

The Insys Therapeutic executives only represent a drop in the Big Pharma corruption bucket, and until that bucket is emptied, the true masterminds behind the opioid epidemic will avoid prosecution.

Several states have led the charge against Big Pharma.

Discouraged by the lack of federal action against Big Pharma executives, on January 23, 2018, New York City Mayor Bill de Blasio announced the City of New York had filed a lawsuit against big drug manufacturers (like Purdue Pharma and Johnson & Johnson) and major drug distributors (like McKesson and Cardinal Health) that manufacture and/or distribute opioid prescription drugs.  New York City’s lawsuit blames Big Pharma for participating in deceptive marketing, distributing large amounts of opioids in New York City, and causing opioid addiction and overdose, causing the city to need spend millions of dollars addressing the addiction problems through law enforcement, emergency medical services, and substance abuse treatment programs.  According to Mayor de Blasio, “It’s time for Big Pharma to pay for what they’ve done.”


On January 23, 2018, New York City Mayor Bill de Blasio announced the City of New York had sued Big Pharma.

On February 19, 2018, Kentucky Attorney General Andy Beshear filed a civil lawsuit against Ohio-based Cardinal Health for distributing excessive amounts of opioids in Kentucky and failing to report the suspiciously large shipments as required by law to “reap a windfall off the wave of addiction.”



These suits take time.  In 2014, Chicago sued Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc., Endo Health Solutions Inc. and Actavis plc.  Chicago Mayor Rahm Emanuel said at the time, “For years, Big Pharma has deceived the public about the true risks and benefits of highly potent and highly addictive painkillers in order to expand their customer base and increase their bottom line.  This has led to a dramatic rise in drug addiction, overdose and diversion in communities across the nation, and Chicago is not immune to this epidemic.”  Chicago’s suit is still simmering in court after having generated more than 10 million pages of documents.  So the time when Big Pharma need actually pay for what it has done, if at all, may be years away.


On February 14, 2018, Chicago Mayor Rahm Emanuel announced Chicago was suing AmerisourceBergen Drug Corp., Cardinal Health Inc., and McKesson Corp.  The year before, Chicago spent $700,000 on opioid addiction treatment and services.  Chicago claimed the drug companies failed to “exercise due diligence to prevent the illicit distribution of pharmaceuticals.”   Photo credit Antonio Perez / Chicago Tribune.

Opioid prescriptions and opioid deaths have been reduced in states that have legalized medical marijuana.

In October 2014, Marcus A. Bachhuber, M.D., leading a team of researchers at the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, published in the JAMA Internal Medicine Journal an article entitled “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010.”  The study’s abstract states in pertinent part,

"Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain.  Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them.

* * * *

"Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999.  Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010.  States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate . . . compared with states without medical cannabis laws.  Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time . . . In secondary analyses, the findings remained similar.

"Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.  Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose."  See JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005.


Marcus A. Bachhuber, M.D., leading a team of researchers at the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, found medical cannabis laws are associated with significantly lower opioid overdose deaths.

A July 2016 study compared (1) the average numbers of daily opioid doses filled annually to treat pain per physician in states with medical marijuana laws with (2) the average number of opioid prescriptions in states without medical marijuana laws.  The study found the average number of daily opioid doses filled annually to treat pain per physician dropped an average of 1826 in states where medical marijuana was legalized.  That is 1826 less daily opioid doses annually per physician in states where patients could chose a cannabis-based alternative to an opioid-based pain medications.  See Health Aff (Millwood). 35(7):1230-6.


In a Canadian study, 63 percent of those who began using medical marijuana substituted marijuana for their usual prescription drug, especially if their prescription drug was opioid based.  See Int J Drug Policy. 2017 Apr;42:30-35. doi: 10.1016/j.drugpo.2017.01.011. Epub 2017 Feb 9.

In June 2017, a team led by Amanda Reiman, PhD, MSW, at the University of California at Berkeley and HelloMD released a survey conducted of 2897 medical cannabis patients.  Thirty-four percent of the patients had used opioid-based pain medications, and 64 percent of the patients had used a nonopioid-based pain medication within the preceding six months.

According to the survey:

97 percent of those surveyed who took an opioid pain medication “strongly agreed” or “agreed” they were able to decrease the amount of opiates they used when they also consumed cannabis;

81 percent of those surveyed who took an opioid pain medication “strongly agreed” or “agreed” taking cannabis without also taking opioids was more effective than taking cannabis with opioids;

71 percent of those surveyed who took an opioid pain medication “strongly agreed” or “agreed” cannabis produced the same amount of pain relief as their opioid medication;

92 percent of those surveyed who took an opioid pain medication “strongly agreed” or “agreed” they preferred using cannabis to opioids to treat their painful condition;

93 percent of those surveyed who took an opioid pain medication “strongly agreed” or “agreed” they would likely choose a cannabis based pain medication over an opioid based pain medication if the cannabis based remedy was more available;

96 percent of those surveyed who took a nonopioid pain medication “strongly agreed” or “agreed” they did not take as much of their nonopioid pain medication when using cannabis; and,

92 percent of those surveyed who took a nonopioid pain medication “strongly agreed” or “agreed”, cannabis eased their pain better than their nonopioid pain medication.

See Reiman, Amanda; Welty, Mark; Solomon, Perry: “Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report;” Cannabis and Cannabinoid Research, Vol. 2, No. 1; Jun 2017; https://doi.org/10.1089/can.2017.0012.


Amanda Reiman, PhD, MSW, earned her BA in psychology from the University of Illinois Circle Campus, her Masters Degree in Social Work from Jane Addams College of Social Work, and her PhD in Social Welfare from the University of California.  A study she led revealed a lot of people preferred to switch from an opioid-based pain reliever to a cannabis based pain reliever.

In March 2018, the Journal of Health Economics published a research paper written at the Pardee RAND Graduate School by a team led by health economist David Powel.  According to the study entitled: “Do medical marijuana laws reduce addictions and deaths related to pain killers?” Powel’s team examined Medicare and Medicaid data and reported that in states where medical marijuana had been legalized, the number of daily doses filled for opioids was reduced, and there were reduced opioid overdose deaths.  Significantly, it was found that the less stringent the regulation of the medical marijuana dispensaries, the more noticeable the substitution of cannabis-based medications for opioid prescription medications.  Thus, the easier it is for patients to switch from opioid-based narcotics to cannabis-based remedies, the more likely patients will make the switch, and the more opioid overdose deaths will be avoided.  See David Powell, Rosalie Liccardo Pacula, and Mireille Jacobson, "Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?" Journal of Health Economics, Vol. 58, March 2018, 29-42.


David Powel is a health economist who has a PhD in Economics from MIT, a B.A. in Applied Mathematics from Harvard, and is on the Core Faculty of the Pardee RAND Graduate School.  A study he led revealed the easier it was to get cannabis based remedies, the more lives were saved from opioid overdose deaths.

In Hemp 109, we explore the effect Big Pharma is presently having on the Trump administration and how that has affected the battle against the opioid epidemic.

 

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