If The Cannabis Industry Is Serious About Health Care, It Must Learn From The Opioid Crisis

America is in pain.

Opioids, once thought to be a “wonder drug” for curing pain, are now the driving force behind America’s most pressing health concern: addiction. The problem began in 1986 when doctors and health organizations began advocating for the use of opioids to treat chronic pain, according to the Mayo Clinic.

In the three decades since, opioid use has built to a full-blown, fever pitch crisis. From rural West Virginia to Chicago’s inner city, communities have been inundated with prescription pain killers and their illicit counterparts like heroin. One West Virginia town with 3,200 residents has been flooded with 21 million prescription painkillers in the last decade alone.

As a result of our health care system’s overreliance on opioids, there are an estimated 2 million Americans who are dependent on opioids. Between 1992 and 2012, opioid prescriptions rose from 112 million annually to 282 million. Opioids are the leading cause of death in people under 50. The spike in opioid addictions and deaths is driven in large part by the wanton disregard for the effects of prescription pain killers on the part of drug manufacturers and prescribing doctors.

Meet the movers and shakers in the cannabis space next month at the Cannabis Capital Conference.

Local Communities Fight Back

Communities are desperate to turn back the tide of opioid addiction. Florida, one of the states hit hardest by the crisis, with 14.4 deaths per 100,000 residents in 2016, is taking a novel approach.

In November, Florida Attorney General Pam Bondi announced a lawsuit against Walgreens Boots Alliance Inc WBA and CVS Health Corp CVS, accusing the of worsening the opioid crisis by overselling painkillers and failing to take precautions to prevent illegal sales. 

Florida added the two drugstores to an earlier lawsuit the state filed against Purdue Pharma, the maker of OxyContin, and several opioid distributors.

Florida’s lawsuit is part of a growing trend of communities seeking to hold pharmacies and drug makers responsible for the record opioid addiction rates across the country.

Shital Parikh Mars, the CEO of South Florida health services organization Progressive Care, argues that such lawsuits represent a grey area, because it is difficult to tell what constitutes a fraudulent prescription. But in the Florida case, it is apparent there is some responsibility on the part of pharmacies, she said. 

“When you have two or three patients coming as a group from some doctor hundreds of miles away, there are red flags. You can see that they’re not being honest about their disease state. They’re not talking to you about their care. They’re not concerned about the cost. They don’t want to use insurance. If you ignore those red flags and you’re just interested in making money, now you’re putting people at risk. And that’s when you’ve got to hold people’s feet to the fire.”

CVS spokesman Mike DeAngelis dismissed the charges.

“CVS has taken numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic," DeAngelis said in a statement, according to CNBC.

If the lawsuits against drug makers and pharmacies are successful, they could mark a watershed moment in the fight against opioid addiction by removing financial incentives for doctors to liberally prescribe painkillers and reducing the number of pills available in communities.

Addressing Underlying Issues

Help can’t come soon enough. According to a new report in the American Journal of Public Health, opioids will be responsible for 510,000 deaths in the next decade.

Simply removing painkillers from the equation doesn’t solve the underlying problems that are fueling opioid use.

The first problem is chronic pain. According to the CDC, 50 million Americans suffer from chronic pain, a leading reason for opioid prescriptions. As Vox argued earlier this year, opioids cannot be removed from the health care system. Patients who are dependent on opioids need to be safely weaned off, and doctors need to learn how to treat pain without them.

As some treatment centers are learning, marijuana use can help opioid addicts stay in treatment, where they can safely go through withdrawal and hopefully move on to non-opioid forms of treatment.

The second problem, though, is far more pernicious: the failure of the American health care system. People often talk about the burden of opioid addiction on the health care system. But the health care system in this country is a burden as well.

Too many citizens lack coverage, and many that do have insurance can’t afford the high deductibles that stand between them and care. It’s unsurprising that ultra-powerful pain killers are being overprescribed to treat patients with chronic pain. It’s a simple treatment to a complex problem: an alluring formula for corporate health care and understaffed hospitals. Treating chronic pain without opioids is a complex issue requiring trial and error to find the right mix of therapies.

In other words, treating chronic pain requires a personalized approach to health care. That’s something today’s system is not equipped to handle, and one of the reasons opioid pain killer use has exploded.

Making Patient-Centered Care Possible

Many companies and groups are aiming to solve the opioid crisis and change the impersonality of our health care system.

The startup PillPack is an online pharmacy that creates personalized doses of medicines in easy-to-use to use packages for customers. Amazon.com, Inc. AMZN recently purchased the company for nearly $1 billion, and part of the allure is that its proprietary technology “helps manage patient data and figure out how to balance meds together in safe doses for its customers,” according to TechCrunch.

Progressive Care's Parikh Mars sees Amazon’s PillPack acquisition as a sign of the future of health care. For the CEO, the future of health care has to be personal, not driven by the same bottom-line logic that helped fuel the opioid crisis.

“Technology should make health care more personal, not less,” she said. “We want it to be patient-centered care, not patient-burden care.”

The Role Of Cannabis

As more and more states legalize cannabis for recreational and medicinal use, the industry is poised to disrupt health care and the pharmaceutical industry in particular, as more and more people see the value of marijuana as an alternative to opioid use.

As a much safer alternative than opioids, marijuana could be a key stepping stone in mitigating the opioid crisis. If marijuana is legalized at the federal level, it would open up a flood of research funds that have otherwise been blocked by its status as a Schedule 1 drug.

But with opportunity comes challenges.

Hillary Blackburn, writing for Health Further, said that not everything to do with medical green is golden: the efficacy, dosing and side effects of cannabis were not taught to the nation's 308,000 pharmacists in school.

Part of this problem lies in the fact that the federal government considers marijuana to be as dangerous a drug as heroin, placing a barrier between the cannabis and health care industries.

There are signs the U.S. is moving toward federal legalization. If and when that occurs, the cannabis industry will need to ensure that it has learned the lessons of the opioid crisis.

If marijuana is going to be a part of our health care, the industry must focus on educating doctors, pharmacists and patients.

Medical marijuana could be one part of America's strategy to end the opioid crisis. Is the industry preparing to be better than those that came before it?

Related Links:

Cresco Labs Approved For Ohio's First Medical Marijuana Dispensary

FDA Snubs Mallinckrodt's Abuse-Deterrent Opioid Reformulation