Medical marijuana helping users combat opioids in Minnesota, but some doctors have concerns
ST. PAUL - Katy Cummins-Bakko was wrapped in a haze that confined her to bed.
Her husband was downstairs in their St. Paul home with friends and she could hear the chatter of life, just out of reach. Her heart pulled toward the living room but she could not join them.
It was not her connective tissue disease, which can trigger pain or dislocation with each step, that kept her bedridden. It was the nearly 200 milligrams of OxyContin and Oxycodone she took each day to treat it.
“It just went through my head — hearing my family living without me — that (the pills were) going to kill me,” Cummins-Bakko said. “And I just started sobbing. I was like, ‘I can’t do this.’ ”
She had heard that medical marijuana could also provide pain relief. Would it work for her?
Many Minnesotans in pain are using medical marijuana to leave behind highly addictive opioids, which can have grave consequences. It is not just happening here — states like New York and Pennsylvania have recognized marijuana as an alternative to opioids.
But some doctors are skeptical of the science behind the switch; opioids have been tested and approved by regulators, while medical marijuana in most cases has not. Plus, there is little research to back up its supposed health benefits.
In Minnesota, medical marijuana is available only in the form of processed pills, liquids and vaporizable oils. These drugs are costly and not covered by insurance.
Prescription opioids, on the other hand, are affordable and easy to get. But they can be deadly if abused. There were nearly 400 opioid overdose deaths in Minnesota in 2016, and about half of those came from prescription abuse.
There are more than 15,000 patients in Minnesota’s medical cannabis program. Almost two-thirds of them use the drug to treat intractable pain.
A Department of Health survey of some intractable pain patients found that 64 percent of those who were on opioids when they entered the program were able to reduce their intake or wean off them after six months.
“A large proportion of patients report that they find a relatively high degree of benefit,” said Dr. Tom Arneson, research manager for the Office of Medical Cannabis. “But we still don’t know very well what exactly we’re doing. ... There needs to be a heck of a lot more research.”
Signs of success
To Cummins-Bakko, the evidence is clear — marijuana saved her life.
She enrolled in the medical cannabis program and weaned off her opioids over the next several months.
Marijuana has given her the pain relief of opioids without the fog that can come with them. The drug eases the back and hip pain brought on by her Ehlers-Danlos syndrome, a condition that makes her joints overly flexible and her skin fragile and stretchy.
She is sticking with medical marijuana despite its high price tag — it costs her almost $700 per month.
“Being on narcotics and being doped up is the worst feeling. It’s like swimming through Jell-O all day every day,” Cummins-Bakko said. “With cannabis, you’re totally present. You know what’s going on.”
The conversation about marijuana and opioids is catching on in medical and research circles across the country. Two studies published last year found that fewer opioid prescriptions were filled in states with medical or recreational marijuana laws on the books.
Some studies even suggest that marijuana could help treat opioid addiction by reducing cravings and withdrawal symptoms.
This has prompted states like New York and Pennsylvania to legalize the use of marijuana for those who have opioid-abuse disorder.
New York went even further last summer, establishing “opioid replacement” as a qualifying condition for its medical marijuana program. Patients who have any condition for which an opioid could be prescribed can opt to use marijuana instead.
"Medical marijuana has been shown to be an effective treatment for pain that may also reduce the chance of opioid dependence," New York State Health Commissioner Dr. Howard Zucker said at the time, calling the move a “critical step in combating the deadly opioid epidemic.”
A tough sell for doctors
Not all are sold on the switch.
Opioid-abuse disorder was pitched as a new qualifying condition for Minnesota’s medical marijuana program last fall, but it was not approved.
Doctors opposed the addition, according to the Minnesota Department of Health. They argued that other drugs have been proven to treat opioid-abuse disorder and the addition of medical marijuana might confuse patients.
Some researchers have found that cannabis use can increase the risk of opioid use.
There is relatively little research on the effects of marijuana because of its federal classification as a Schedule I drug. Schedule I drugs are defined as having high potential for abuse and no accepted medical use.
Researchers who want to study these substances face procedural hurdles. They must register with the U.S. Drug Enforcement Administration and disclose their qualifications, research protocol and where the study will take place.
The lack of research leaves some medical professionals wondering what could be, and others doubtful.
“The science, we don’t know a lot about,” said Dr. Douglas Wood, president of the Minnesota Medical Association. “People have been clamoring for the federal government to relax its restrictions for awhile because we could certainly benefit from much more research.”
Dr. Charles Reznikoff is an addiction medicine doctor at Hennepin Healthcare in Minneapolis, where he treats patients addicted to opioids. He is also a member of the state medical cannabis task force.
Reznikoff said that he and other doctors look at marijuana with skepticism. While the drug is “in almost all cases” safer than opioids, he said there is too little evidence to show it can replace their role in pain relief.
“For those who are not addicted to opioids … my guess is that some of them are going to be able to … get off opioids using medical cannabis, and some of them are not,” Reznikoff said. “Rigorous, meaningful medical outcomes — we just don’t have those.”
For Dr. Adam Locketz of Timewise Medical, the evidence lies in his clinics in Lake Elmo and Hibbing. He has certified about 2,800 patients for the medical cannabis program. Hundreds of them have used the drug to alter their medication lists, he said.
“I hear just dramatic positive success stories,” Locketz said.
‘Losing a generation’
Joan Barron has taken opioids for 18 years, ever since she fell off the front steps of her home during an ice storm and damaged the main motor and sensory nerve in her pelvis.
Since entering the medical cannabis program, the Ramsey resident has cut her opioid use down from 240 milligrams of Methadone per day to one 10-milligram tab.
The less Methadone that Barron takes, the less she has to think about what it did to her son Adam.
He was in 11th grade at the time of her fall and had been showing signs of depression. It was not until later that she realized he had been stealing from her medicine cupboard.
Her opioids were Adam’s gateway drug.
His next drug was heroin.
After years of struggling with addiction, Adam’s life ended in the basement of his mother’s home, when he stole her Methadone one last time and injected it into his arm.
To Barron, the choice between medical marijuana and opioids is clear.
“My son did not go from cannabis to heroin. He went from my … opiates to heroin, and he died from those pills,” she said. “We are losing a generation to the opioid epidemic.”