Teens abusing painkillers are more likely to later use heroin
July 8, 2019
Science Daily/University of Southern California
It's an unforeseen side effect of the nation's opioid epidemic: Adolescent heroin users.
A USC study in the July 8 issue of JAMA Pediatrics shows that teens who use prescription opioids to get high are more likely to start using heroin by high school graduation.
"Prescription opioids and heroin activate the brain's pleasure circuit in similar ways," said senior author Adam Leventhal, a professor of preventive medicine and psychology and director of the USC Institute for Addiction Science at the Keck School of Medicine of USC. "Teens who enjoy the 'high' from prescription opioids could be more inclined to seek out other drugs that produce euphoria, including heroin."
Leventhal said the study, conducted from 2013-2017, is the first to track prescription opioid and heroin use in a group of teens over time. In 2017, 9% of the nation's 47,600 opioid overdose deaths occurred in people under the age of 25, according to data from the Centers for Disease Control and Prevention. In addition to overdose, health risks of heroin use are devastating and include severe addiction, hepatitis C, HIV and other infections.
Using twice-yearly surveys to track high schoolers' use of various drugs, researchers followed 3,298 freshmen from 10 Los Angeles-area high schools through their senior year. Participants were asked about their previous and current use of prescription painkillers -- such as Vicodin, Oxycontin and Percocet -- to get high.
The researchers also asked the students if they used heroin or other substances like marijuana, alcohol, cigarettes, methamphetamine and inhalants. They made statistical adjustments to account for differences in family environment, psychological disposition, family history of substance use and other factors associated with nonmedical prescription opioid use.
Of the nearly 3,300 students in the study, 596 reported using prescription opioids to get high during the first 3.5 years of high school. The researchers found that prescription painkiller use made a big difference in who later used heroin: 13.1% of current prescription opioid users and 10.7% of previous prescription opioid users went on to use heroin by the end of high school. Only 1.7% of youth who did not use prescription opioids to get high had later tried heroin by the end of high school.
"Adolescents are sometimes overlooked in the opioid epidemic discussion," said first author Lorraine Kelley-Quon, a pediatric surgeon and assistant professor of surgery and preventive medicine at Children's Hospital Los Angeles and the Keck School of Medicine. "The association between nonmedical opioid use and later heroin use in youth is concerning and warrants further research and health policy interventions."
To further confirm their results, the researchers also evaluated whether marijuana, alcohol, and methamphetamine use were linked to later heroin use. But the association between prescription opioids and heroin use was stronger than the associations for heroin use with other substances.
"While we can't definitively conclude that there is a cause-and-effect relation, there may be something unique about opioid drugs that makes youths vulnerable to trying heroin," Leventhal said. "The results do not appear to be driven by the tendency of some teens to act out, rebel, or experiment with many types of drugs."
https://www.sciencedaily.com/releases/2019/07/190708112504.htm
What drives patients to use medical marijuana: Mostly chronic pain
New study seeks to understand whether people are using cannabis for evidence-based reasons
February 4, 2019
Science Daily/Michigan Medicine - University of Michigan
A new study seeks to understand whether people are using medical cannabis for evidence-based reasons.
Slowly but surely, the stigma surrounding marijuana use is losing its grip in the U.S. Since the 1990s, advocates have pushed for a re-evaluation of cannabis (the plant species name often used interchangeably with marijuana) as a viable treatment for a host of ailments. As of 2018, 33 states and the District of Columbia have approved the medical use of cannabis, while 10 states have legalized marijuana for recreational use. Despite this fact, at the federal level, marijuana remains a Schedule 1 drug under the Controlled Substances Act, defined as a drug with no currently accepted medical use and a high potential for abuse.
New research from the University of Michigan, published in the February issue of Health Affairs, takes a deeper dive into state medical marijuana registry data to provide more insight into its use.
"We did this study because we wanted to understand the reasons why people are using cannabis medically, and whether those reasons for use are evidence based," says lead author Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center.
He and his U-M colleagues Daniel J. Clauw, M.D., a professor of anesthesiology, medicine, and psychiatry and Rebecca L. Haffajee, Ph.D., assistant professor of health management and policy, as well as U-M alum Saurav Gangopadhyay, M.P.H., a consultant at Deloitte, sought out data from states with legalized medical use of marijuana.
To examine patterns of use, the researchers grouped patient-reported qualifying conditions (i.e. the illnesses/medical conditions that allowed a patient to obtain a license) into evidence categories pulled from a recent National Academies of Sciences, Engineering and Medicine report on cannabis and cannabinoids. The report, published in 2017, is a comprehensive review of 10,000 scientific abstracts on the health effects of medical and recreational cannabis use. According to the report, there was conclusive or substantial evidence that chronic pain, nausea and vomiting due to chemotherapy, and multiple sclerosis (MS) spasticity symptoms were improved as a result of cannabis treatment.
Evidence-based relief
One major finding of the Health Affairs paper was the variability of available data. Less than half of the states had data on patient-reported qualifying conditions and only 20 reported data on the number of registered patients. The authors also noted that the number of licensed medical users, with 641,176 registered medical cannabis patients in 2016 and 813,917 in 2017, was likely far lower than the actual number of users.
However, with the available data, they found that the number of medical cannabis patients rose dramatically over time and that the vast majority -- 85.5 percent -- of medical cannabis license holders indicated that they were seeking treatment for an evidence-based condition, with chronic pain accounting for 62.2 percent of all patient-reported qualifying conditions.
"This finding is consistent with the prevalence of chronic pain, which affects an estimated 100 million Americans," the authors state.
This research provides support for legitimate evidence-based use of cannabis that is at direct odds with its current drug schedule status, notes Boehnke. This is especially important as more people look for safer pain management alternatives in light of the current opioid epidemic.
Notes Boehnke, "Since the majority of states in the U.S. have legalized medical cannabis, we should consider how best to adequately regulate cannabis and safely incorporate cannabis into medical practice."
https://www.sciencedaily.com/releases/2019/02/190204172220.htm
Medical marijuana could reduce opioid use in older adults
Study shows up to 65 percent of older adults who use medical marijuana significantly reduced their chronic pain and dependence on opioid painkillers
May 1, 2018
Science Daily/Northwell Health
A study shows up to 65 percent of older adults who use medical marijuana significantly reduced their chronic pain and dependence on opioid painkillers.
A questionnaire of older men and women suffering from chronic pain who were given medical marijuana found that the drug significantly reduced pain and their need for opioid painkillers, Northwell Health researchers report.
The results of the study, "Older Adults' Use of Medical Marijuana for Chronic Pain: A Multisite Community-Based Survey," are scheduled to be presented May 3, 2018 at the annual meeting of the American Geriatrics Society in Orlando, FL.
To gauge how effective medical marijuana was at managing chronic pain and reducing opioid use, researchers surveyed 138 medical marijuana users with an anonymous 20-question survey focusing on how often they used the marijuana, in what form they took it, how much it reduced pain and whether or not they were able to cut back their use of other painkillers.
When patients were asked if they were able to curb their use of other painkillers after starting medical marijuana, 18 percent reported decreasing their use "moderately," 20 percent "extremely" and 27 percent "completely." An overwhelming number of subjects (91 percent) would recommend medical marijuana to others.
Comments from patients tell the tale:
"My quality of life has increased considerably since starting medical marijuana," one patient said. "I was on opiates for 15 years, and 6 months on marijuana, and off both completely."
Another patient said: "It [medical marijuana] is extremely effective and has allowed me to function in my work and life again. It has not completely taken away the pain, but allows me to manage it."
"I was on Percocet and replaced it with medical marijuana. Thank you, thank you, thank you," said another.
These patients had been living with chronic pain from osteoarthritis, spinal stenosis, hips and knees that could not be replaced, and pain not relieved by steroid injections, said Diana Martins-Welch, MD, a co-author of the study and physician in the Division of Geriatric and Palliative Medicine, Department of Medicine at Northwell Health.
Based on these results, she believes that medical marijuana could be effective in curbing the opioid epidemic now ravaging the United States. "What I'm seeing in my practice, and what I'm hearing from other providers who are participating in medical marijuana programs, is that their patients are using less opioids," said Martins-Welch. "I've even gotten some patients completely off opioids."
As effective as medical marijuana can be, it's not widely available or prescribed, Martins-Welch said. Plus, people have to jump through many hoops just to get certified to receive it, she said.
Martins-Welch believes medical marijuana should be more widely available and easier to get. Medical marijuana is legal in only 30 states, she said. In addition, because marijuana is federally illegal, it's expensive and not covered by insurance, putting it beyond the reach of many patients who could benefit from it, she said.
Medical marijuana can cost on average $300 for a one-month supply, Martins-Welch said. "And it's a cash-only business."
"Even the process you have to go through to get certified is expensive," she said.
Martins-Welch and colleagues surveyed men and women between the ages 61 to 70 about their use of medical marijuana. Patients responded to 20 questions about their marijuana use. The researchers found that most patients, 45 percent, used vaporized oil, while 28 percent used pills and 17 percent used marijuana-laced oil. Twenty-one percent used marijuana once a day, 23 percent used it twice daily, and 39 percent used marijuana more than twice a day.
Using marijuana in these forms dramatically reduces its mind-altering effect, Martins-Welch said.
In most cases, a doctor recommended medical marijuana (46 percent) followed by a family member or friend (24 percent) or another health care provider (6 percent), while others did not specify who recommended it (24 percent).
When asked how pain levels changed before and one month after starting marijuana, most patients reported that average pain scores dropped from 9.0 on a scale of 0-10 to a more moderate pain threshold of 5.6.
However, older patients reported a reduction in the use of other painkillers less often than younger patients (64 percent versus 93 percent), the researchers found. Older patients also recommended medical marijuana less often than younger ones (86 percent versus 100 percent respectively).
When patients were quizzed about whether side effects of medications impacted their daily activities, the average score went from 6.9 before starting medical marijuana to 3.5 a month after using the drug.
https://www.sciencedaily.com/releases/2018/05/180501085137.htm
Study questions link between medical marijuana and fewer opioid deaths
Association appears to be changing as medical marijuana laws and opioid epidemic change
February 7, 2018
Science Daily/RAND Corporation
The association between medical marijuana and lower levels of opioid overdose deaths -- identified previously in several studies -- is more complex than previously described and appears to be changing as both medical marijuana laws and the opioid crisis evolve, according to a new RAND Corporation study.
The report -- the most-detailed examination of medical marijuana and opioid deaths conducted to date -- found that legalizing medical marijuana was associated with lower levels of opioid deaths only in states that had provisions for dispensaries that made medical marijuana easily available to patients. Opioid death rates were not lower in states that just provided legal protections to patients and caregivers, allowing them to grow their own marijuana.
In addition, the association between medical marijuana dispensaries and fewer opioid deaths appears to have declined sharply after 2010, when states began to tighten requirements on sales by dispensaries.
"Our findings are consistent with previous studies showing an association between the legalization of medical marijuana and lower deaths from overdoses of opioids," said Rosalie Liccardo Pacula, co-author of the study and co-director of the RAND Drug Policy Research Center.
"However, our findings show that the mechanism for this was loosely regulated medical marijuana dispensaries, and that the association between these laws and opioid mortality has declined over time as state laws have more tightly regulated medical dispensaries and the opioid crisis shifted from prescription opioids to heroin and fentanyl," Pacula said. "This is a sign that medical marijuana, by itself, will not be the solution to the nation's opioid crisis today."
The study was published online by the Journal of Health Economics.
Researchers from RAND and the University of California, Irvine analyzed information about treatment admissions for addiction to pain medications from 1999 to 2012 and state-level overdose deaths from opioids from 1999 to 2013. They also identified state laws legalizing medical marijuana, examining provisions such as whether the regulations made marijuana easily accessible to patients by allowing dispensaries.
When the researchers narrowly focused on the time period from 1999 to 2010 and replicated a model used by other researchers, they obtained results similar to those previously published, showing an approximately 20 percent decline in opioid overdose deaths associated with the passage of any state medical marijuana law. However, these general findings were driven by states that had laws allowing for loosely regulated marijuana dispensary systems.
When researchers extended their analysis through 2013, they found that the association between having any medical marijuana law and lower rates of opioid deaths completely disappeared. Moreover, the association between states with medical marijuana dispensaries and opioid mortality fell substantially as well.
The researchers provide two explanations for the decline in the association between medical marijuana dispensaries and opioid harm. First, states that more recently adopted laws with medical marijuana dispensaries more tightly regulated them, in response to a U.S. Justice Department memo saying it would not challenge state-level medical marijuana laws so long as dispensary sales were in full compliance with state regulations. Second, beginning in 2010, the primary driver of the opioid crisis and related deaths became illicit opioids, mainly heroin and then fentanyl, not prescription opioids.
The study also found no evidence that states with medical marijuana laws experience reductions in the volume of legally distributed opioid analgesics used to treat pain. Even if medical marijuana patients were substituting medical marijuana for opioids in medical marijuana states, these patients did not represent a measurable part of the medical opioid analgesic market.
"While our study finds that medical marijuana dispensaries reduce some of the harms associated with the misuse of opioids, there is little evidence that this is happening because a large number of patients suffering from pain are using marijuana instead of opioid medications," Pacula said. "Either the patients are continuing to use their opioid pain medications in addition to marijuana, or this patient group represents a small share of the overall medical opioid using population."
The RAND study was conducted before any any states had begun to allow retail sales of recreational marijuana.
"Our research suggests that the overall story between medical marijuana and opioid deaths is complicated," Pacula said. "Before we embrace marijuana as a strategy to combat the opioid epidemic, we need to fully understand the mechanism through which these laws may be helping and see if that mechanism still matters in today's changing opioid crisis."
Support for the study was provided by the National Institute on Drug Abuse. Other authors of the study are David Powell of RAND and Mireille Jacobson of UC Irvine.
https://www.sciencedaily.com/releases/2018/02/180207090111.htm#