‘Cannabis and the Opioid Crisis’ at UCI

February 5, 2018 by Fred Gardner. Researchers with establishment credentials are calling for a change in the federal Controlled Substances Act to facilitate access to cannabis. The Center for the Study of Cannabis at UC Irvine will host an all-day conference on “Cannabis and the Opioid Crisis” February 9. The event was organized by Daniele Piomelli, UCI School of Medicine, and Bob Solomon, UCI School of Law, who stated their intentions in a Los Angeles Times op-ed (see below).

The roster of speakers:

Donald Abrams, M.D., University of California, San Francisco; Specializing in integrative oncology, Dr. Abrams has conducted numerous clinical trials investigating conventional and complimentary therapies in patients with HIV including medical marijuana.
Marcus Bachhuber, M.D., Albert Einstein College of Medicine; Dr. Bachhuber conducts research focusing on health systems and policy approaches to address drug misuse.
Graham Boyd, J.D., Stanford Law and Third Way Think Tank; Attorney, consultant and scholar specializing in political efforts to reform drug laws and reduce mass incarceration. Provided research, and legal drafting and campaign design for cannabis reform measures.
Stanton Glantz, Ph.D., University of California, San Francisco, Truth Initiative Distinguished Professor of Tobacco Control; Dr. Glantz conducts research on a wide range of topics including the health effects of second hand smoke to efficacy of different tobacco control policies.
Keith Humphreys, Ph.D., Stanford University; Dr. Humphreys’ research focuses on interventions for substance abuse and psychiatric disorders. He is a leader in developing health services research-related applications for innovative qualitative and quantitative research techniques and analyzing national mental health policy.
Rosalie Pacula, Ph.D., RAND Corporation; Dr. Pacula is senior economist at the RAND Corporation. Her research has largely focused on issues related to illegal or imperfect markets, measurement of the size of these markets, and the impact on behavior, and the effectiveness of policy interventions.
Susan Weiss, Ph.D., National Institute on Drug Abuse; Dr. Weiss oversees the Institute’s extramural programs, research training, operations planning, and trans-NIH initiatives. Prior to her Directorship at the National Institute she served as the Senior Director of Research T the National Mental Health Association

Program discussion will be moderated by Dr. Ziva Cooper, Department of Psychiatry, Columbia University and Mireille Jacobson, Paul Merage School of Business, UC Irvine.

Retro Message

Piomelli and Solomon stated their political perspective in a Los Angeles Times op-ed December 21: “The Controlled Substance Act is the single greatest impediment to increasing our knowledge of cannabis.” Here is their piece with a few retro messages:

Can pot blunt the opioid epidemic? We don’t know because the federal government blocks research.

The editors could not stop themselves from making a pun in the headline, even though the subject involves mass deaths. It’s a form of OCD —Intractable Pun Compulsion, 420.6.

An epidemic of opioid abuse is ravaging the United States and, as we look for ways to respond to it, some see cannabis as part of the solution, while others see it as part of the problem. This is just one area in which unbiased scientific research is necessary, but outdated federal legislation, having concluded almost 50 years ago that there is no medical value to cannabis, is blocking all meaningful efforts to understand the real benefits and risks of the plant.

There are critical open questions about cannabis, and without research conducted under rigorous scientific standards, we will not find answers. If you think these questions don’t really matter in daily life, let’s look at three scenarios.

Your friend is one of the 1,125,000 people in California who use medical cannabis. Before going to bed, he drinks a cannabis tea because it helps him go to sleep. The morning after, he feels well rested and doesn’t experience any aftereffects. But one day, as he is driving to work, the police stop him for a random blood THC test (this type of test is already in use in Colorado and may be adopted in California). Your friend turns out to be THC positive and loses his driver’s license, even though there is no correlation between blood THC levels and intoxication. The same person can have detectable blood THC levels and be perfectly functional, or have undetectable levels and be impaired. We need research to develop objective, unbiased ways of measuring cannabis intoxication, or innocent people will end up paying for a crime they did not commit.

Realistic scenario, wrong conclusion. We need research to develop objective, unbiased ways of measuring cannabis impairment or innocent people will end up paying for a crime they did not commit… One wrong word, like one misplaced amino acid in a protein, can wreak havoc down the line.

Or let’s say your grandfather is convinced that cannabis is the only thing that helps him with his arthritis pain. He is not alone in believing this — cannabis use in persons over 50 has tripled in the last 10 years, a phenomenon primarily driven by self-medication for pain and sleep problems. You are happy for grandpa, but then you notice that he has become more forgetful than he used to be. Is this a normal consequence of age, or a side effect of the drug? Will forgetfulness turn into memory impairment? We can’t answer this question now, because the effects of cannabis have never been studied in elderly people. Research shows that that in old mice, low doses of cannabis may actually improve memory — but what about in humans?

Note to self: get old-mice study.

One last example, which takes us back to the opioid crisis. States in which cannabis is legal have 25% fewer deaths for opioid overdose than states in which medical use of the drug is not allowed. These are credible data,

Irrefutable, actually.

but do not necessarily mean that cannabis is a solution to the opioid crisis.

The dramatic drop in opioid overdose deaths in MMJ states does necessarily mean that cannabis is a partial solution to the opioid crisis.

Cannabis reduces many forms of chronic pain in people, but we do not know if it can replace opioids.

“Replace” is a tricky word. We certainly do know that many pain patients can reduce opiate use and some can get off opiates entirely. Tod Mikuriya and colleagues in the Society of Cannabis Clinicians documented this pattern in their files and published findings based on hundreds of thousands of patients in O’Shaughnessy’s. But Piomelli (and the medical/scientific establishment for which he stands) does not recognize the validity of such clinical evidence.

The op-ed goes on:

Nor do we know if the use of cannabis attenuates or worsens the risk of developing an opioid addiction.

Finding the answers to all of the above questions is more than feasible.

Yet the Controlled Substance Act of 1970, or CSA, stands in the way. First, researchers seeking to study cannabis and its chemical constituents (even the innocuous cannabidiol) may only use plant material from a single federal contractor, the University of Mississippi. That cannabis is very different from the cannabis generally available to the public in California and elsewhere, which creates a problem of “external validity”: what researchers are allowed to study in the lab or the clinic does not tell them much about what happens in the real world. In addition, the Food and Drug Administration and the Drug Enforcement Administration must approve any use of the University of Mississippi cannabis, a process that requires researchers to jump through unnecessary hoops.

This is not news. We have known for years that the Controlled Substance Act is the single greatest impediment to increasing our knowledge of cannabis. It matters now because, come January, Proposition 64 (the Adult Use of Marijuana Act approved by California voters in November 2016) will take effect in full and cannabis will be legally available for recreational use in the most populous state in the union.

California’s Bureau of Cannabis Control is working hard to put sensible guidelines in place and regulate its use, but even the most thoughtful regulation cannot replace research. If science does not fill the knowledge void, then interest-driven pseudo-science will. Ideologists and special interests are already pushing hard in that direction.

I wonder who they mean?

Proposition 64 calls for and funds research on cannabis.

And UCI and UC San Diego and UCSF want some of those taxpayer dollars.

Despite out-of-date federal legislation, it is essential that we implement this key component of the proposition and support the rigorous scientific work needed by medical providers, consumers, law enforcement and entrepreneurs alike.

It is essential that y’all acknowledge the validity of the abundant clinical evidence. Capital-M Medicine has been intimidating us, the people, with the line Groucho Marx used in an authoritative voice to fluster and seduce a foolish lady: “Who are you going to believe? Me or your own eyes?”