Board to consider adding opioid addiction to medical marijuana conditions list

Lisa Silver Crow Perreault of Norwich, a patient of Dr. Stefana M. Pecher, uses her portable vaporizer with hash oil in Dr. Pecher's North Stonington office on Oct. 20, 2016. (Tim Martin/The Day)
Lisa Silver Crow Perreault of Norwich, a patient of Dr. Stefana M. Pecher, uses her portable vaporizer with hash oil in Dr. Pecher's North Stonington office on Oct. 20, 2016. (Tim Martin/The Day)

Since Connecticut's medical marijuana program began in 2014, the list of diagnosed conditions that can qualify someone for a medical marijuana card has grown from 11 to 22.

On Monday, a board of Connecticut doctors will hear appeals to add four more conditions to that list, including one not allowed in any other states with medical marijuana programs: opioid addiction.

Connecticut's medical marijuana regulations — passed in 2012 with 11 approved conditions: cancer, glaucoma, HIV or AIDS, Parkinson's disease, multiple sclerosis, epilepsy, cachexia, wasting syndrome, Crohn's disease and post-traumatic stress disorder — have been updated through the regulatory process twice since then, adding six new conditions.

Another five were added to the list with a 2016 bill that legalized medical marijuana for children with certain conditions like cystic fibrosis.

In January, the Department of Consumer Protection's Board of Physicians recommended adding more conditions that are under consideration by department officials and legislators.

People can petition the Board of Physicians to consider adding new conditions to the list. The board then votes on whether to endorse each condition and recommend its inclusion in the medical marijuana program to the Department of Consumer Protection.

On Monday, the board will consider a petition to add opioid use disorders and opioid withdrawal to the list, conditions that are not approved for treatment with medical marijuana in any other state and that face an uphill battle for inclusion on Connecticut's list.

Medical marijuana is widely used in Connecticut and other states to treat chronic pain and other medical conditions, though no state so far has approved therapeutic cannabis to treat addiction.

The bodies governing medical marijuana programs in multiple states, including Maine, Vermont and New Hampshire, have considered measures allowing medical marijuana for use treating opioid addiction symptoms in recent years, but all the proposals have been shut down, mostly for lack of scientific research on whether it's effective.

The advisory board to New Mexico's Medical Cannabis Program twice has recommended the state allow medical marijuana as a treatment for opioid addiction. That state's health department rejected the panel's first recommendation, and has not yet made a decision on the second recommendation it made in November.

While some research shows that cannabis successfully can be used for pain patients to reduce the amount of opioid medication they need, almost none show that cannabis can be effective against drug addiction itself, said Dr. Kevin Hill, the director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center.

"If your physician is prescribing opioids for you, there is a fair amount of data ... coupled with anecdotal support, that people who use medical cannabis will require fewer opioids," Hill said.

A 2014 study published in the Journal of the American Medical Association found opioid overdose deaths went down 25 percent in states that had legalized marijuana for medical use.

But the lack of evidence that cannabis can help with addiction, and the existence of multiple, federally approved treatments for addiction — like suboxone, buprenorphine and naltrexone — mean Hill said he would caution doctors against prescribing medical cannabis for addiction.

"If they meet the requisites for opioid use disorder, I'd be leery of using a non-FDA-approved medication that has no research supporting it," he said.

The Department of Consumer Protection does not release the names of those who submit petitions to the Board of Physicians to consider new conditions for the medical marijuana program, but provides redacted versions of the petitions on its website.

The petitioner asking the board to consider adding opioid use disorder and opioid withdrawal wrote on their petition form that they could not provide medical evidence that medical marijuana is a proven treatment for opioid addiction symptoms.

"I have been unable to connect with medical professionals at this time," they wrote. "Although there are likely many who may support the use of cannabis to treat these two diseases. I work everyday directly with Medical Marijuana Patients, and dispensary pharmacists, yet I was unable to get any statements."

Jeffrey Goldblatt, a retired surgeon who evaluates patients applying for Connecticut's medical marijuana program, said he thinks medical marijuana could be beneficial to people seeking to stop using opioid drugs.

"I see people all the time that are in the methadone programs for addiction," he said. "I think that (cannabis) definitely has a strong place in medical therapy."

While he acknowledged that research is scarce on the treatment of addiction with cannabis, Goldblatt said he suspects it could be used as an aid to treatment for people trying to stop taking the "bags of pills" he said doctors prescribe to his patients with pain or PTSD.

John D., a Waterford resident who has been in recovery for opioid addiction for 12 years, said he was open to the possibility that medical marijuana could help addicts' symptoms, but was skeptical.

He said the cravings, pain and nausea he experienced while detoxing from opioids could not be stopped with marijuana.

"It's like using a spitwad to kill a bear," he said. But, he said, "I'm curious to see how it would play out."

On Monday in Hartford, the Board of Physicians also will consider endorsing adding albinism, osteogenesis imperfect — a group of genetic diseases affecting the bones — and progressive degenerative disc disease.

m.shanahan@theday.com

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