L.D. 411, An Act To Add Addiction to or Dependency on Opiates or Prescription Drugs to the List of Qualifying Conditions for Medical Marijuana

Joint Standing Committee on Health and Human Services
Room 209, Cross State Office Building
Wednesday, January 10, 2018, 9:30 am 

Good morning Senator Brakey, Representative Hymanson, and Members of the Joint Standing Committee on Health and Human Services. I am Peter Michaud, Associate General Counsel for the Maine Medical Association (MMA) and a registered nurse. I live in Readfield, and I am speaking in opposition to LD 411, An Act To Add Addiction to or Dependency on Opiates or Prescription Drugs to the List of Qualifying Conditions for Medical Marijuana.

The MMA is a professional association representing more than 4,000 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens. We represent physicians from all medical specialties, as well as public health and primary care.

There is simply no decent, scientific evidence that cannabis is effective in treating dependence on opioids “or prescription drugs.” The reference to “prescription drugs” is simply too vague to guide any clinical decision.

There is absolutely no research to support the use of cannabis for the treatment of opioid use disorder (OUD). In fact, cannabis use is a risk factor for OUD because it negatively affects the part of the brain (the prefrontal cortex) responsible for cognition & judgment.

Dr. Jeffrey Barkin, a Maine psychiatrist, said to us as follows in connection with the same argument about opioid dependence made in 2016 and the references submitted by the proponents:

I looked at each of the references. None of them demonstrate efficacy of cannabis in opiate treatment. They are either animal studies, biochemical concepts, or observations. Not one of them assessed the efficacy of CBD in opiate treatment, either directly against placebo or an against an active drug treatment. Double blind, placebo controlled studies remain the standard in determining the efficacy and safety of a treatment and such studies are commonly used by the FDA and other regulatory authorities.

I am not aware of any appropriately designed clinical trial which establishes the efficacy and safety of CB for addiction and - as you know -  there are recognized harms associated with cannabis.

Dr. Mark Publicker, a Portland addiction treatment specialist, has expressed the following thoughts in October 2017:

Cannabis use in adolescence is, in fact, a major gateway drug for opiate addiction. In adolescence the brain is extremely vulnerable to the effects of cannabis: early use predicts the likelihood of lifetime problems with drug addictions of all types. And, if cannabis was in fact an effective treatment for opiate addiction the epidemic would have been over long ago. Virtually every patient who is addicted to opiates uses cannabis. So much so that if I see a drug screen result that is negative for cannabis I suspect that the specimen was fake.

In the 19th Century Sigmund Freud's first major publication was "On Cocaine."  He prescribed it (and promoted it) as a treatment for morphine addiction. Note that he himself then became addicted to it.  In mid-century America the tobacco companies promoted cigarettes as healthy and fought against the medical evidence that it was a killer. Then, in the 90's we were told that opioids were safe and non-addictive and here we are today. And now, we're asked to believe that cannabis is a safe panacea, a cure for opiate addiction. 

There has been discussion earlier today about label versus off-label uses of medications. The statutory list we are discussing in this bill is, in essence, the “label”. The Maine Legislature is acting somewhat like an FDA. In order for a condition to be added to the list, there must be scientific evidence of marijuana’s safety and efficacy for that condition. Anecdotal evidence, individual personal experience is not sufficient, no matter how apparently “obvious”, well-meaning, or honestly believed. It may even end up being proven someday; but unless it is scientifically proven now, it must not be used as a reason to add a condition to the list.

We respectfully ask you to vote the bill “Ought Not To Pass.” I would be happy to respond to any questions you may have.