On April 20, a popular day for cannabis enthusiasts, headlines were filled with pot puns, promises of legalization from politicians and an announcement that Albuquerque ended criminal penalties for possession of small amounts of marijuana. But after the smoke cleared, some medical cannabis advocates are still holding their breath, waiting to hear from New Mexico’s top medical cannabis decision maker on whether or not opioid addicts can legally obtain derivatives of the plant to aid in trying to defeat an opioid addiction.
New Mexico Department of Health Secretary Lynn Gallagher is expected to decide soon whether to accept or reject, for the third time, a recommendation from a board of medical professionals to add opioid use disorder to the list of 21 conditions that currently qualify someone to be a part of the state’s medical cannabis program. Gallagher has not indicated publicly if she will add opioid use disorder to the list of qualifying conditions.
Documents obtained by NM Political Report, through an Inspection of Public Records Act request, show staff discussions about recommended conditions an advisory board sent to Gallagher.
Throughout the month’s worth of records NM Political Report reviewed, there was little discussion amongst DOH staff regarding the pros or cons of adding opioid use disorder to the list of medical conditions. What little indications DOH staff did provide, pointed toward caution rather than eagerness.
One email thread includes a DOH doctor organizing a meeting of colleagues to discuss the possible merits or problems in approving eight new conditions such as eczema and psoriasis, Tourette Syndrome and opioid use disorder.
On February 27, DOH epidemiologist Michael Landen emailed four other department doctors and said Gallagher wanted more information.
“A couple of months ago I mentioned that Lynn Gallagher requested that a group of DOH physicians review the medical cannabis advisory board recommendations and that we wanted your help on this,” Landen wrote to the doctors.
Landen wanted to arrange an initial meeting to discuss the review process, assign one or two proposed conditions to each doctor and then arrange a follow-up meeting to discuss their respective findings.
The group met on March 1 and, according to minutes of the meeting provided to NM Political Report, discussed ways to uniformly and consistently research conditions recommended by the advisory board. The group planned to meet again in April.
A few hours before the March 1 meeting, Medical Cannabis Program Medical Director Leah Roberts, MD explained how colleagues should evaluate each recommended condition.
“In framing our reviews of the petitions and recommendations it is important to note the wording from Lynn and Erin Compassionate Use Act as well as the rules/regulations,” Roberts wrote. “The act was not intended for cannabis to be a treatment or cure for any medical condition or disorder, rather to allow for the use of cannabis to alleviate symptoms of debilitating medical conditions.” The emphasis is Roberts’.
Similar language showed up in the March 1 meeting minutes as well, though it was not attributed to any specific person.
An addiction specialist in Albuquerque says medical cannabis can indeed alleviate symptoms of opioid withdrawal.
Jeffrey Holland is a clinical social worker and director of Endorphin Power Company, a substance abuse recovery housing facility. He said using cannabis to help combat muscle cramps, nausea and severe anxiety is better than using medically administered opioids—such as methadone—to wean addicts off other drugs. Holland said using methadone adds another layer of withdrawals.
“I’ve experienced both and I can tell you that the withdrawal from methadone absolutely dwarfs the withdrawal from heroin,” Holland said.
Holland himself has been clean and sober for 15 years. He does not use cannabis and runs an abstinence-based treatment facility. But he is financially invested in a New Mexico medical cannabis production company. Holland said he’s not trying to promote his company or make money from an increased patient load. Instead, he called himself a “strong believer and proponent of this medicinal plant.”
“I would call it the most underutilized, most understudied tool and possibly one of the most useful tools that should be in our toolbox,” Holland said.
But plenty of people oppose adding opioid addiction to the list, too.
During the 2018 legislative session, when two lawmakers tried to expand the qualifying condition list, almost 20 people wrote to Gallagher, urging her not to add opioid addiction to the condition list. Each of those opposition letters matched each other word for word.
The identical letters said it was the “marijuana lobby” pushing for medical cannabis expansion. The letters also asserted that studies showing an opioid death decrease associated with increased legal cannabis access are “weak and shortsighted.” Those studies, the opposition argued, did not take into account other preventative measures like overdose reversal medication and treatment options like methadone or buprenorphine—the latter is often referred to by the trade name Suboxone, another medically-administered drug used to combat opioid addiction.
“Our efforts should concentrate on expanding these measures, not introducing another
addictive substance to the problem,” according to the letters.
The human brain reacts to both buprenorphine and methadone similar to opioids and both medications have been shown to create physical dependencies.
Another inference that Gallagher will deny opioid use disorder as a reason to use medical cannabis is an uncredited and unsigned document NM Political Report obtained through a records request titled, Evidence-based Treatment of Opioid Use Disorder. In it, the unknown author states that it is relatively easy to make a determination about the effect cannabis has on addiction symptoms.
“A literature review was completed looking at 3 possible treatments for opioid use disorder – 1) medication assisted treatment, 2) marijuana, and 3) medical detoxification,” the document reads. “Marijuana treatment of opioid use disorder is the easiest to evaluate since there are no rigorous high quality studies that support its use for this condition.”
It goes on to say that treatment methods such as methadone and buprenorphine are ideal for addiction treatment, citing a New England Journal of Medicine article.
“Consistent data support the effectiveness of buprenorphine maintenance when compared to placebo and naltrexone,” the unknown author wrote. “When methadone and buprenorphine are compared, both approaches improve outcomes similarly but patient retention might be better in methadone maintenance (Schuckit 2016).”
Two staffers did share news or academic articles about recent studies that show cannabis can help with the national opioid epidemic.
Dr. Roberts shared two articles from the Journal of the American Medical Association (JAMA), both showing a decrease in opioid prescriptions in states that have expanded medical cannabis programs.
“I wanted to share two articles of significant interest and importance for our discussion next
week that were just published in JAMA on 4/2/18,” Roberts wrote.
Two days before Roberts’ email, a DOH environmental scientist sent a CNN story about the same study to a top medical cannabis administrator, with no explanation except a subject that read “Good article.”
NM Political Report reached out to a DOH spokesman to clarify issues like when Gallagher was expected to make a decision on the list of advisory board recommended conditions or who penned the internal Evidence-based Treatment of Opioid Use Disorder document and what role it might pay in the secretary’s decision.
DOH spokesman Paul Rhien initially said he was “glad to respond” to the questions but ultimately never did.
