
States with Medical Marijuana Have Fewer Painkiller Deaths - robg
http://www.smithsonianmag.com/smart-news/states-medical-marijuana-have-fewer-painkiller-deaths-180952552/?no-ist
======
dbbolton
Side note: acetaminophen is a much bigger threat than most opioid analgesics
themselves. It's directly involved in something like 10% of all overdoses in
the US. There's no practical reason for opioids like hydrocodone to be mixed
with it (as opposed to just being prescribed/administered concurrently) except
that you get sick if you try to take enough of the opioid to get high.
Personally, I feel that hepatotoxicity is a poor abuse deterrent, both in
theory and practice.

~~~
Alex3917
There are around 115 U.S. acetaminophen deaths per year, versus around 17k
opioid analgesic deaths. That said, as far as I can tell there is no reason to
take it acetaminophen ever; for pretty much any use case, there is another
drug that's more effective and safer.

[http://www.propublica.org/article/tylenol-mcneil-fda-
behind-...](http://www.propublica.org/article/tylenol-mcneil-fda-behind-the-
numbers)

[http://www.cdc.gov/media/releases/2013/p0220_drug_overdose_d...](http://www.cdc.gov/media/releases/2013/p0220_drug_overdose_deaths.html)

~~~
pjc50
There are some painkillers that contain both; which column do those go in?

~~~
Alex3917
Whichever one kills you. The Tylenol takes several days to kill you, whereas
the opiates would be entirely worn off by then, so it should never be
ambiguous.

~~~
dbbolton
The article clearly states that there were 16,651 overdose deaths "involving"
opioids. It does not say anything about cause of death or exclusion of other
drugs.

------
codeshaman
I haven't read the scientific study on JAMA, but I would venture to speculate
that there could be several reasons for such sharp drops in mortality due to
opioid overdoses:

\- fewer people resort to opioids for recreational purposes, due to higher
availability of marijuana

\- alcohol + opioids is a deadly combination. People who are high on marijuana
tend to drink less, because alcohol doesn't go well with marijuana either.
Marijuana, however, can be combined with many drugs and tends to enhance the
experience, requiring less of the drug.

\- Marijuana makes people more cautious and health-conscious due to it's
capacity to induce temporary paranoia and anxiety at larger doses.

A quick google search for 'marijuana combined with heroin' led me to a forum
where people are reporting full-blown panic attacks when combining the two,
with users generally reporting that the two drugs tend to enhance one another.
Such panic attacks are powerful experiences and can be life-changing in a
positive way.

Several countries have eased on marijuana prohibition due to the opiod
addiction problem getting out of control (Switzerland, Portugal, Spain and
probably other countries) and as a consequence saw decreases in overdoses and
HIV infections so this study just corraborates what has been observed in other
places around the world.

~~~
jsonne
Marijuana and Alcohol are considered economic compliments actually. The more
you smoke the more likely you are to drink and vice versa.

~~~
kahirsch
It looks like the research on this is mixed.

See

The Legalization of Recreational Marijuana: How Likely is the Worst-Case
Scenario?, with Daniel Rees. _Journal of Policy Analysis and Management_ 33
(2014) 221-232.[1]

and

Williams, Jenny, Rosalie Pacula, Frank Chaloupka, and Henry Wechsler. 2004.
“Alcohol and Marijuana Use among College Students: Economic Complements or
Substitutes?” _Health Economics_ 13: 825-843.[2]

It seems that the research based on natural experiments is intrinsically
better than the price-related studies, and so far, that indicates that
marijuana legalization reduces alcohol consumption.

Anderson's research also indicates that medical marijuna legalization resulted
in a significant decrease in traffic fatalities, which is a huge win.[3]

[1][http://dmarkanderson.com/Point_Counterpoint_07_31_13_v5.pdf](http://dmarkanderson.com/Point_Counterpoint_07_31_13_v5.pdf)

[2][http://www.uic.edu/orgs/impacteen/generalarea_PDFs/HCAS_Alc_...](http://www.uic.edu/orgs/impacteen/generalarea_PDFs/HCAS_Alc_pot_06-26-01.pdf)

[3][http://www.dmarkanderson.com/Medical_Marijuana__Accidents_an...](http://www.dmarkanderson.com/Medical_Marijuana__Accidents_and_Alcohol_7-8-13_v1.pdf)

PDFs may differ from published versions.

------
ac29
"However, the study authors caution that their analysis doesn’t account for
health attitudes in different states that might explain the association."

As the article suggests, correlation does not equal causation. Looking at this
map: [https://en.wikipedia.org/wiki/File:Map-of-US-state-
cannabis-...](https://en.wikipedia.org/wiki/File:Map-of-US-state-cannabis-
laws.svg)

one can imagine numerous other reasons that might lead to differential rates
of painkiller (ab)use between states. Socioeconomic status is fairly clear to
me (states with higher status are more likely to have medical marijuana),
other correlations are a bit more of a can of worms.

~~~
aet
They do account for unemployment, but I agree with you. More evidence needed.

------
Crito
I'm a big fan of recreational weed (ideally sativa strains), but my experience
with indica strains for pain relieve is not good. I find that rather than
making me forget about chronic pain that I currently experience (neck cramps,
sore muscles, etc) it makes me remember/re-experience pain from years-old
injuries. Surgical scars I got when I was in my teens and haven't felt since
suddenly have dull unignorable sensations of pain. A toe I broke a year ago
starts hurting again. Etc.

Nobody that I have mentioned this too has ever said they experienced the same
so I've usually just written it off as some sort of strange psychosomatic
thing, but the article's passing mention that _" marijuana doesn’t replace the
pain relief of opiates. However, it does seem to distract from the pain by
making it less bothersome."_ makes me wonder if something is actually going on
here.

~~~
scythe
Sativa is probably the better strain for pain relief, as it contains primarily
THC (which is analgesic), whereas indicas contain roughly equal amounts of THC
and CBD (which is anxiolytic and sedative).

A lot has been said in this debate and a sort of misguided idea that has been
floating around lately is that the therapeutic effects of cannabis are
entirely due to CBD, but this is _not_ the case. Current thinking is that the
cannabinoid receptor type 1 -- CB1 -- is responsible for analgesic (anti-pain)
and recreational properties, while CB2 is responsible for antiinflammatory
effects; these are both targeted by THC, not CBD. CBD binds to a novel binding
site GPR55 (iirc) and to 5-ht1a, which is believed to be partially responsible
for the prosocial effects of MDMA, but not to cannabinoid receptors. Wrt.
cancer, a bad summary is that THC activates some parts of the body's natural
cancer defenses via CB2 (all CB2 agonists do so) and CBD might have some
strange, mechanism-not-yet-determine antiproliferative activity. However,
these effects may be too modest to be practically useful (who knows?); cancers
easily become resistant to CB2 agonists.

While I'm blabbering I might as well dispense with the idea propounded by some
that cannabis should only be used medically in the form of precisely
calibrated extract compositions: this idea, while attractive, is simply too
expensive, and unfair to poor people seeking pain relief, somnolescence, etc.
However, from what I've seen here today, it might not be bad to try to
implement a system where doctors can prescribe a specific terpenoid ratio
w.r.t. THC, CBD, and THCV; the last is an antagonist and may give strains a
"ceiling" effect, which can be useful if people need to smoke all day for some
reason.

~~~
ewoodrich
Indicas don't contain roughly equal amounts of THC and CBD -- the difference
between the two is at least an order of magnitude. An exemplar indica might
have 20% THC and 1.5% CBD, which would be considered an extremely high level
of CBD. Your main point is still valid though, I just wanted to make the
relative quantities clear.

Some nonspecific examples of tested strain concentration:

[https://budgenius.com/strains.html?tab=0&high_rating=0&sleep...](https://budgenius.com/strains.html?tab=0&high_rating=0&sleep_aid=0&pain_relief=0&nausea_relief=0&anxiety_relief=0&appetite_stimulation=0&location=&coordinates=&radius=10)

~~~
scythe
> An exemplar indica might have 20% THC and 1.5% CBD, which would be
> considered an extremely high level of CBD.

[https://budgenius.com/ATF-B-Shangri-La-Farms-
BG0010001EB64.h...](https://budgenius.com/ATF-B-Shangri-La-Farms-
BG0010001EB64.html)

[https://budgenius.com/Titan-OG-7-Points-Medical-
BG0010001EE9...](https://budgenius.com/Titan-OG-7-Points-Medical-
BG0010001EE99.html)

Many strains according to this site of yours certainly seem to contain
significantly more than 1.5% CBD. Ditto this study:

[http://www.amjbot.org/content/91/6/966.full](http://www.amjbot.org/content/91/6/966.full)

... which doesn't include any modern US strains but provides strong support
for the idea that there are plants with large amounts of both CBD and THC. I
actually may have made a separate mistake...

>Elevated levels of CBDV and/or THCV were much more common in plants of C.
indica than in plants of C. sativa. Plants with elevated levels of THCV,
sometimes exceeding THC, were detected in all four biotypes of C. indica, but
not in all accessions.

So my memory has failed me, or the common-wisdom I absorbed: Cannabis indica
contains more of both THC and CBD than Cannabis sativa, but _also_ contains
larger amounts (and proportion) of the antagonist homologue THCV. And modern
strains are all really hybrids anyway.

~~~
ewoodrich
Hmm, to be honest, I've never encountered any strain above 1.5% or so CBD, so
that takes me by surprise, a bit. I also have access to a fairly diverse
selection of MMJ options in a permissive state, so I'm surprised I haven't
seen any strains like that.

Learn something new every day, I suppose. I appreciate the info - I'll keep on
the look out.

