Last October Dr. Caplan spoke at a forum in Pittsfield, MA concerning the opioid crisis in America and how medicinal cannabis can help, safely, fight the growing death tolls from addiction. He covered a wide variety of topics: explaining why opiate addiction has risen to being a national health crisis, dispelling some of the misinformation commonly spread regarding cannabis, and expanding on how medical cannabis is an option which has diverted patients from the dangers of addictive pain management drugs. His speech is available here.
(Below is the speech that Dr. Caplan gave at this forum, a link to an article about the event he spoke at is included here.)
Thank you for sharing your evening with us, and for the warm welcome. I am a Massachusetts native, and actually went to school up the street from here, at Williams College. I am a family physician, licensed, board-certified, and trained right here in Massachusetts. Along with 20 or so Canna Care physicians, I spend most of my days teaching, and taking care of, a wide variety of individuals who are suffering with debilitating medical conditions, and have picked Cannabis as their choice for trying to find relief.
My goal, tonight, is to reflect on the disturbing opioid epidemic, and to share some of what’s happening behind the curtains within the Cannabis Medicine movement.
Before I paint the picture of how Cannabis works, I want to outline some tragic statistics about what’s happening with opiates and narcotics. Then, I’ll cover more detail about how the use of Cannabis has moved from something on the fringe, pushed away from the mainstream, and with accidental benefits, to something that has burst out from the shadows, with greater understanding, new acceptance, and now – clear, reproducible, and prescribed benefits.
Last year, about 62,000 Americans died of drug overdoses. That makes it not only the leading cause of death for Americans under 50, but just in 2016, overdoses killed more Americans than the Iraq War and Vietnam wars, combined. This year, it seems likely that overdose deaths could pass car crash deaths, gun mortality, homicides, and suicides, all put together. Our meeting tonight is not about pointing fingers to assign blame, or throwing our hands up in defeat, but to do the opposite – to understand what is going on around us, and to try to help.
When I say “around us,” let me be more specific: In Massachusetts, last year, there were an estimated 2107 deaths from opioids. That is over a 500% increase from 17 years ago.
Here, in Berkshire county, the number is actually a 650% increase between 2000 and 2016. In each of the last 4 years, here in Pittsfield, between 14 and 18 people have died from opioid-related causes. Where I live near Boston, the numbers are, unfortunately, even worse.
On a cultural, systemic level, the question of “why” this is happening is full of many possible answers. Some people talk about the pharmaceutical industry or the system of distributing pills, or the more than $600 billion dollars that is involved in the business of these medications. Others look at the prescriptions and where they are coming from. My perspective is slightly different. I take care of these people that are gravely ill, and… these are not evil people who are becoming addicted. They are certainly not “druggies” or “delinquents” or what sometimes society unfairly labels “failures.” In reality, they’re not different from you and I. I don’t mean this in a racial or socioeconomic sense, because the CDC has shown us that the opioid epidemic certainly isn’t choosing sides. Instead, I’m talking about the biological story.
Opioid medications work by binding to receptors in our brains, interrupting the perception of pain, and producing a sense of well-being and comfort. Opioids are usually associated with the build-up of tolerance (so one needs more of the same type of medication to achieve the same relief), and as they are consumed, the body’s natural production of opioid chemicals is smothered (which is where withdrawal and craving comes from, and likely the biological driving force for the epidemic.) To be complete, however, Some of the less publicized effects of opioids also include drowsiness, mental confusion, nauseousness, constipation, and terrible mood lability.
So, how does a medicine like this become the dagger of one of the deadliest epidemics in modern times? Practically speaking, because we don’t really have alternatives that are well-liked. We have anti-inflammatory medications like Tylenol or Ibuprofen, local numbing medicines in the Novacaine family, and medicines that relax muscles or work on “nerve pain.” We have a different group of medicines that help the anxiety and depression associated with a life of pain and suffering. Plus, when we look at compliance, it seems like nobody wants to take pills anyway. Ok, we have psychiatric and addiction talk therapies. And, sadly, our culture even uses prison as a way of trying to regulate people who are suffering. Suffice it to say, our modern medical system has very limited options for the treatment of suffering. If you think about the physical agony of broken body parts, or cancer tearing through your body, even crippling depression or paralyzing social anxiety, these illnesses are horrific, and if there’s something else we can do to help people who are suffering, people like our neighbors, don’t we have a moral or human obligation to pursue it?
As you might suspect, for me, that’s where Cannabis medicine comes in. From a broad-strokes, neurochemical point of view, opiates and cannabis effect our bodies in parallel ways. When we look at the active molecules in Cannabis, called Cannabinoids, we see that, like opiates, they bind to receptors in our brains, they reduce the perception of pain, and they improve a sense of well-being and comfort. Unlike opiates, though, Cannabis has no painful/sharp withdrawal experience, and no woefully unpleasant side effects. Sure, users may snack more than they might intend, or feel so relaxed they want to doze off, but nothing like bowel-plugging or wild swings of anger and pain that come with the narcotics.
Unfortunately, from there, the parallels between the way opiates and cannabinoids work must be cut short. Not because there aren’t any more, but because since 1971, Cannabis has been classified by the US government as a Schedule 1 narcotic, a designation reserved for extremely dangerous drugs without any accepted medical use. As best it can, this classification has made it very difficult for researchers to study Cannabis, or to show what individuals, states, and whole nations across the world seem to agree on - that the components of this plant could be the polar opposite of this one powerful law’s account. What we do know, and it has been produced, and reproduced time and again, is that Cannabinoids are safe. In fact, they are some of the most safe, non-toxic substances that humans consume as medicines. In spite of the obstacles, we have thousands upon thousands of quality studies, from animal studies looking at how Cannabis works in the brain and throughout the body, to laboratory studies that show exactly what’s happening on a molecular level. Sure, controlled human trials are more difficult to carry out under the Federal law, but as States and voters keep pushing ahead with more evidence-based medical cannabis laws, we’re starting to see learn amazing facts:
For our Q&A, I am glad to talk more about the challenging questions and the controversy around Cannabis. But first, to switch gears, I want to tell you about what it takes to try Cannabis as an alternative medicine, and what you might expect to find.
The Massachusetts legislature, in 2012, stated that residents would be allowed to consider Cannabis as medicine if they have conditions which meet specific, defined, criteria. The condition must be debilitating, cause weakness, cachexia, wasting syndrome, intractable pain, nausea, impair strength or ability, and must substantially limit the individual in major life activities. There are specific conditions outlined, including HIV, AIDS, hepatitis C, ALS, Crohn’s disease, Parkinson’s disease, and MS, but physicians are respectfully given the right to evaluate the appropriateness of other diagnoses as well.
One of the most important differences about Cannabis Medicine from Western Medicine, is that the driving force of control is changing. These days, it is common practice for a doctor to tell a patient how to treat their illness, what pills to take, how often to take them, what to expect, what not to expect - for all of that, the tables are turning. I think it’s one of the happy outcomes of the Federal suppression of research, alongside its ultimate lack of significant toxicity, but with Cannabis Medicine, it’s more a matter of teaching patients about the plant, and the ways to consume it (what sorts of options there are, with respect to eating it, or using it just topically, or inhaling it), and less of a paternalistic “do as I say” approach.
This way, doctors are able to guide patients with how to dose themselves in ways that are both safe and more comfortable for them, to take on (or avoid) sensations as they want to, and increase or decrease dosages according to real life conditions that aren’t always the same, day after day. Although the paradigm of treatment has shifted considerably, it is by no means “hands-off.” Patients are required to follow up at least yearly, and encouraged to come back much more often.
In my office, like any other medical office, we register potential patients at a greeting desk, and we collect background information on past and current medical conditions. As part of the onboarding experience, we outline the letter of the law to each patient, we educate newcomers about the thousands of choices, both from a birds-eye perspective, what they can expect from their use and their particular circumstances, as well as practical tools to help guide every day experiences.
For some examples, one patient of mine, a 58-year-old honorable Marine Corps veteran is a full-time employee, with wife and two children, suffering from debilitating pain. His longest battle is a result of injuries sustained while serving his country. He has found himself addicted to opiate medications, seeking brief and intermittent relief, so he can fulfill his daily responsibilities. Another patient is a young woman, 23-years-old, who lost her parents in a tragic accident. She has been unable to find comfort with weekly therapists or medications, neither of which seems to alleviate her deep depression and anxiety. Instead, she looks to a variety of illicit substances for reprieve from what she calls "her living nightmare."
Fortunately, both these patients came in, were taught about their options in the Cannabis space, and are now doing wonderfully. The veteran is taking opiates on an as-needed basis, instead of 4 times a day….. and the young woman is now thriving in psychotherapy, taking all of her medications, with more hope and a personality that’s almost cheerful. These are two examples of the kinds of mind-blowing successes I hear about 10-15 times every day. There are rarely days that go by when I’m not hearing patients describe having access to Cannabis that is pure and tested and predictable, as “life changing” or “changing my world completely,” or “Where was this 100 years ago” or “I’m a much better father/mother/parent now that I’m not in agony all the time.”
Lastly, before I conclude, I want to cover a topic that seems especially concerning for everyone, The controversy around accessibility by children and teenagers. For understandable reasons, we are all very protective of growing brains. Fortunately, though, around Cannabis, the data is telling us that, actually, the more medical cannabis available, the lower the rates of use are in 12 to 17 year olds. Many opponents of the legalization movement have long-predicted that loosening national restrictions on Cannabis will “send the wrong message” to teens, and that drug use would increase the way it has with other substances. But, this is the same propagandist scary story that has been alleged about Cannabis since the 1930s. In 2015, however, a powerful study probing into the relationship between marijuana laws and adolescent use found that there was no significant change, at all. In 2016, according to federal survey data (and we know quite clearly where the government stands on this issue), as the rates of Cannabis use in adults over age 18 has increased with legal access to it, the rate of cannabis use among 12 to 17 years has, in fact, dropped to its lowest level in more than 20 years. Coincident with appropriate packaging for materials coming out of dispensaries (which is mandated by law), the safety of access to medical marijuana by children is really no different than it would be for undesired access to any other kind of medicine or pills. Parents should be using common sense, locking up all medications out of the reach of children, using child-proof locks, and educating and modeling for their children what we all consider good medical practice.
So, to summarize, my hope was to give a sense of the very real numbers in the struggle of the opiate problem, to convey that Cannabis has a clear place to be considered, for individuals who are suffering, to put on bullhorn that it does actually work, and really well, and – that we should make sure that what we’re doing is more ethically, morally, and scientifically aligned.