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by Peter Moskos

September 16, 2016

Legal weed means 25% fewer overdoses

This is pretty striking data, as published in JAMA and reported in Newsweek. From JAMA:
States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time.

Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
It's not rocket science to figure out a likely cause-and-effect.


R.K. Brumbelow said...

The first sentence is useless information. Like the old Soviet Union Joke about Pravda and Izvestia, truth and information. Pravda was all truth and no information, Izvestia was all information and no truth.

The valid comparison is how overdose rates compare year by year before and after implementation of new laws, not across states since states have OD rates which vary widely based on a number of factors, however your summary does not lead with such information, instead it begins with a faulty comparison. In fact it should really not even be from year to year, unless the statistical data year sets are set to the same dates as the legal year, and even then I would discount the year immediately proceeding and trailing such a change as statistical abnormalities are introduced such as increased visibility and marketing.

JAMA is becoming a shadow of its former self with the publication of such dribble.

Peter Moskos said...

That's what they looked at, I think. How the rates compared before and after. And looked at years later makes sense, since the effects of legal marijuana may increase over time (which is what they find), as more people smoke weed instead of popping pills.

And statistically, you can and should compare states. I believe (I haven't read the whole paper, just the summary) it makes sense. Overdoses have increased everywhere, right? And they researcher take other variables into account. And in states with legal marijuana, overdose deaths end up 25 percent lower. I don't see a methodological flaw there. What else could account for the divergence in overdose deaths? Perhaps there's another explanation, some overlooked variable (overly hoppy IPAs?). But until an alternate explanation is found, I'm willing to assume legal marijuana is the main causal factor.

Peter Moskos said...

And just wondering, was "Izvestia" another newspaper? Or was "Pravda and Izvestia" the full name of what I know just as "Pravda"?

R.K. Brumbelow said...

There were 2 newspapers: The most popular one was Pravda, the 2nd major newspaper was Izvestia.

I read the JAMA paper. I could almost write a paper dissecting it, but the causal link really makes a LOT of assumptions. Looking at it I would actually make an argument for a link between CRPS and similar disorders and the rise in some other treatments using alternative neural pathways other than opiates, such as AMPA and cytokine modulators.

NB I am a Neuropharmacology and Biochem Student at a research Center in Georgia, so this is kind of my wheelhouse. I also advocate for the disabled and people who suffer for refractory pain (refractory means it does not respond to standard treatments). So if this article were true and informative I would be the first to tout it.

Looking at the modeling system used for example they account for the partial years, but with fractions and no leading or trailing skew.

My point being that they have designed models which appear initially to account for the issues I named above, but they really do not. It really just comes across as a and so we should legalize drugs across the board. If you want to make that kind of a message: Portugal offers much better data.

Portugal decriminalized drug possession and use, and instead offered rehab and treatment.

A copy of the paper can be found in multiple formats here: http://www.cato.org/publications/white-paper/drug-decriminalization-portugal-lessons-creating-fair-successful-drug-policies

So I am not arguing that ODs are not tied to legalization. I am simply arguing that the JAMA paper is not well founded.

I will argue that drugs should not be decriminalized, for recreational use and I will argue that the current paths of legalization are the wrong way to do it if someone wants me to make an argument expressing what I honestly believe, but that does not come to play in my critique of the JAMA paper.

Peter Moskos said...

Wells and fair enough. I appreciate the critique! Thanks. And once we get into training skew, I can assure you it's not my wheelhouse. I mean, I kind of know... but it's not my wheelhouse. (Not to mention it turns out I'm wrong about what a cytokine modulator is. I could have sworn it ensured the stability of dilithium crystals in extreme thermal environments.)

And yes, Portugal should be getting more attention. It's kind of amazing how successful their approach has been. For over a decade now. And it's like nobody seems to notice. Data and facts don't matter if one thinks drugs are "evil." Then you fight Satan.

That said, leaving aside this article, do you think that people with legal access to weed are more likely to avoid other prescription pharmaceuticals (for things like stress, anxiety, and pain)? Because I sure do.

Peter Moskos said...

My father once appeared on "Vremya." He was pleased he could use one word he remembered from his college Russian: может быть (maybe/perhaps). He said it worked for every single question!

R.K. Brumbelow said...

I think people use drugs for any number of reasons and to lump them into a single category is over generalization.

For people with CRPS (complex regional pain syndrome) inflammation appears to be a large part of the issue. Opioids increase inflammation, compounds in marijuana can reduce it. Similarly, ketamine has 2 forms one is pro inflammatory the other is anti-inflammatory. So if you have a condition where pain is an issue, and it is long term pain there are much better alternatives than opioids for long term treatment, some of which might include marijuana or variants of marijuana.

Side note: I would love to get funding for a THC knockout (genetic term) of the cannabis plant so that we could remove at lease some of the psychogenetic effects and be safer with release, problem is that means access to MJ and the Fed doesn't like that even at my institution (one of 3 research universities in GA).

On the anti-side, no people should not be taking THC for anxiety or stress. Learn to modulate stress yourself, anxiety has much better treatments like rTMS, ketamine (IN) or (IV) and, dare I say it, CBT (shudder).

Further on the anti-side, ask yourself the following question:

Presuming evolution, why do THC and similar compounds exist?
Plausible answer: As a defense mechanism for the plant. The more animals feed on it, the more vulnerable the animal becomes to being fed upon itself, thus reducing predation on the plant.
If the above answer is correct, why do we want to set up our citizens for predation?

Going back to the issue of Opioids and overdose: Yes, many patients get caught up in the cycle of addiction and inflammation caused by opioids. Should studies be allowed to create non psychoactive versions of plants like marijuana? I think so, I think it would be beneficial in the long run to have more non NSAIDS, more Non-Opioids and more novel (new) or even an orphan type drug classification for GMO marijuana. In the mean time, one does have to ask, are we better off studying and fast tracking inside the current legal system or letting the genie out of the bag completely unbound and unfettered. By my language you can easily guess I prefer the latter.

Peter Moskos said...

I don't buy that evolutionary argument at all: "The more animals feed on it, the more vulnerable the animal becomes to being fed upon itself, thus reducing predation on the plant." It could be equally likely that it's not a defense mechanism but a way to encourage reproduction, like a sweet fruit. And heightened senses and a bit of paranoia could be very useful survival mechanisms, in the wild.

R.K. Brumbelow said...

Peter, for your arguments to be valid it would require situations not present.

For the first to like it to a fruit, there would need to be a benefit tot he plant such as seed distribution or processing the outer husk, such is not seen in marijuana. Another alternative would be a hook and loop system like velcro or burs/ thistles where the plant would be caught up in the grazing and carry the fruit/ seed to another area, again such is not seen in marijuana.

For the second, it might be of a benefit to the animal to be paranoid (it is not but for your argument to hold it would need to be) but what we have seen time after time is that it is better to use energy to respond to real threats, not imagined ones. A pro evolutionary attentive type example would be why ADHD survives in the human population: It is beneficial to have scouts at the edge of the camp who are easily attracted to small movements and then become hyper aware of their surroundings like ADHD people do, while maintaining a higher energy level and not focusing on things long term. So the border scout is easily attracted to movement, color sound etc, gets a boost of energy and a release of dopamine and can then in short order examine the thing that caused the distraction and then if it is safe abandon it and move on to the next possible threat. The kind of anxiety and paranoia brought on my marijuana does not appear to have the same survival type benefits.

The truth is that the THC in marijuana in located in the bud more so than anywhere else, specifically in unfertilized female plants, so THC concentration increases in plants unfertilized and late in the season, this is pro my argument, and anti yours.

Again my model is animals consume the marijuana, become less abel to defend themselves and so have increased predation. Can you really argue that people who consume marijuana recreationally are not showing the same model? They are slower, more suggestible, less violent, less opportunistic, less motivated. Basically, less trouble for a predator this easier to prey upon.

JPP said...

One thing that improved in Portugal after liberalization, according to one book, is the antipathy towards police lessened quite a bit, leading to more cooperation during investigations generally.

Why bother discussing evolution with regards to policy? Educate people so they can make their own choices with regards to consumption and then butt out.

Ian Tyrrel said...

Hi there! Great blog by the way. I am no scientist so I won't comment on the validity of the information but having lived in Colorado for three years during legalization I can say that I either met or overheard many people talking about how they switched from opiate-based prescription drugs in favor of strong Indica strains of marijuana and never looked back. Personally I have back pain from scoliosis which weed really doesn't do anything for, and I currently live in Southeast Asia where you *really, really* don't want to get caught with it so I just gave it up. Anyway, this isn't surprising news, but obviously it's good news.