Most of us in the AOD prevention business are not medically trained, however we are often asked to weigh in on medical matters. The recent focus on prescription drug abuse is one example of this. Another is medical marijuana.
Two recent events bring these two topics together, highlighting the conflicts that are brewing within the field. First, a story that pharmaceutical companies appear to be racing to get a pure Hydrocodone (the opiate in Vicodin) approved and to market (Huffingtonpost, 12/26/11). The second is a scientific research paper published that demonstrates that cannabinoids may allow for a reduction in opioid doses needed to manage pain (Abrams, Couey, Shade, Kelly, & Benowitz, 2011).
The story that a new, possibly crushable time-release opioid may hit the market sends shivers down the spine of anyone who already is working to reduce OxyContin abuse. Apparently, the Vicodin mixture of Hydrocodone and Acetominophen can cause negative side effects such as kidney damage because of the high dose of Acetominophen within it; thus the need for a pure form. But it is hard to imagine that the drug will remain solely in the medical setting; addiction and overdoses are predictable outcomes of a pure version of such a widely abused opioid (CDC Vital Signs). But we must also not lose sight of the pain relief that these medicines are rightly providing.
So what does this have to do with medical marijuana? The Abrams and colleagues (2012) study may point to ways of using active agents within marijuana to lessen the need for opiates in pain management. But those of us who are worried that the current direction for implementing medical marijuana may be ignoring public health consequences of greater access cringe at the direction such line of thinking leads.
So this means, prevention efforts need to remain flexible to the direction medical management of pain advances may lead. Conflicting pressures may at some point in the future make it necessary to consider the harm reduction value of new approaches to pain management. However, we must continue to remind the health and regulatory communities about the risks diverted medicines pose to public safety.
References:
Abrams, D. I., Couey, P., Shade, S. B., Kelly, M. E., & Benowitz, N. L. (2011). Cannabinoid-Opioid Interaction in Chronic Pain. Clin Pharmacol Ther, 90(6), 844-851.
CDC Vital Signs - Prescription Painkiller Overdoses in the US. Retrieved January 18, 2012, from http://www.cdc.gov/Vitalsigns/PainkillerOverdoses/index.html
Zohydro, Pure Hydrocodone Prescription, Concerns Painkiller Abuse Experts. (12/26/11). Retrieved January 5, 2012, from http://www.huffingtonpost.ca/2011/12/26/zohydro-pure-hydrocodone-vicodin_n_1170104.html
