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Saturday, September 25, 2021

Opioid misuse concerns remain amid pandemic

Study reveals counties with increased number of cannabis dispensaries have decreased rates of opioid-related deaths

As COVID-19 continues to dominate public health concerns, another epidemic still remains prevalent in the background—the opioid crisis. According to the Centers for Disease Control (CDC), the U.S. saw the highest number of deaths within a 12-month period during the pandemic due to overdoses, the primary driver being synthetic opioids. Recent research conducted by Greta Hsu, a professor of management at the UC Davis Graduate School of Management, sheds light on a potential direction for researchers to take in addressing opioid misuse. 

“Given how serious the epidemic of opioid misuses and drug overdose deaths has become, we thought this was an important public health question worth investigation,” Hsu said via email.

When Hsu and her collaborator Balazs Kovacs, an associate professor of organizational behavior at the Yale School of Management, began looking at the increased prevalence of legal cannabis stores, they realized that looking at cannabis dispensaries on a county-level could shed light on whether the availability of legal cannabis had any implications on opioid misuse. 

They found that counties with a higher number of cannabis dispensaries were associated with reduced opioid-related mortality rates. Hsu elaborated that this was the case for both medical dispensaries, which only serve patients with a physician’s recommendation, and recreational dispensaries, which cater to any adult 21 years and older. 

Naileshni Singh, an associate clinical professor in the department of anesthesiology and pain medicine at UC Davis Medical Center, explained that opioids are commonly used in pain management, such as for cancer-related pain, acute pain and post-surgery pain. While the substance used to be the primary treatment for chronic pain in the mid 1990s and early 2000s, according to Stephen Henry, an assistant professor of general medicine at UC Davis Medical Center, present-day clinicians know that the long term use of opioids may not necessarily be better or safer compared to alternative treatments such as anti-inflammatory medicine or exercise-based treatments. Singh also emphasized the need for clinicians to understand more about how to treat pain with non-opioid based methods. 

“It’s not just prescribing a medication, but it’s encouraging patients to exercise, to engage in physical therapy, to engage with family members, to try other medications that are not opioid based, to lose weight, to get on a healthy noninflammatory diet,” Singh said. “There’s a lot of things that patients can do other than take medication to alleviate their pain.”

For the past couple of years, Singh has been incorporating more opioid education into the medical school curriculum so students can have more knowledge when prescribing and using opioids for medical cases. She believes opioids are an important aspect of pain management and have many benefits such as helping patients be more functional and less socially isolated. However, it is important for medical students to understand the balance between the risks and benefits of its use. In some cases, opioid use could result in respiratory depression, constipation, osteoporosis, unintentional overdose or death.

“You need to understand what the opioids can do, what the opioids can’t do and how it’s one piece of the bigger pain management puzzle,” Singh said. “So if the benefits appear to outweigh the risks, then it could be an appropriate therapy.” 

Henry explained that one of the barriers patients and primary care clinicians face when dealing with effective pain management is having difficult conversations about opioids and chronic pain, often involving mutual mistrust. Such barriers make pain treatment difficult in a climate where opioid prescriptions for pain are already strongly discouraged. 

“In some of my research, I found that many times primary care physicians can have a very difficult emotional conversation with a patient about opioids that leads them to be suspicious of all patients who are taking opioids for chronic pain, even though the majority of patients just want to get better treatment for their pain,” Henry said. “On the other hand, patients often have experience being stigmatized or mistrusted by primary care physicians and so can be on guard and suspicious of clinicians.”

He expressed that although opioid use disorder and opioid overdose are major public health problems, the vast majority of patients who are taking opioids for pain management only take low doses for short periods of time. He stated that it is important to be able to identify high risk patients, such as those with a history of a substance use disorder, in order to minimize opioid misuse. 

Hsu explained her study cannot demonstrate whether there is a causal relationship between increased prevalence of cannabis dispensaries and reduced opioid-related mortality rates, but may be able to help inform public health policies. While Henry stated that there haven’t been many studies looking at cannabis as a potential pain treatment option, he hopes regulations guarding it may be reduced for more research to be conducted with the substance. Singh also named cannabidiol (CBD) oil and tetrahydrocannabinol (THC) related products as possible alternatives. 

“Overall, we believe greater understanding [of] the public health outcomes of cannabis legalization on opioid misuse is needed so that policymakers can properly weigh the potential benefits versus harms of promoting cannabis legalization,” Hsu said via email. 
Written by: Michelle Wong —science@theaggie.org

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