[Congressional Record Volume 163, Number 164 (Thursday, October 12, 2017)]
[House]
[Pages H7977-H7978]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
OPIOID CRISIS
The SPEAKER pro tempore. The Chair recognizes the gentleman from
Oregon (Mr. Blumenauer) for 5 minutes.
Mr. BLUMENAUER. Mr. Speaker, Dana Milbank had an interesting column
in the morning Post about the feckless congressional response to the
opioid crisis. Both the administration and Congress have been good at
hyping the crisis, but when it comes time to actually taking action,
almost nothing happens.
The failure to protect our citizens is appalling, especially since
most of the opioid crisis is a result of failed public policies. We
have spent over $1 trillion on a failed war on drugs that concentrates
on prohibition and punishment instead of treatment, which would help
people break the cycle of addiction.
The challenges that drove people to abuse opioids in the first place,
like chronic pain, depression, and lax policies prescribing vast
quantities of ever-more powerful opioids, should never have been
allowed to happen in the first place. It was a public policy failure of
government, the industry, and, sadly, some unscrupulous practitioners
that allowed the addiction genie out of the bottle.
When denied access to opioids, people, understandably, turn to heroin
and other damaging and addictive drugs because they were trapped by
these powerful forces. Few people willingly damage their bodies and
destroy their families and careers, if not for powerful forces beyond
their control.
As appalling as this failure is, what is even worse is that we fail
to take reasonable, commonsense steps to stop it. The easiest solution
is to provide more access to medical marijuana, already available in 28
States. This availability, by the way, has been driven as a result of
citizen action and not politicians, who have too often been afraid to
touch it.
The evidence is powerful and overwhelming. Where there is access to
medical marijuana to treat the problems that drove people on the path
to addiction in the first place, there are fewer pills prescribed and
overdose deaths drop.
It is clear that using medical marijuana is as effective, or perhaps
even more effective, than opioids to treat pain. They cause less damage
to people's health and are far less costly than pharmaceuticals. I
provided the subcommittee taking testimony with the facts and citations
that would justify digging deep into this potential solution.
Cannabis reduces overdose deaths, reduces opioid consumption, and it
can prevent dose escalation and the development of opioid tolerance,
which leads to that cycle, and too often, tragically, opioid deaths:
175 people a day.
As my friend, Greg Walden, pointed out in the subcommittee hearing
yesterday, more people die in Oregon from opioid overdose than traffic
accidents.
More benefits, fewer side effects, lower costs.
Mr. Speaker, I include in the Record the evidence I gave to the
Subcommittee on Health yesterday.
Physician Guide to Cannabis-Assisted Opioid Reduction
(Prepared by Adrianne Wilson-Poe, Ph.D.)
Cannabis reduces opioid overdose mortality.
In states with medicinal cannabis laws, opioid overdoses
drop by an average of 25%.
[[Page H7978]]
This effect gets bigger the longer the law has been in place.
For instance, there is a 33% drop in mortality in California,
where compassionate use has been in place since 1996.
This finding was replicated by Columbia's school of public
health, using a completely different analysis strategy.
Cannabis reduces opioid consumption.
Cannabis is opioid-sparing in chronic pain patients. When
patients are given access to cannabis, they drop their opioid
use by roughly 50%. This finding has been replicated several
times from Ann Arbor to Jerusalem.
This opioid sparing effect is accompanied by an enhancement
of cognitive function once patients begin cannabis therapy:
this effect is most likely due to the fact that patients
reduce their opioid use.
Cannabis use is associated with a reduction in not only
opioid consumption, but also many other drugs including
benzodiazepines, which also have a high incidence of fatal
overdose. In states with medicinal cannabis laws, the number
of prescriptions for analgesic and anxiolytic drugs (among
others) are substantially reduced. Medicare and Medicaid
prescription costs are substantially lower in states with
cannabis laws.
Cannabis can prevent dose escalation and the development of
opioid tolerance.
Cannabinoids and opioids have acute analgesic synergy. When
opioids and cannabinoids are coadministered, they produce
greater than additive analgesia. This suggests that analgesic
dose of opioids is substantially lower for patients using
cannabis therapy.
In chronic pain patients on opioid therapy, cannabis does
not affect pharmacokinetics of opioids, yet it still enhances
analgesia. This finding further supports a synergistic
mechanism of action.
Pre-clinical models indicate that cannabinoids attenuate
the development of opioid tolerance.
Cannabis, alone or in combination with opioids, could be a
viable first-line analgesic.
The CDC has updated its recommendations in the spring of
2016, stating that most cases of chronic pain should be
treated with non-opioids.
The National Academies of Science and Medicine recently
conducted an exhaustive review of 10,000+ human studies
published since 1999, definitively concluding that cannabis
itself (not a specific cannabinoid or cannabis-derived
molecule) is safe and effective for the treatment of chronic
pain.
When 3,000 chronic pain patients were surveyed, they
overwhelmingly preferred cannabis as an opioid alternative.
97% ``strongly agreed/agreed'' that they could decrease
their opioid use when using cannabis.
92% ``strongly agreed/agreed'' that they prefer cannabis to
treat their medical condition.
81% ``strongly agreed/ agreed'' that cannabis by itself was
more effective than taking opioids.
Cannabis may be a viable tool in medication-assisted
relapse prevention.
CBD is non-intoxicating, and is the 2nd most abundant
cannabinoid found in cannabis. CBD alleviates the anxiety
that leads to drug craving. In human pilot studies, CBD
administration is sufficient to prevent heroin craving for at
least 7 days.
Cannabis users are more likely to adhere to naltrexone
maintenance for opioid dependence.
Mr. BLUMENAUER. There is a reason that up to 90 percent of the
American public favors greater access to medical marijuana. Last year,
voters in Florida approved their program by over 70 percent.
Mr. Speaker, the Federal Government continues to interfere,
threatening medical marijuana programs, which requires Congress to step
in to shield it, as we have done last year and for the previous 2
years. Unfortunately, the Rules Committee denied us a chance to vote on
it.
Last Congress, both Houses approved measures for VA doctors to be
able to consult with veterans who have a serious overdose problem.
Despite passing both Chambers, it was stripped out and the Rules
Committee failed to allow us to vote on this as well.
Most tragically, Congress continues to allow the Federal Government
to have a stranglehold on research to be conducted to be able to
definitely answer these questions.
I strongly urge my colleagues to join my friend, Dr. Andy Harris, and
me on our research bill, H.R. 3391. There is no reason that the Federal
Government denies research to be able to definitively answer these
questions.
I am tired of looking at the opioid damage in my State and around the
country, and have Congress propose Band-aids when there is a simple,
commonsense, widely accepted, and popular approach: allow people access
to medical marijuana.
The time to do it is now. Lives are being lost as we dither.
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