[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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