Since anecdotes do not rise to the level of evidence, this should be all we need to know, but two points should be emphasized. First, the decrease in opioid use in states where medical cannabis is legal is fully consistent with its usefulness for pain. This is a promising finding for pain treatment but should not be interpreted as suggesting any usefulness for treating opioid use disorder. Second, promoting a treatment for OUD with unknown effectiveness may cause significant harm, not just from untreated OUD itself, but from fatal overdose. An important feature of the medication component of "Medication-Assisted Treatment" is that buprenorphine and methadone significantly reduce overdose death, which is otherwise common in early or intermediate recovery from OUD. Medication-assisted treatment (which is used together with counseling and many non-medical approaches) is the only evidence-based treatment for opioid use disorder and is highly effective for long-term recovery as well.
Americans are protected from prescription drugs that don't have demonstrated effectiveness for good reason. While we should always look for new treatments, there is an urgent need to expand access to existing effective treatments. Exposing people to treatments with unknown effectiveness, especially for opioid use disorder, is likely to be harmful.
Dr. Joseph Adams, Baltimore
The writer is chair of the Public Policy Committee, Maryland-DC Society of Addiction Medicine.