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An Opioid Prescription In Illinois Could Be A Ticket For Medical Marijuana

flickr/snakegirlproductions/CC BY-NC 2.0
Legislation passed in Illinois could open access to medical cannabis for anyone with an opioid prescription. It's unclear whether the governor will sign it.

Across the country, states desperate to prevent opioid addiction are increasingly looking to medical cannabis as a solution. Lawmakers in several states, including New York, Indiana, Georgia and Tennessee, have taken action to initiate or expand their medical marijuana programs to try and address the opioid crisis.

Illinois is trying to do the same.

On May 31, the last day of the spring session, state lawmakers passed legislation that could open access to medical marijuana for millions of patients. The Alternatives to Opioids Act would allow more patients to apply for temporary access to the state’s existing medical cannabis pilot program.

"As we see the horrible damage inflicted by opioid use and misuse, it seems like a very low-cost and low-risk alternative." -Illinois state Sen. Don Harmon

To qualify, a person must be 21 or older and have a condition for which opioids might be prescribed. Patients would no longer be fingerprinted or need criminal background checks. Instead of waiting months for approval, patients could get near-immediate access to cannabis products at licensed dispensaries by presenting paperwork signed by their doctor.

The bill streamlines the program and reduces the backlog of applications, said lead sponsor Sen. Don Harmon, a Democrat from Oak Park.

“As we see the horrible damage inflicted by opioid use and misuse, it seems like a very low-cost and low-risk alternative,” Harmon said.

More States Push For Medical Marijuana Access

Harmon joins a growing cohort of state politicians who’ve gone on the record lately in support of medical marijuana as a tool to prevent opioid addiction. When Indiana Republican Rep. Jim Lucas of Seymour proposed a medical marijuana bill last fall he mentioned “possible benefits of medical marijuana as an alternative to opioids.”

Last week, New York Republican state Sen. George Amedore cited the opioid crisis when he spoke about legislation that would allow doctors to prescribe cannabis oil as an alternative to opioids for certain conditions, as WAMC reported.

Illinois is one of 29 states plus Washington, D.C., with a law that allows patients access to medical marijuana. Under the current program, a doctor must certify a patient has one of 41 qualifying conditions, which include HIV/AIDS, cancer, terminal illness and post-traumatic stress disorder. Chronic pain does not qualify a patient, although earlier this year, a judge ordered Illinois to expand the program to include intractable pain that can’t be effectively treated with other therapies. That move is on hold as the state’s Department of Public Health appeals that ruling.

Mixed Reaction

The new measure could increase the number of people in Illinois who can access marijuana for a medical condition. The medical cannabis program currently has about 38,000 licensed users. The number of prescription opioids filled in 2017 topped 5 million.

Credit Illinois Department of Public Health

Harmon said he hopes the measure will reduce the number of prescription opioids to new patients and help others taper off opioids. Now it will be up to the governor whether this legislation, which received wide bipartisan support from the House and Senate, becomes law.

Advocates for medical marijuana see the measure as a necessary step to combat the state’s opioid crisis. In 2017, more than 13,000 people in Illinois overdosed on opioids. About 2,000 of those were fatal.

“I think it will save a lot of people’s lives to be quite honest,” said Dan Linn, executive director of the Illinois chapter of National Organization for the Reform of Marijuana Laws, which advocates for the legalization of marijuana.

The measure will be “both a lifeline to those patients who are being prescribed opioid-based painkillers, as well as the medical cannabis industry in Illinois,” Linn said.

The state’s 54 licensed cannabis dispensaries crafted their business models with the expectation they would have 100,000 qualifying patients in the program by now, he said. Linn anticipates the bill could almost double the patient count to 75,000 within a year of implementation.

Some who work on the frontlines of addiction treatment are concerned the policy is getting ahead of the science.

Aaron Weiner directs addiction services at Linden Oaks Behavioral Health in Naperville. He said lawmakers are replacing one addictive substance with another. “People are prescribed opioids inappropriately all the time,” he said. “That doesn’t mean they should be smoking pot” instead.

Weiner said some scientific research supports the use of marijuana to treat chronic pain, referring to a 2017 report from the National Academy of Sciences, Engineering and Medicine. But he said the industry, as it currently stands, puts patients at risk.

"People are prescribed opioids inappropriately all the time. That doesn't mean they should be smoking pot." -Aaron Weiner, addiction specialist

That’s because patients who receive a medical cannabis card must use trial-and-error to find what works among a plethora of marijuana products. Weiner is concerned that cannabis dispensary staff aren’t trained adequately and he said they’ve been found to make recommendations that can harm patients.

He’s also worried about how the products are sold under names such as Bio Jesus and OG 18. “This is not marketed to 50-year-old people in intractable pain,” Weiner said. “If we’re going to pass something like this, I think it’s our responsibility to protect patients while we do it. I really don’t see that right now.”

The Illinois Association for Behavioral Health, which represents more than 60 behavioral health organizations across the state, has taken a neutral stance on the bill. But the group’s chief operating officer, Eric Foster, said he supports efforts to reduce opioid prescriptions.

'I think the public is unaware of how little data we have that’s rigorous on the therapeutic effects of cannabis.' -Ziva Cooper, cannabis researcher

Where The Science Stands

The most recent guidelines from the Centers for Disease Control and Prevention find no evidence that opioids are effective for treating chronic pain. As many as one in four patients who take opioids long term struggle with addiction.

Whether medical marijuana is an effective alternative to opioids for pain is still an open question, said Ziva Cooper, a cannabis researcher and associate professor of clinical neurobiology at Columbia University Medical Center in New York.

“I think the public is unaware of how little data we have that’s rigorous... on the therapeutic effects of cannabis,” said Cooper, who is one of the authors of the 2017 NASEM report on medical marijuana.

Earlier this year, Cooper published a study in the journal Nature that found medical cannabis can work in conjunction with low doses of opioids to provide greater pain relief than opioids alone.

There are many anecdotal reports of patients using medical cannabis to reduce their reliance on opioids, but Cooper said more research is needed to know definitely whether that’s the case.

What The Future Holds

While the changes to Illinois’ medical cannabis program could increase access to the drug, Sandy Champion, an advocate for medical marijuana who helped draft legislation for the pilot program in 2013, remains cautious.

She said some patients with qualifying conditions can’t find a doctor who will complete the paperwork to apply to the program and she thinks that’s unlikely to change.

Sen. Harmon said doctors will not be compelled to participate. But he thinks the argument that the measure would replace one addictive drug with another is “ridiculous.”

“Opioids and heroin is killing scores of people. No one has died from overdose of cannabis,” said Harmon, who agrees more research on marijuana is needed. But he said the drug’s Schedule 1 classification, which means it’s considered highly addictive and has no medical use, presents challenges to scientists.

Champion said she does not expect Gov. Bruce Rauner to sign the bill because his administration has been opposed to expanding the medical cannabis program in the past.

But Harmon is optimistic the governor will sign it because of how closely he worked with state agencies throughout the legislative process. “I think we were very tuned in to their concerns and tried to make it a better program for them to administer,” Harmon said.

Rauner’s office did not respond to a request for comment. The governor did tell the Kane County Chronicle Wednesday that his medical experts are looking at the measure and he will make a decision “in the not too distant future.”

This story was produced in partnership with Side Effects Public Media, a news collaborative covering public health.

Follow Christine on Twitter: @CTHerman

Editor's Correction: An earlier version of this story incorrectly stated that Illinois' medical marijuana pilot program started in 2015. It actually started in 2013.

Christine Herman is the managing editor for Side Effects Public Media