Rio Arriba County, just north of Santa Fe, New Mexico, has long struggled with some of the highest rates of drug overdoses in the United States. Between 2010 and 2014, at least 78 people died from overdoses for every 100,000, compared with 24 instate and 14 across the nation. Heroin and other opioids – highly effective painkillers that include oxycodone, hydrocodone and fentanyl – have been consuming the small, high desert communities in the Southwest. The state has introduced harm-reduction efforts – like syringe exchange services, overdose training and the distribution of naloxone, an injection that can reverse the effects of an overdose – but New Mexicans are searching for ways to cut ties with opioid abuse altogether.
On March 17th, two days after Attorney General Jeff Sessions told law enforcement that marijuana is "only slightly less awful" than heroin, the New Mexico State Senate passed HB 527, a GOP-sponsored House bill aimed at modernizing the state's strategies to combat multigenerational opioid abuse. "We're hoping to make things easier on the patients enrolled in the program," says state House Minority Leader Rep. Nate Gentry. "Medical cannabis has great potential as an opioid replacement drug and we want to move people away from being prescribed highly addictive opiates."
Medical marijuana is legal in New Mexico. The state is among 28 others and the District of Columbia where people can legally use cannabis to treat a host of state-determined qualifying conditions like cancer, glaucoma, AIDS/HIV, PTSD and chronic pain. Jessica Gelay, coordinator at Drug Policy Alliance's New Mexico office, says the state has licensed 35 dispensaries for 33,000 patients since medical marijuana became legal in 2007. "The program is established," says Gelay. "People continue to use marijuana here and lessen the stigma." Now, Republican Governor Susana Martinez has until April 7th to decide whether her state becomes the first-ever to legalize the use of medical marijuana to treat opioid addiction.
Martinez, a former prosecutor turned two-term governor, has long been opposed to marijuana legislation. But the fate of the bill remains uncertain because of bipartisan support and a statewide effort to curtail the opioid crisis, while Martinez finishes her final year allowed in office. "I hope the governor recognizes medical marijuana as a tool to help save lives," says Gelay. "No other solution is working. Overdose death rates are still going up. Naloxone works, but we need to find a more proactive solution. It's pretty clean cut, and she would be such a hero if she signed the bill." If Martinez vetoes the measure, advocates can direct final pleas to Lynn Gallagher, the Secretary of the New Mexico Department of Health, to sign a petition separate from the legislative process aimed to add opioid addiction to the state's existing 21 conditions of medical marijuana use.
The author of the petition is Anita Willard Briscoe, a psychiatric nurse practitioner with a private practice in Albuquerque. Briscoe grew up in Espanola, a largely Hispanic and Latino city in Rio Arriba, settled by the Spanish in 1598 and more recently taken over by devastating drugs. "Heroin took over this area starting in the 1940s with the Lowrider culture and then in the 1970s with Vietnam veterans," says Briscoe. "I saw it absolutely ravage my hometown. I had a lot of high school classmates who died." Briscoe became a registered nurse in 1977 and a psychiatric nurse in 1992. In 2005, she became a nurse practitioner because she saw medical professionals "misdiagnosing people, over-prescribing pills, and patients were suffering as a result." After the state legalized medical marijuana in 2007, a colleague showed her its ability to help patients with PTSD and she started referring patients to the state Medical Cannabis Program in 2009.
Last year, Briscoe teamed up with her "cannabis prescribing colleagues" – two other psychiatric nurse practitioners and one psychiatrist – to collect self-reported data from 400 patients, and they found that many were "successful at quitting opiates using cannabis." Between 2015 and 2016, Briscoe observed that 25 percent of her patients reported being able to "kick" opioids with marijuana. "They state it calms down their cravings, relaxes their … anxiety and is helping to keep them off opioids," Briscoe wrote in November to the Department of Health's medical advisory committee, which approved the petition and passed it onto Gallagher. "If they are in pain, cannabis is helping relieve their pain, often to the point that they don't need opiates anymore." A 2014 study published in JAMA Internal Medicine, which examined data between 1999 and 2010, found that states with medical marijuana laws had 25 percent lower annual opioid overdose death rate compared to states without such laws. Briscoe's team is not looking to replace the use of methadone and Suboxone with marijuana completely, but rather to use cannabis as "an adjunct to treatment."
New Mexicans are not the only people searching for alternative ways to ward off opioid-related deaths. Last year, the Maine Department of Health and Human Services denied a petition drafted by a medical marijuana caregiver requesting to add opioid addiction to the state's list of qualifying conditions, citing the "lack of rigorous human studies" and the "lack of any safety or efficacy data." Advocates admit direct evidence is needed, but they contend that funding is limited since marijuana is federally listed as a Schedule 1 drug, on par with LSD and heroin. In the meantime, they turn to a Centers of Disease Control report to make their point on the safety of marijuana, comparing the 33,000 Americans who died from prescription painkillers and heroin overdoses in 2015 to the number of people who died that year from using cannabis: zero.
Earlier this year, the National Academy of Sciences, in a 395-page report, refuted the "gateway drug" theory that using marijuana can lead to opioid addiction and instead found evidence of cannabis having therapeutic and health benefits. Joe Schrank, a social worker who worked at various detox centers and clean houses, is now practicing the report's findings at High Sobriety treatment center in Los Angeles, where he offers clients medical and therapeutic sessions, and daily doses of marijuana to treat a variety of addictions.
Schrank, who has been sober for 20 years and doesn't smoke marijuana, says his most recent efforts started with the death of his friend Greg Giraldo, the comedian who died in 2010 in after accidentally overdosing from prescription drugs in a hotel. As Schrank tells it, he suggested that Giraldo use pot instead of cocaine or painkillers weeks before his death – unpopular advice in the rehab world. "I think Greg's death was the moment I said, 'Fuck this, if people can get better smoking pot rather than using cocaine and Valium, I'm going to help,'" says Schrank. After Giraldo's death, Schrank began working with addiction psychiatrist Dr. Scott Bienenfeld and former Drug Policy Alliance law and policy expert Amanda Reiman, who lectures at her alma mater UC-Berkeley on marijuana issues. Schrank has found success since opening the treatment center in January 2017. "Having worked in rehab for many years, my first thought is, 'Why didn't we do this years ago?'" says Schrank. "One of the barriers in entry to treatment is detox. Many people are afraid of it. It's difficult to break this step. But when they're told, 'Hey, you can smoke pot.' It softens the blow."
According to Bienenfeld, heroin, morphine, Oxycontin, oxycodone and Vicodin activate the opioid system in the brain, causing a sense of extreme pleasure, sedation, numbing and euphoria – well above and beyond what normal pleasure feels like from food and sex. Side effects of opiates include analgesia and respiratory depression. "Opiates kill you in overdose by cutting off the brain's sense that it needs oxygen, thus the reflex to breathe is cut off and people die of respiratory failure," says Bienenfeld. "Combining opiates with other drugs like alcohol and sleeping pills makes it easier to overdose." Still, opioids seem to have a profound ability to reduce anxiety and depression in some people. These drugs rapidly induce a physical dependence and users become hooked quickly and need more of the drug to get high, and if they stop the drug abruptly, they experience withdrawal, which contrary to its uncomfortable feeling is usually not life-threatening. Marijuana stimulates cannabinoid receptors in the brain and causes mild psychedelic effects and a range of other feelings such as calmness, paranoia, anxiety and hunger – which can alleviate the symptoms of withdrawal.
But Schrank says others in the rehab business criticize High Sobriety as a "money-making scheme" for charging $42,500 a month. "Cardiologists make money and so do lawyers," says Schrank. "I'm a socialist and I fucking hate it. I don't like class systems. I don't like that suburban white kids go to rehab and black kids go to jail. We're trying to get insurance companies to accept what we do." It would be great to have "the blessing from a scholarly journal," says Schrank, who adds that he has clients telling him they haven't shot heroin in years because of cannabis. But as Bienenfeld notes in an email, "There are no actual data or studies that prove marijuana treats opioid addiction, but there are studies to suggest it may be a viable option."
Though marijuana is not fatal in overdose, Bienenfeld notes that people can have intense reactions. "There seems to be an association between cannabis use and psychotic mental illness in people who either have an underlying psychotic disorder, or a strong family history of schizophrenia, therefore it can be risky," says Bienenfeld. Yet he believes that's no reason to stop their treatments.
Schrank and Bienenfeld believe their position is controversial because established addiction treatment programs like Alcoholics Anonymous are against using any intoxicants in sobriety. "The 12-step advice to fight the opiate epidemic is to go to more 12-step meetings and programs," says Bienenfeld. But, he notes, the statistics show that approach isn't working. "People are dying by the tens of thousands per year due to the opiate epidemic. If this was Zika Virus, the National Guard would be called in and it would be panic in the streets. Nobody would oppose trying experimental approaches based on research trends and medical anecdotes."
The established medical community is less sure. The position of the Philadelphia-based Treatment Research Institute, a nonprofit organization focused on substance abuse treatment reform and policy, is that until there is research to conclusively prove the connection, the experimental treatment is too risky. "Until there is research that deems safe and successful outcomes for the use of FDA-approved, marijuana-derivative medications to treat a substance abuse disorder it does not align with the currently available FDA-approved Medication Assisted Treatments for Opioid Use Disorders," writes TRI spokeswoman Debra Snyder in email. (Snyder declined to comment on the High Sobriety treatment protocols specifically.)
Thomas McLellan, founder of TRI and a former deputy drug czar under the Obama administration, believes that the pending New Mexico bill is misguided: "The United States has the safest, most effective medications in the world," writes McLellan. "We should not approve something as serious and important as medications by voice vote." But such beliefs are not helping existing opioid addicts clean up, according to Bienenfeld, who adds that marijuana is already preventing new addictions from forming.
Even though there is a lot of support, New Mexico's bill is going to face problems since Governor Martinez seems uncertain on the potential benefits of marijuana. Earlier this year, she supported legislators killing a measure seeking to join Colorado, Nevada, California, Washington, Alaska, Maine, Massachusetts and the District of Columbia in the legalization of recreational marijuana. In New England, where lawmakers are reviewing cannabis regulation in the wake of legalizing recreational use in two of four states last year, legislators are also trying to figure out how to reduce high rates of opioid-related deaths. As thousands of people in Massachusetts have already been using cannabis as a replacement to prescription opioids, Integr8 Health, a Maine-based medical marijuana physicians practice, has reporting an uptick in patients using marijuana to manage chronic pain. A 2016 study published in Health Affairs Journal supports the trends, finding that Medicare patients received fewer prescriptions for pain and other conditions between 2010 and 2013, as states adopted medical marijuana laws. "We're finding strong evidence that approving medical cannabis can be effective in preventing people from using opiates," says W. David Bradford, a health economist at the University of Georgia, who published the findings with his daughter, a master's student Ashley C. Bradford. The research duo expects to publish a follow-up study in the summer that has "promising results" supporting marijuana's replacement of prescription drugs among Medicaid patients.
"The clinical community has passed the Reefer Madness stage," adds W. David Bradford. "Opioid addiction is killing over 600 people a week. That's more than two 747 planes crashing every week. There's no single solution to that problem, but we haven't really seen the beginning of the deaths that are rooted in this country and anything we can do to slow that down we just have to take advantage of."
What will become of New Mexico, a state that has the opportunity to set new standards in the prevention and treatment of opioid addiction? Briscoe, who has gained attention from drug policy groups seeking help with drafting petitions in Arizona, Oregon, New York, New Jersey and Maine believes the move will save lives in her hometown of Espanola and elsewhere in New Mexico. "This will help the state's children if the parents aren't hooked on prescription pills and heroin," says Briscoe. "It will help our economy, because they will get on their feet and get jobs. Crime will go down. This is a simple solution to our heroin problem. There is no reason not to sign off on this."
Correction: A previous version of this article stated that opioid addiction is killing 6,000 people a week. The correct number is 600.