By William “Stash” Jones
Oregon Cannabis Connection
Oregon Health Authority approved guidelines that recommend physicians include monitoring patients’ marijuana use, as well as testing them for other drugs. The change in policy is intended to address the increasing opioid abuse occurring in Oregon.
The guidelines were adopted in response to new guidelines directly issued by the Centers for Disease Control (CDC) this past March. After a state led task force adopted them, they spent months nailing down the specific remedies they felt were needed in Oregon. One of the differences was to include the “monitoring” of marijuana use.
The guidelines are not meant to take away any medications, according to an article at Oregonlive, where they reported, “The guidelines are not trying to eliminate any form of treatment or take patients’ prescription painkillers away altogether.”
“The focus really is that what else can you offer patients,” Dr. Katrina Hedberg, Oregon’s Health Officer, told Oregonlive. “How can you make sure that patients are continuing to function, maintain or improve their function.”
The guidelines also address: When to initiate opioid use for chronic pain, opioid selection, dosage, duration, follow-up and discontinuation, and assessment of the overall risk and harm of opioid abuse.
Their focus is on the negative effects of marijuana with opioid use, not beneficial ones. The guidelines state, “Clinicians should assess for contraindications and precautions to the concurrent use of marijuana and opioids.”
However recent studies have shown a direct relationship to increased marijuana use and decreased opioid use, including a study in September that appeared in the American Journal of Public Health. Also, a new study is underway in Colorado, funded by their cannabis tax revenue, to study the potential for cannabis to reduce narcotic pain medications.
From the Oregon Opioid Guidelines:
IV. Additional Considerations: Marijuana and Safe Storage and Disposal
1. Marijuana — With Oregon’s recent legalization of recreational use of marijuana, its use is relatively prevalent. Current data are limited on the interactions between opioids and marijuana.
– Clinicians should discuss and document the use of marijuana with their patients, including: whether they use, if so, amount, type, reasons for use, etc.
– Clinicians and their organizations have an obligation to closely follow the emerging evidence on the use of marijuana for treatment of pain, and adopt consistent best practice. Refer to the OHA medical marijuana prescribing guidelines, at https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/Physicians.aspx
– As with all pain treatment, consideration of marijuana use concurrent with opioids should be focused on improving functional status and quality of life, and ensuring patient safety. Clinicians should assess for contraindications and precautions to the concurrent use of marijuana and opioids.
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