As the Count would say: 1,2,3 … 3 medical journal articles … Ha Ha Ha

It is arguably in only the last two decades that computers have been properly used to analyze large amounts of data to make critical decisions about healthcare. The advent of cheaper and cheaper disk space and microprocessors, has made it possible to turn relatively small and simple groups of computers into extremely powerful analysis tools. All of this is important to know because without pedantic data collection as well as large-scale data analysis that can be done in a reasonable amount of time, doctors would simply not know how to best manage many medical cases.

The obvious question of course is, how did doctors manage cases before all of this modern technology. The unfortunate answer is that a great deal of older medicine was based on limited [if any] evidence. More often than not, a doctor chose to treat a patient according to his or her personal experience. And I believe that anyone who has been regularly following my blog, knows the dangers in allowing a doctor to treat based on personal perspective.

Of late, there has been an intensified debate in the United States, and even here in Israel, about the risks of having medically certified marijuana be distributed to patients. Generally speaking, marijuana is used in chronic pain patients or patients with specific medical conditions [like glaucoma]. Another medication that is often used for pain control is morphine. Morphine is classified as an opioid, and is used in various forms to treat a tremendous number of people every year for short-term and long-term pain conditions.

Unfortunately, despite the effectiveness of opioids in helping patients with pain, there has been a national epidemic in the States of drug poisoning, that began at least in the 1990s. Many of the deaths that have occurred in the last 20 years are associated with prescription [versus illicit] opioids. Therefore, this cannot be treated as a classic “street drug problem”, but must be dealt with as a fundamental issue in all medical practice.

To quote from the following article [which quotes an article from JAMA] “nationwide, overdose deaths involving opioid analgesics have increased dramatically over the past decade. While fewer than 4100 opioid induced fatalities were reported for the year 1999, by 2010 this figure rose to over 16,600, according to the US CDC”. While this data comes from the United States, it indicates an alarming trend, which demands some form of response.

Let me now share another statistic, quoted in the same article. “States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws. Specifically, overdose deaths from opioids decreased by an average of 20 percent one year after the law’s implementation, 25 percent by two years, and up to 33 percent by years five and six.”

The obvious question is as follows: can legalization of medical marijuana across an entire country, dramatically counter the progressive increase in opioid related deaths? It would seem from the quotes above, that there is no question of a clear correlation between legalization of marijuana and reduced opioid related deaths. The problem is, that this was not a formal study that truly compared two groups of people, one group using opioids and another group using marijuana, to see what their outcomes would be. Until such a study is done, researchers will be very hesitant to officially accept the apparent correlation. On the other hand, it is very hard to ignore this existing data, especially if you are a physician who is treating a patient for pain with opioids, in a state or country that has legalized marijuana.

Admittedly, many more people may die unnecessarily before studies are done to truly prove that legalizing marijuana saves lives. This is the reality and the necessity of searching for evidence that fundamentally changes worldwide medical practice, and in parallel, the law. As more and more states within America, legalize marijuana, there may be an opportunity to do such a study. In other words, if a state legalizes marijuana today, researchers could track those patients who begin using medical marijuana versus those who continue to use opioids.

I admit, that on the personal level, I find it hard to ignore the existing data. If I was personally asked for my best suggestion regarding pain control, I would advise using marijuana where possible, before beginning the use of opioids. The point is that none of this discussion would be possible without data. I have heard the whole gamut of opinions on the potential risks of legalizing any form of marijuana. There are people who will easily quote you lists of people who have had their lives ruined by marijuana. But with actual data to compare the risk of injury and death between marijuana users and opioid users, the picture becomes very different, and very in favor of legalization.

There will be people who will deny the legitimacy of any study that comes out in favor of using marijuana. It would not surprise me if the same people who refute all of the evidence in favor of vaccinations, would just as easily ignore the medical literature on the benefits of medical marijuana.

Medicine is unquestionably a work in progress. But it is only in the last few years, that we have become a medical community based far more on evidence than anecdote. There are many doctors out there who will continue to practice as they have for the last 30 to 40, if not more, years. My humble advice would be to stay clear of these doctors no matter how pleasant they are and how wide their smile is. Every patient owes it to him or herself, to be treated by a physician who uses whatever data is available, to provide the best possible care.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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