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HARRISBURG — Some Pennsylvania hashish firms are utilizing incomplete or deceptive claims to advertise marijuana as a remedy for opioid dependancy, doubtlessly placing sufferers’ lives at larger danger, a Highlight PA investigation has discovered.
In a first-of-its-kind evaluation, Highlight PA examined greater than 60 web sites providing companies in Pennsylvania and consulted quite a few well being coverage specialists in regards to the validity of the claims. In some cases the place medical analysis was cited on a web site or by an organization official, the information group instantly contacted examine authors.
The investigation discovered a variety of deceptive ways: cherry-picking and misrepresenting elements of research, making broad claims with out citing any particular analysis, and offering incomplete details about what it takes to qualify for the state’s medical marijuana program.
About half the web sites promoted hashish dispensaries, whereas the opposite half had been for physicians or firms that assist certify sufferers.
Essentially the most alarming examples, in keeping with a number of of the specialists, had been on-line statements made by two firms that assist sufferers turn out to be licensed to purchase medical marijuana at state dispensaries.
With out citing particular proof, internet pages for Releaf Specialists and Compassionate Certification Facilities used an identical language to assert analysis suggests medical marijuana is usually a “viable substitute” for buprenorphine, one in all three medication accredited by the federal authorities to deal with opioid use dysfunction.
A number of well being coverage specialists, hashish researchers, and medical suppliers informed Highlight PA the declare was inaccurate, deceptive, or probably harmful.
Officers with each firms defended the language in response to questions from Highlight PA. However analysis supplied by every firm didn’t substantiate their claims as they advised, and a few of the authors of these journal articles strongly pushed again on the characterization of their work.
New York dependancy psychiatrist Adam Bisaga, an creator of one of many scientific articles cited, warned of the chance of utilizing marijuana as a substitute of one of many federally accredited opioid use dysfunction medication, saying in an electronic mail that “advocating substituting hashish for buprenorphine, methadone, or naltrexone isn’t based mostly on any analysis and it could be harmful.”
The scenario exemplifies the confusion and blended messages sufferers obtain in Pennsylvania, a state with one of many highest deadly drug overdose charges within the nation and one of many few to particularly endorse hashish as a remedy choice for individuals with opioid use dysfunction.
Regardless of Pennsylvania’s outlier standing and the excessive stakes for individuals looking for remedy, state regulators do little to make sure hashish dispensaries make correct medical claims on their very own web sites, 1000’s of pages of information obtained by means of Proper-to-Know requests present.
And whereas the state’s 2016 medical marijuana legislation requires the Division of Well being to limit the promoting and advertising of hashish, it doesn’t particularly point out the certification firms that usually play a vital function in connecting sufferers with physicians. A division spokesperson stated the company doesn’t “have any regulatory authority” over these firms.
Chelsea L. Shover, an epidemiologist and assistant professor-in-residence on the David Geffen College of Medication at UCLA, stated selling hashish as an alternative choice to buprenorphine as an opioid use dysfunction remedy is “actually harmful.”
“That’s full nonsense. If it had been as much as me, you wouldn’t be allowed to make claims like that,” stated Shover, who has studied state hashish insurance policies and unsupported medical claims made by dispensaries, after reviewing Highlight PA’s findings. “That’s form of the worst-case state of affairs of this promoting.”
Shover was removed from the one professional alarmed to see hashish firms in Pennsylvania making this declare. Individuals with opioid use dysfunction are about 50% much less prone to die when they’re handled long-term with buprenorphine or methadone, a serious nationwide consensus examine present in 2019. No such proof exists for hashish.
“That’s horrible,” stated Erin Zerbo, an dependancy psychiatrist in New Jersey and an affiliate professor at Rutgers New Jersey Medical College, as she reviewed Highlight PA’s findings. “‘A viable substitute?’ No, that’s dangerous.”
Among the many different findings of Highlight PA’s investigation:
Seven web sites cited a 2014 examine that discovered medical marijuana legal guidelines had been related to decrease charges of deadly opioid overdoses. However they ignored a later examine that confirmed the development didn’t maintain up over time and, in actual fact, reversed. (One dispensary web site eliminated such a reference after Highlight PA contacted it in December.)
Seven promoted the advantages of the hashish compound CBD for opioid dependancy remedy, together with to assist with withdrawal or cut back cravings. However a number of specialists informed Highlight PA that at the very least a few of the messages went past what analysis helps.
The Wolf administration says opioid use dysfunction ought to solely be a qualifying situation for medical marijuana in sure circumstances, akin to when standard remedies are ineffective, however at the very least 13 web sites didn’t embrace these caveats once they described what it takes for dependancy sufferers to qualify for hashish.
“The findings reveal a considerably misleading technique — whether or not intentional or not — adopted by many dispensaries and hashish certification web sites the place very particular and restricted scientific analysis is commonly cited to help very broad statements about hashish’ advantages,” Stephanie Lake, a postdoctoral fellow on the UCLA Hashish Analysis Initiative, stated in an electronic mail. “The results of this technique is an oversimplified and scientifically inaccurate message about hashish.”
Keith Humphreys, an dependancy researcher and professor at Stanford College College of Medication, stated medical hashish firms needs to be held to a better normal than nonmedical companies.
“Nearly every thing in right here is, if not a lie, pushing the border of fact,” Humphreys stated after reviewing Highlight PA’s findings and examples.
Restricted oversight, potential penalties
When Pennsylvania lawmakers legalized medical hashish in 2016, they put safeguards in place for the messages sufferers obtain. However these have vital limits.
The Pennsylvania Division of Well being has the authority to approve or reject promoting, promotional, and advertising supplies from hashish dispensaries, growers, and processors.
However the division hardly ever makes use of its energy to make sure these firms make correct medical claims on their web sites and social media, in keeping with information obtained by means of the state’s Proper-to-Know legislation relationship again to the beginning of this system.
When the company did take enforcement motion, the problem typically was whether or not medical marijuana dispensaries did not observe the required approval course of for submitting promoting and advertising supplies to the Division of Well being, or whether or not they made references to leisure use.
Brendan Saloner, an affiliate professor at Johns Hopkins Bloomberg College of Public Well being, is an creator of a 2014 examine that discovered medical marijuana legal guidelines had been related to decrease charges of deadly opioid overdoses. That analysis has been cited by dispensaries and certification firms in deceptive methods.
Saloner stated Highlight PA’s findings had been “positively in step with the necessity for extra oversight.”
“There’s a necessity to speak with customers in a constant approach that when dispensaries or different marijuana retailers are making claims that these claims needs to be vetted for accuracy,” he stated.
Well being Division spokesperson Maggi Barton stated the company “continues to work with medical marijuana dispensaries to make sure they’re offering prime quality companies to Pennsylvanians for all accredited medical circumstances.” Barton additionally advised, in some circumstances, the division didn’t have sufficient workers to maintain up with the quantity of promotional and advertising supplies.
Barton stated the division doesn’t have enforcement energy over hashish certification firms like Releaf Specialists and Compassionate Certification Facilities, which join individuals to medical doctors who make consequential remedy choices.
‘False hope’
Releaf Specialists described itself on-line as “an trade chief,” whereas Compassionate Certification Facilities’ web site promoted “PA’s Most Trusted Medical Marijuana Certification Suppliers.”
In sections of their web sites centered on opioid dependancy, every displayed an identical statements: “Analysis means that medical marijuana is usually a viable substitute for opioids akin to buprenorphine and different pharmaceuticals.” Neither internet web page included a hyperlink to stated analysis.
Releaf Specialists proprietor Bob Scherer, who’s not a doctor, advised the web site language was supplied by a third-party contractor that he declined to call. He defended the assertion, saying it’s “broad and generalized sufficient that it permits sufferers to find and do extra analysis about how hashish might help them” with opioid dependancy.
“I’m simply saying that, based mostly off of the state pointers, and if sufferers haven’t had constructive outcomes with conventional therapies, then hashish may very well be a viable means for them, they usually have the choice within the state of Pennsylvania to attempt it,” he stated.
Scherer later shared two medical science journal articles with Highlight PA to help the declare.
One in every of them was an article coauthored by Bisaga, the New York dependancy psychiatrist who informed Highlight PA he was involved about the potential of individuals with opioid use dysfunction utilizing hashish as an alternative choice to federally accredited medicine.
The opposite journal article Scherer shared was a evaluation of present analysis, and it included context and notes of warning that Releaf Specialists’ internet web page didn’t. In a piece titled “Shortcomings of Hashish in Remedy-Assisted Remedy,” the authors wrote there was conflicting proof for the effectiveness of hashish for “remedy for opioid misuse.”
Beth Wiese, a neuroscience doctoral candidate on the College of Arizona and an creator of the article, stated she helps having opioid use dysfunction as a qualifying situation for hashish however she nonetheless sounded a observe of warning.
“I don’t know that we’re there to name it a substitute but,” Wiese stated. “Some people might discover that it really works higher for them in its place. However different individuals, it could not. I simply don’t suppose we’re there to know precisely.”
Compassionate Certification Facilities leaders additionally defended the language and shared two medical science journal articles in protection, neither of which claimed medical marijuana is usually a viable substitute for buprenorphine.
Chief government officer Melonie Kotchey — who has an MBA in health-care administration and medical billing and coding, in keeping with the corporate’s web site — additionally referred Highlight PA to a report on the corporate’s web site. Kotchey didn’t specify which report, however her description matched one dated December 2019 that was based mostly on a affected person survey the corporate helped develop.
That report didn’t examine outcomes for sufferers who use hashish as a substitute of buprenorphine, which isn’t talked about in any respect. It additionally lumped collectively a number of circumstances, saying 99.62% of sufferers surveyed “had been in a position to cut back ache, higher sleep, much less anxiousness, much less seizures, urge for food enhance, much less vomiting, nausea, dependancy withdrawal signs, lower with muscle spasms, improved vitality and fewer seizures.”
Bradford Buege, a doctor who the corporate web site describes as board-certified in household apply and emergency drugs, didn’t cite any research in an electronic mail to Highlight PA. “My [patients’] enter is and at all times will probably be valued extra above all else,” Buege wrote. “[D]on’t contact me once more w your pharmaceutical bs.”
Jennifer Hawks, the corporate’s chief medical director, took the argument in favor of hashish over buprenorphine additional than the online web page, saying in an electronic mail that hashish and the hashish compound CBD “are a lot much less invasive and far safer than buprenorphine by far.” A 2019 report from the Nationwide Academies of Sciences, Engineering, and Medication stated buprenorphine and different federally accredited drugs for opioid use dysfunction “are secure and extremely efficient.”
Hawks is a licensed naturopathic physician in Arizona, a state the place these practitioners can certify sufferers for hashish. That isn’t the case in Pennsylvania, in keeping with the Wolf administration.
Hawks cited two medical science journal articles, however neither examined dependancy remedy outcomes for individuals who used medical marijuana vs. buprenorphine.
Matisyahu Shulman, an dependancy psychiatrist in New York and an creator of one of many articles, informed Highlight PA that the purpose of a piece Hawks cited is that individuals ought to use buprenorphine as a long-term remedy, not for only a week or two weeks. The article, an summary of analysis on buprenorphine, didn’t point out hashish or CBD.
Shulman informed Highlight PA “buprenorphine saves lives,” and he stated utilizing something aside from a federally accredited medicine for opioid use dysfunction is “fairly harmful.”
Neuroscientist Yasmin Hurd, a number one CBD researcher and an creator of the second article Hawks cited, known as Compassionate Certification Facilities’ on-line statements about hashish and opioid use dysfunction “blatantly incorrect” and “past deceptive.”
“They’re giving false hope,” Hurd informed Highlight PA.
Hurd, director of the Habit Institute on the Icahn College of Medication at Mount Sinai, hopes the hashish compound CBD will someday turn out to be a federally accredited medicine for opioid use dysfunction.
She and her colleagues have discovered CBD can cut back cue-induced craving and anxiousness for individuals who have a historical past of heroin use, however she stated these had been smaller research that lay the groundwork for extra analysis. A 2019 examine by Hurd and fellow researchers, for example, examined 42 sufferers over 10 days, and her group stated long-duration remedy research had been wanted.
And he or she informed Highlight PA it’s vital to tell apart between CBD, which is one compound of hashish, and medical marijuana, which incorporates many compounds that may have completely different results. They aren’t interchangeable, Hurd stated.
“We should always maintain individuals accountable, particularly at present, to be very clear about what’s it that they’re selling and actually substantiate that,” Hurd stated.
‘Lots of optimism’ however little proof
When Pennsylvania added opioid use dysfunction as a qualifying situation for medical marijuana in 2018, the Wolf administration stated it was the primary state to take such an motion.
An April report from that 12 months written by the state’s Medical Marijuana Advisory Board cleared the way in which for the change, however didn’t cite any particular analysis to help it. As a substitute, the report stated hashish had “been reported by sufferers to ease the signs and technique of opioid withdrawal. It has been utilized by sufferers as an ‘exit drug’ to get off of heroin and different opiates.”
A number of well being coverage specialists informed Highlight PA that some individuals might need success utilizing hashish as an alternative choice to different medication. However they stated there are limits to counting on particular person tales and anecdotes for creating broad coverage or pointers on the best way to deal with sufferers — particularly when there may be good proof behind different remedies.
“The best way my subject works is you’ll be able to’t go from, ‘Properly, one particular person can do it’ to ‘This needs to be a remedy for 1,000 individuals,” stated M-J Milloy, an epidemiologist and analysis scientist on the British Columbia Centre on Substance Use in Canada. “There’s quite a lot of optimism round hashish being an alternative choice to these kinds of issues. However we’re not there but when it comes to what has been confirmed by means of managed trials and different high-quality scientific research.”
The state’s well being secretary on the time, doctor Rachel Levine, additionally didn’t cite any particular analysis when she formally added opioid use dysfunction as a qualifying situation. Levine stated opioid use dysfunction ought to solely be a qualifying situation in sure circumstances: when standard therapies are contraindicated or ineffective, or if hashish is used alongside one other main remedy.
“It’s vital to notice that medical marijuana isn’t an alternative choice to confirmed remedies for opioid-use dysfunction,” Levine, who now serves in President Joe Biden’s administration, stated in a information launch on the time.
Pennsylvania’s laws enable any of its approved hashish medical doctors to certify for opioid use dysfunction. At a Medical Marijuana Advisory Board assembly in Could 2019, pediatric neurologist William Trescher raised considerations in regards to the apply, saying he didn’t know what number of of these physicians had been “true specialists” in dependancy.
“They’ll say the particular person has it,” Trescher, a board member on the time, stated in keeping with a gathering transcript. “However I don’t know in the event that they’re going to know the best way to handle it.”
Neighboring New York has created a better bar. So as to approve hashish for opioid use dysfunction there, practitioners should even have a federal waiver to dispense and prescribe buprenorphine.
The requirement helps guarantee these practitioners have some expertise treating sufferers with a substance use dysfunction, Freeman Klopott, a spokesperson for the state’s Workplace of Hashish Administration, informed Highlight PA.
Deepika Slawek, a New York doctor at Montefiore Well being System and assistant professor of drugs at Albert Einstein School of Medication, coauthored new scientific pointers for practitioners in that state’s medical hashish program. The authors stated if there’s a function for medical hashish to handle opioid use dysfunction, “will probably be to reinforce quite than substitute” buprenorphine or methadone.
“[E]vidence to help taking medical hashish to deal with opioid use dysfunction (OUD) is scant,” the authors wrote. “Randomized managed scientific trials are wanted to grasp the connection between medical hashish use and opioid-related outcomes.”
By limiting who can approve hashish to deal with dependancy, Slawek stated she hopes these suppliers are “possible providing buprenorphine in the beginning.”
However the requirement highlights a significant issue: Slawek says there are already too many federal restrictions on which practitioners can prescribe buprenorphine. That creates vital boundaries for sufferers.
The American Society of Habit Medication tells practitioners to not advocate hashish for the remedy of opioid use dysfunction. Zerbo, the dependancy psychiatrist in New Jersey, has a nuanced view.
She believes hashish might help some sufferers with opioid use dysfunction in the event that they use it along with a main remedy. However she stated suppliers “need to be very cautious to clarify to everybody that it isn’t” a substitute for the federally accredited medication.
“If we don’t put individuals on medicine, the relapse charge is so excessive, and folks lose their tolerance,” Zerbo stated. “They usually’re so more likely to die.”
