The Exit Drug: Can cannabis help solve the opioid crisis?

DEDHAM, Mass. — Above a pizza parlor, in a nondescript brick building in Natick, Dr. Uma Dhanabalan said she’s saving lives.

“I want everybody to know cannabis is a medicine and that it has killed nobody,” Dhanabalan said.

The odor of marijuana was strong the day we sat down with her inside her offices on Central Street. Dhanabalan is passionate about the the plant, enthusiastic for it’s potential in medicine, disdainful of politicians and doctors who she said, “know jack s*** about” cannabis.

“It’s not for everybody,” she admits. “It should be a first line option and that’s not what’s happening.”

There's growing evidence medicinal marijuana does have a positive impact on the opioid crisis. A study published in the American Journal of Public Health in October found "legalization of cannabis in Colorado was associated with short-term reductions in opioid-related deaths."

An oft-cited 2014 study found states with medical marijuana laws had 24.8 percent fewer opioid related death than states without them.

Dhanabalan said she’s helped “thousands” of patients overcome opioid-use disorder and said she rarely denies a patient a medical marijuana recommendation.

She likes to say she’s referred the plant as “the exit drug” for years. Her website sells this point: “Cannabis is not an entrance drug, it is an exit drug from pharmaceuticals and narcotics,” it reads.

But when it comes to weening users off of street-level drugs like heroin and fentanyl, Dr. Kevin Hill said doctors need to be extremely cautious.

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“It is critical…to distinguish between patients with chronic pain on opioids and those using illicit opioids like heroin and fentanyl,” said Hill, an addiction psychiatrist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School. “Medical cannabis for the former may make sense, but I worry about the latter group. Giving medical cannabis in lieu of FDA-approved medications for opioid use disorder is risky.”

Hill said the FDA-approved medications include Suboxone, Methodone and Naltrexone, substances he’s had success with.

“Those that use heroin and fentanyl are the ones that die,” Hill said. “We know this because we do our best to follow them once we come in contact with them. Would Dr. Dhanabalan know if patients she treated with cannabis for [opioid-use disorder] instead of suboxone or methadone died from overdoses?”

Dhanabalan couldn’t give us a number or a success rate for the patients she’s treated. She believes she’s issued around 6,000 recommendations for medical marijuana between Washington state and Massachusetts.

She also said she doesn’t use synthetic drugs in her treatment.

“Cannabis is food, fuel, fiber, paper and medicine. We’ve replaced it [with] synthetic, synthetic, synthetic, synthetic, synthetic, synthetic,” Dhanabalan said. “We’ve created illnesses because our bodies were not meant to be exposed to synthetics.”

Hill said he’s “bullish” on the benefits of medicinal marijuana, but still needs to rely on “evidence-based treatments” for his patients.

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