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Controversies over marijuana, naloxone explode in Maine

April 27, 2016
by Gary A. Enos, Editor
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The state of Maine captured national attention rather dramatically on two separate occasions in recent days, with the opioid crisis at the heart of each development. First, a state Department of Health and Human Services hearing gathered testimony from those who would like to make Maine the first state to include opioid addiction on the list of approved conditions for use of medical marijuana. The day after that hearing, in an unrelated but equally controversial action, Maine Gov. Paul LePage vetoed a bill that would allow pharmacists in some cases to dispense naloxone without a prescription, despite the legislation's unanimous passage and its widespread support among healthcare and law enforcement leaders.

In both cases, the events left members of the state's addiction treatment community seething.

Regarding the push by individuals affiliated with marijuana growers to have opioid addiction included on the list of qualifying conditions for medical marijuana, the president of the Maine Association of Substance Abuse Programs says, “Personally, I am rather appalled by it.”

Pat Kimball adds that, absent any clear medical evidence of marijuana's effectiveness in combating opioid withdrawal, “It's almost like a charlatan. They're creating false hope for people.” Kimball serves as executive director of Wellspring, Inc., a Bangor-based provider of residential and outpatient substance use treatment services.

Although the April 19 Health and Human Services hearing did feature some testimony from healthcare professionals opposed to the suggestion, Kimball says the addiction treatment provider association did not choose to participate directly. “In hindsight, we're assuming now that we probably should have,” she says. “The lack of our presence there led people to believe certain things.” She emphasizes, “The treatment community is not in any way in favor of this.”

The state agency is accepting public comments on the proposal through May 3, and the department has six months to decide whether to approve or reject the suggestion to add opioid addiction to the list of approved conditions.

Kimball says Wellspring's attending psychiatrist, W. Allen Schaffer, MD, has spoken out loudly about the dangers of today's marijuana and the reasons why it should not be considered as medicine, from existing gaps in knowledge about the properties of cannabinoids to a lack of comparative effectiveness studies involving cannabis. In a summary of remarks he made last fall at an educational forum on marijuana in the new millennium, Schaffer stated, “Simply acceding to patient demands for a treatment on the basis of popular advocacy—without comprehensive knowledge of an agent—does not adhere to the ethical standard of medical care.”

This month's hearing featured testimony from several individuals who said they had failed with other treatments for opioid dependence and that using marijuana had helped ease their cravings. The Portland Press-Herald quoted Waterville resident Matthew Low as saying, “The [methadone] clinics aren't helping. They're treating, not curing. I believe cannabis can cure this epidemic.”

Naloxone veto

Maine legislators had unanimously approved, with no roll call, a bill that would allow a pharmacist to dispense naloxone without a prescription in cases involving individuals at risk of an opioid overdose. But LePage on April 20 vetoed the bill, issuing some strong words in his veto message.

The Press-Herald quoted from the governor's message: “Naloxone does not truly save lives; it merely extends them until the next overdose.” LePage added, “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

LePage has emphasized in the past, and continues to highlight, the need for more drug use prevention efforts and moves to curb drug trafficking as the strategy to combat the opioid crisis.

Legislators are expected this week to take up a possible override vote on the governor's veto, which has garnered some strong protests. State Sen. Cathy Breen said in a news release, “With this insensitive statement, Gov. LePage is insinuating that Mainers suffering from addiction are beyond reach—that they cannot be saved. I disagree. Narcan can be the difference between an early grave and an intervention that can put an addict on the path to recovery.”

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