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Medical Marijuana Can Now Replace Opioid Painkillers in Illinois

The new law is a response to the epidemic of overdose deaths from narcotics, which killed almost 2,000 people in the state in 2016 and an estimated 72,000 people nationwide last year.

By Robert McCoppin

A measure that could dramatically expand access to medical marijuana in Illinois -- making it available as an opioid painkiller replacement and easing the application process for all who qualify -- was signed into law by Gov. Bruce Rauner on Tuesday.

The new law is a response to the epidemic of overdose deaths from narcotics, which killed almost 2,000 people in the state in 2016 and an estimated 72,000 people nationwide last year. It would allow doctors to authorize medical marijuana for any patient who has or would qualify for a prescription for opioids like OxyContin, Percocet or Vicodin.

"We've got to do everything we can to stop this vicious epidemic," the governor said as he signed the bill into law on Chicago's West Side on Tuesday. "... We are creating an alternative to opioid addiction. ... It's clear that medical marijuana treats pain effectively, and is less addictive and disruptive than opioids."

But the measure is also noteworthy for removing some of the major restrictions on the medical marijuana program in Illinois.

No longer will any applicants have to be fingerprinted and undergo criminal background checks. And those who complete an online application with a doctor's authorization will get a provisional registration to buy medical cannabis while they wait for state officials to make a final review of their request.

Rauner signed the bill Tuesday at the Chicago Recovery Alliance, a nonprofit that distributes clean needles and overdose-reversing naloxone, and conducts other programs to help prevent deaths from heroin overdose.

Suzanne Carlberg-Racich, director of research for the alliance and assistant professor of public health at DePaul University, said she welcomes the new law as a way to prevent overdose deaths and provide a less addictive treatment for pain relief.

"This is a great step in the right direction," she said. "I'm pleased to see an alternative for pain management that doesn't have any potential for a fatal overdose."

Dr. Nirav Shah, director of the Illinois Department of Public Health, said research has shown clear evidence that marijuana can be effective for treating pain and can reduce opioid use and opioid overdose deaths. He cited a National Academy of Sciences review that found "substantial evidence" that marijuana is effective for treating chronic pain in adults.

"And initiatives like this frankly just makes sense," Shah said.

Shah said the elimination of background checks and fingerprinting for applicants goes into effect immediately, and all patients may now get provisional approval to buy medical marijuana immediately upon receiving a receipt for payment from the state health department.

But it will take the state until Dec. 1 to implement all the new rules for the program, and will take until early next year to develop a new system to monitor the program to make sure that opioid replacement patients don't go to multiple dispensaries and don't buy marijuana for more than 90 days at a time. The 90-day period can be renewed by patients' doctors.

Patients who qualify for medical marijuana for something other than opioid replacement can maintain their authorization for three years.

Some local health departments are now offering services to help patients complete applications for medical marijuana.

To qualify for medical cannabis in Illinois, patients must have any of about 40 debilitating medical conditions listed in the law, including cancer, AIDS and multiple sclerosis. The program -- one of the most restrictive among the 31 states that allow medical marijuana -- has approved about 42,000 authorized patients, who have bought about $200 million worth of pot since sales started in November 2015.

By contrast, about 2.3 million patients in Illinois received about 5 million opioid painkiller prescriptions in 2017, according to the Illinois Department of Public Health. While that may include people with multiple prescriptions, the number suggests the potential increase in the number of patients qualifying for medical cannabis.

The pilot medical cannabis program is due to expire in July 2020. But state lawmakers have proposed legalizing recreational marijuana next year for those over age 18. The Democratic candidate for governor, J.B. Pritzker, supports the measure, while Rauner opposes it.

Sen. Don Harmon, a Democrat from Oak Park who sponsored the bill, said a patient who got a doctor's certification to use medical marijuana in place of opioids could do so immediately, without applying to the public health department.

"It's an exit ramp for opioid use," he said.

Harmon asserted that the measure's passage "makes Illinois a national leader in addressing opioid crisis."

In general, Rauner has opposed expanding the medical marijuana program, but a recent poll showing Pritzker with a large lead may have put pressure on him to support the politically popular measure. In addition, Rauner recently approved other measures requiring insurance coverage for opioid abuse and continuing education for doctors about opioid prescriptions.

Kevin Sabet, president of Smart Approaches to Marijuana, raised concerns about the expansion of medical marijuana, warning that it could lead to more addiction, more drivers who are under the influence and more users suffering from the drug's harmful effects on attention, memory, decision-making and brain development.

"From a scientific perspective, it makes no sense," Sabet said. "The most comprehensive study on the issue was just published in The Lancet and found marijuana didn't help with pain, nor did it reduce opioid use.

"From a political perspective," Sabet added, "it likely signals he feels pressure from J.B. Pritzker, who has welcomed pot with open arms."

The Lancet study, published in July by substance abuse researchers, involved interviews and surveys of about 1,500 non-cancer patients in Australia with opioid prescriptions for chronic pain. Following up after four years, participants who used cannabis reported more severe pain than people who did not use cannabis, with no evidence cannabis decreased opioid use.

The authors urged large clinical trials to further research the effects of marijuana on pain treatment.

But in states that have legalized medical marijuana, some studies have shown a decrease in opioid prescriptions and in opioid-related overdose deaths. Cannabis remains illegal under federal law.

Tim McAnarney, an Illinois lobbyist with Sabet's group, said it doesn't oppose medical marijuana or decriminalization, but opposes legalization and feels the new law will be far too expansive.

"This bill should have been much stricter on who is eligible to access marijuana," he said. Cookies, candies and lollipops containing medical marijuana are dangerously appealing to children, he said.

Aaron Weiner, director of addiction services for Linden Oaks Behavioral Health in Naperville, said the legislation was a missed opportunity to correct a "deeply flawed" medical marijuana program in Illinois.

Medical marijuana is available in extracts that are up to 93 percent THC, the active ingredient that makes users high, the effects of which have never been studied sufficiently, he said. And Illinois medical marijuana patients can buy up to 2.5 ounces every two weeks, enough for about 10 joints a day, far more than typically necessary and more than enough to develop an addiction, he said.

Weiner was set to debate marijuana policy with a sponsor of the legalization bill, state Sen. Heather Steans, Tuesday night at LaGrange Village Hall.

Medical marijuana industry leaders were ecstatic at the news that Rauner would endorse the legislative measure.

Ben Kovler, founder and chairman of GTI, which has both cultivation centers and dispensaries in Illinois, issued a statement calling Tuesday "a great day" for tackling the state's opioid epidemic and saving lives.

"Now those suffering from pain can opt for medical marijuana -- which has zero deaths related to overdose -- over opioids," he said. "Numerous studies show that marijuana is effective at treating pain and we are thrilled the people of Illinois will now have that choice."

One patient at the signing did credit medical marijuana with helping her get off opioid drugs. Melissa Hallbeck, 41, of Sugar Grove, who is co-founder of the Midwest Cannabis Education Conference, said she was addicted to Norco after multiple surgeries for interstitial cystitis, which caused severe pelvic pain.

Non-psychoactive cannabis oil allowed her to work again and take care of her 6-year-old daughter.

"It's given me my life back," she said.

Given that advocates on either side of the issue can cite statistics to back up their positions, Rauner credited patient testimonials like Hallbeck's for helping convince him to allow marijuana as a medical option.

In fact, Illinois Department of Public Health officials helped negotiate changes to the bill to allow for immediate patient approval, and said elimination of the background checks would reduce the workload and delays in processing applications.

Illinois was the only state that required fingerprints and criminal background checks, which prohibited certain convicted felons from getting medical marijuana. Eliminating that restriction will be a blessing for some of the more than 600 people who were denied a license last year, including those trying to get off opioids who have drug convictions, advocates said.

But the governor emphasized that he remains opposed to legalization of marijuana, based on talking to Colorado's governor, who said it's caused problems, such as more people driving with marijuana in their system.

State Rep. Kelly Cassidy, co-sponsor of the opioid bill, countered that Colorado has had an overall successful experience, with some issues that will be addressed in the pending legislation to legalize pot.

The consensus among several of the speakers was that this will likely be the largest expansion of the medical marijuana program to date. If even a small percentage of the millions in Illinois prescribed opioid pain pills use marijuana instead, Shah said, that is likely to save lives.

(c)2018 the Chicago Tribune

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