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What Does Dr. Julian Somers Actually Believe? – Cannabis | Weed | Marijuana



What does Dr. Julian Somers actually believe?

Dr. Julian Somers is a researcher and professor in the mental health and addiction field in British Columbia, Canada. He is currently a professor at Simon Fraser University and serves as the Research Director of the Mental Health and Addictions Research Program.

In addition to his research, Julian has received numerous awards and recognitions for his contributions to the field of mental health, including the Canadian Institutes of Health Research (CIHR) Applied Public Health Chair in Urban Health, the Michael Smith Foundation for Health Research Scholar Award, and the Canadian Association for Health Services and Policy Research’s Best Paper Award.

But recently, because of his critiques of government policy and established “safe supply” narratives, he’s some “right-winger” retweeted by – trigger warning – Jordan Peterson and Pierre Poilievre.

Of course, as is usually the case, the reality is more nuanced. I caught up with Julian the other day via a Zoom call. I wanted to know: what does Dr. Julian Somers actually believe? 

Do his critics have a point?

What Does Dr. Julian Somers Actually Believe?

Julian Somers Actually Believe

So what does Julian Somers actually believe? In a nutshell, he believes the same thing Portugal said when they decriminalized drugs: “There is no such thing as addiction treatment.”

But what does that mean?

“They’re not saying overcoming addiction means not using drugs anymore,” says Julian. “They say overcoming addiction means being socially reintegrated.”

And indeed, that is the core of what Dr. Julian Somers actually believes. And that’s based on decades of extensive research.

How to Solve Addictive Behaviours

Social integration is when an individual feels connected to or is involved with their community. This can be as simple as meaningful conversations with friends, participating in social events, and contributing to local activities. 

The idea is that if you build relationships with others, you can create a sense of belonging. Human beings are, after all, social animals. It’s not surprising that research suggests social integration enhances one’s sense of purpose and overall quality of life.

And for many researchers, from experts like Dr. Julian Somers to amateurs like myself, the evidence suggests “addictive behaviour” stems from this lack of purpose and belonging.

“Social integration is very close to what it would mean to have good mental health,” says Julian. “It means you have a job, a place to live, you’re part of a community. You feel good about other people and other people feel good about you.”

What does Dr. Julian Somers actually believe? That addictive behaviour is a mental health issue. That fixing Vancouver‘s Downtown Eastside means addressing the demand for drugs, not the supply.

“If there’s one thing we should have learned from the drug war,” says Julian, “Is that focusing on supply is a wasted effort.” Instead, “all our emphasis should have been on demand. On what’s up with the mental health of people in our population.”

Reasonable positions. And yet, “when I raise that, in one way or another, I am crucified.”

What Does Dr. Julian Somers Actually Believe? The Research 

Julian Somers Actually Believe

Why is Julian Somers criticized for his research? Take safe supply and Indigenous communities. He said: 

“It seems obvious to me from all the available evidence right now that it would not help those communities to provide them with greater access to addictive drugs. It would help them most to support their growth of things they’re asking for: autonomy, resources, the ability to make decisions.”

Rat Park

This isn’t a controversial statement. Since the 1970s and 80s, researchers have known about “Rat Park.” Conducted by Canadian psychologist Bruce K. Alexander and his colleagues at Simon Fraser University, the studies challenged the prevailing narratives, which held that drug addiction was primarily a result of the pharmacology of the drug themselves.

The researchers set up two environments, a standard laboratory cage with access to only water and cocaine; and the other “Rat Park” full of toys, food, and other rats to socialize with, as well as cocaine. The researchers found the rats in Rat Park were less likely to become addicted to cocaine.

Brain Disease Model is Junk

Of course, rats aren’t people. But the general idea that social and environmental factors play a significant role in addiction is supported by numerous other studies. Somers references the number of American soldiers that used heroin in Vietnam. When they returned after the war, fewer than 5% continued using.

And there’s neuroscientist Mark Lewis’ research on brain imaging and the brain disease model of addiction. Mark’s research highlights the importance of environmental factors in addictive behaviour. He argued that addiction is not solely the result of brain changes but influenced by social and cultural factors. He also suggested social isolation and stress increase the risk of addiction.

Who Are Julian Somers’ Critics?

Julian Somers Actually Believe
(Maggie MacPherson/CBC)

This Press Progress article demonstrates the mentality of the people attacking Julian Somers’ position. It posits that Somers and others are in it for the money. 

At no point does it grapple with Julian’s ideas but parrots the open letter that his work criticizing safe supply was “critically low quality.”

“It’s a reinvention of ad hominem attacks,” says Julian, recalling a professor of his many years ago. He taught that when your critics shift the discourse from the ideas to the person making the ideas, you can smile. Because you know they’ve got nothing.

And this is likely the case here. The criticisms that Somers and others like him are only in it for the money are either deeply ironic or blatantly hypocritical.

In his research, Julian and his team have found that “almost all the papers in which authors had been advocating for so-called safe supply, were based in B.C.. They were people who did not have backgrounds in addiction, they came from an HIV centre. And they seem to have simply rolled out a business model that had worked in HIV. Which is obviously, very pharmaceutical.”

Pharmaceutical public-private partnerships are the name of the game.

“They seem to be using the same business model, partnerships with industry, to launch a presence in the addiction field… Their work was conspicuously pharma intensive.”

“And yet, in their documents, in their peer-reviewed publications, not one of them mentions the fact that people need housing, people need help getting jobs. People need help addressing their mental illnesses. Instead they say, we need immediately safe supply. In fact, it goes further. We need safe supply across North America.”

And why is this? Julian Somers believes this might be a follow the money story.

What Does Dr. Julian Somers Actually Believe? Follow the Money 

Julian imagines a scenario that isn’t out of the realm of possibility. A conversation like this has undoubtedly happened more than once.

Somewhere in a New York office, suits are reeling from the oxy scandal. One of them is thinking of getting into diet pills or maybe vitamins. But another suit persuades him otherwise. “There’s this group out in B.C.,” he says, and they’ve figured out how to sell not only opioid compounds but stimulants and benzos.

“They’re calling it safe supply.”

The B.C. government is promising is get Wall Street’s product out front of the Nicaraguans and Colombians. It’s a new era of the drug war. 

“It’s outrageous how it’s happened in a ten year period,” says Julian. “Along the way, there are people who are supporting their agenda and I think it’s conspicuously physicians.”

Physicians know very little about addiction. It’s a small part of med school; when it’s taught, it’s the brain-disease model. So doctors approach addictive behaviours as if it were a diabetes diagnosis.

What Does Dr. Julian Somers Actually Believe?

Julian Somers Actually Believe

Julian Somers believes that if the country could have a mature conversation about drugs and addictive behaviour and take the necessary steps to create a population with better mental health, we would be “very close to having heroin available for purchase.”

The fact is, says Julian: “Most people who have addictions at one point, don’t have them later and they don’t all die.”

Brain imaging does not support the brain disease model of addiction. “What [Mark Lewis’ research] has pointed out,” says Julian, “is that the changes that occur before, during, and after addiction, are consistent with our understanding of how the brain reflects learning.”

“It’s actually tremendously inspiring, optimistic knowledge,” says Julian. “We are capable of changing!” And that’s what Julian Somers actually believes.

That the brain disease model of addiction is “vacuous and offensive” since it creates a segregation between rich and poor treatment.

While the rich are sent to places like the Betty Ford Center to work on their mental health, the poor are kept isolated and fed pharmaceuticals.

“It’s like two different worlds. And if you’re a physician, on some level, you know this,” says Julian.

So the question remains: what are his critics’ excuses? Especially the left-wing populists who claim to work and fight for the poor, oppressed, and helpless.

Don’t they know “safe supply” lines the pockets of corporate pharma without addressing the mental health issues of those suffering from addictive behaviours?

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2022 provisional data overdose

Death Toll Rising: Overdose Deaths 2022 Released




The numbers from the last few years are not encouraging. It seems these days people are dropping left and right, and the main culprit is doctor prescribed medication. Recent data released by the US government shows an increase – though minor – in overdose deaths for 2022. Read on for more info.

Overdose deaths 2022

2022 is now the highest recorded year for overdose deaths in the US, taking the place of the preceding year. Provisional data released by the CDC on Wednesday, May 17th, put the number for 2022 overdose deaths at 109,680. These are not final numbers however. For example, 2021 provisional data put the number at 107,622 deaths. That number rose to 109,179 by the time final numbers came out. Final numbers for 2022 are likely to be a bit higher than what just came out. Either way, still an increase from the previous year.

The most troubling factor in this, is that over 2/3 of these deaths, are attributable to synthetic opioids. Opioids are based on compounds from the opium plant, but are not naturally occurring, and are instead made in a lab. Whereas synthetic versions of weaker opiates (compounds found in the plant) are also given as medication – like codeine; the bigger issue is with the stronger, synthetic offerings. This entire classing of drugs is lab-created, and this whole issue stems not from a black market growing, but from doctors prescribing these medications.

The drug with the biggest share of the death toll? Fentanyl. Its estimated that of 2022 numbers, more than 75,000 of the total 109,680 are attributable to synthetic opioids, with fentanyl leading the way. Fentanyl is strong in its own right, but is often mixed with other drugs, either purposefully, or accidentally; which leads to many deaths. Other drugs that played a big role in 2022 overdose death numbers, are psychostimulants, like meth and coke; which together made up over a quarter of the deaths.

Overdose deaths strong in 2022
Overdose deaths strong in 2022

The White House’s Director of the Office of National Drug Control Policy, Dr. Rahul Gupta, had this to say in a statement about the current drug crisis and what the government is doing about it: “We’ve expanded treatment to millions of Americans, we’re improving access to Naloxone to reverse overdoses, and we’re attacking the illicit fentanyl supply chain at every choke point.”

Of course the bigger issue, which was 100% ignored in the White House statement, is that these are doctor prescribed medications. The whole reason this is an issue at all, is because doctors were acting as dealers…and still are. Whatever other actions might be taken, that point must be remembered. The opioid issue is massively different from other drug issues, in that these drugs are legally prescribed, and their legal prescription is not only what started this mess, but remains ongoing.

Previous years death overdose numbers

On the plus side (however much you can use that term), overdose deaths stayed relatively level from 2021-2022. 109,179 in 2021 is not terribly far from the overdose death number of 2022 – 109,680. Just a rise of a few hundred; although final numbers could put the 2022 number several thousand higher in the end. For now, the numbers indicate that things remained generally consistent, with only a minor increase; but considering an increase is still an increase – it also shows nothing was done to help the problem.

The final number for 2021 overdose deaths – 109,179, was 15%+ higher than 2020, which had approximately 93,000 overdose deaths. That number is a 30% increase from 2019 overdose death numbers, which totaled about ~70,630 deaths. This means just between the years 2019 and 2022, yearly overdose deaths increased by about 40,000 deaths. 2018 numbers weren’t much lower than 2019, with 67,367 overdose deaths that year.

In one of the only instances of a temporary change in trajectory, the 2018 numbers are a 4.1% decline from the previous year’s numbers. In 2017 there were 70,237 overdose deaths, which is almost on par with 2019; making 2018 numbers a temporary dip. Unfortunately, the trajectory did not change overall, and the numbers since increased. Weirdly enough, after that 2018 dip, numbers went up at a much faster rate than they did before. Kind of like the quiet before a storm.

The main issue with synthetic opioids started in the first decade of the century, although it didn’t pick up steam in a grand way until after 2010. Weaker opiate medications have been around for awhile, going back to the late 1800’s. It says a lot about these newer and stronger synthetics, that despite the fact we’ve had access to similar medications for over 100 years, it was only with their entrance that the overdose rate skyrocketed.

Synthetic opioids driving overdose deaths in 2022
Synthetic opioids driving overdose deaths in 2022

Even heroin has been around since the turn of last century, first as an actual medication. And whereas heroin used to represent the worst talking point for overdose deaths; related overdose numbers have stayed at relatively even levels in the last 20+ years. The main increase is in synthetic opioids only. You can see it all very clearly in graphs here.

Issues with White House statement

Obviously, upon information of this nature coming out, the White House must say something. The government has done nothing to stop the legal production of these drugs, which makes it a part of the problem automatically. The government made no bones about illegalizing Quaaludes back in the early 1980’s, despite also saying that they were highly addictive; so it stands to reason that caring about the addictive nature of opioids is not what keeps them legal. For the record, Quaaludes had a negligible death toll, especially compared to opioids.

Black markets exist for drugs that are both legal and not legal. For this particular issue, what set it off was the creation and sale of synthetic opioids. Meaning this is a pharmaceutical company and government-created issue. Given that, it stands out to me that the White House statement says this: “Most of these deaths were caused by illicit synthetic drugs like clandestinely manufactured fentanyl and methamphetamine, often in combination with other drugs including cocaine, heroin, and xylazine.”

Maybe this is true. Maybe most of the deaths are from the black market now, but plenty are not. And it could be that the majority are not. These are doctor prescribed medications. Whatever illicit market there is, is only relevant because of the legal market. The drugs were created by the legal market, NOT the black market. It seems the White House wants readers to associate this entire issue with the black market, and not as a government-regulated problem.

Gupta goes on to say this: “The historic actions taken by the Biden-Harris Administration are saving lives. We’ve expanded treatment to millions of Americans, we’re improving access to Naloxone to reverse overdoses, and we’re attacking the illicit fentanyl supply chain at every choke point. As a result, around 19,000 people are still alive and can be there at the dinner table, at birthdays, and at life’s most important moments.”

Once again, the White House really wants you to focus on the illicit market, not the one it promotes legally. Attacking the illicit supply chain? Why not simply not allow doctors to prescribe the medications? Why not stop their legal production and sale? If you read this without knowing anything about the issue, you’d probably not guess these are legal medications.

Drug overdose deaths
Drug overdose deaths

Even funnier still, is that having done nothing to help the problem, the government then takes credit for saving 19,000 lives. I expect the point Gupta is trying to make, is that the use of Naloxone reversed that many overdoses; but it certainly doesn’t mean that that many people were saved. It means a particular overdose was treated for a person. Not only is the government taking credit, it’s calling this a ‘historic action.’

Gupta goes on, “President Biden has called on us to double down on our efforts to save even more lives so we can beat this crisis, and that’s exactly what we’re doing.” But what does that mean? Even more Naloxone? Is his argument that a drug put out to counteract overdoses, will stop an entire addiction crisis for drugs still wildly available, even legally? Does pumping an alcoholic’s stomach, make them not an alcoholic anymore? Its like, the government is offering nothing, yet trying to take credit for an only small rise in deaths. And ignoring that a rise automatically means nothing improved.

He goes on to talk about seizures of illegal product, seemingly to put attention on the illegal market again. Yet, in not one place does he talk of changing regulation to limit legal production or prescribing. According to the statement, government actions are solely for increasing Naloxone use, and seizures of illicit drugs.

And it continues to ignore the most useful possibility out there: swapping ketamine for opioids. This actual solution is never mentioned at all by any government; which is painfully weird if the idea is to help people. Not only does ketamine show as a more useful pain treatment, and one that can last months after application; but without the addictive properties of opioids. Of course, not mentioning it does go in line with helping pharma companies make money from opioid sales.


Does this leveling off mean that some action is working, and the problem will reverse? Likely, no. Because no suitable actions have been taken. Maybe the problem won’t get worse, and we’ve reached the standard leveling off point. Or maybe this is just a break in the overall trajectory, which will continue up next year. One thing for sure (or pretty sure) is that real change takes real action. Right now, the government isn’t even being honest about where the problem is coming from. So can we really expect it to do anything useful about it?

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Do Genetics Play a Role in Addiction? 




Many of us have heard the term “addictive personality”; obviously in reference to people who seem to struggle with addictive tendencies more than others. When most people think of addiction, they think of drugs and alcohol, but many behaviors and activities can be addictive as well, such as gambling, sex, and eating. Statistics are all over the map, but experts estimate that as many as 46 million Americans struggle with at least one type of addiction.  

So, why do some people get addicted while others do not? Recent studies suggest that up to half of a person’s risk of becoming addicted to anything is hereditary, and certain gene variations can give insight as to what substance or activity a person is more likely to become addicted to. Finding a genetic basis for this risk can help researchers and physicians learn more about “the addictive personality” and come up with better ways to tackle the addiction epidemic.  

What is addiction? 

It’s important to first note that addiction is a disease rooted in mental illness, and as we are now learning, biology. It’s not a character flaw or moral failing. Most people experiment with substances at some point in their lives, but not everyone becomes addicted. That should be enough to determine that there is something deeper going on there, and all major health experts around the world agree including The American Medical Association, The National Institutes of Health, and The World Health Organization. 

Addiction has a lot to do with individual brain chemistry. The human brain is hardwired to reward us when we do something that makes us feel good. This has historically been a reason for our survival over the years, and the reason why things like eating, exercise, and sex trigger the release of a neurotransmitter called dopamine; to encourage to keep doing whatever it was that made us feel good. 

The same thing happens when we take drugs, drink alcohol, smoke cigarettes, gamble, etc. – that reward system in the brain gets triggered. according to the National Institutes on Drug Abuse (NIDA), “large surges of dopamine ‘teach’ the brain to seek drugs at the expense of other, healthier goals and activities.”  

Studies have shown that long-term substance abuse can limit a person’s ability to feel pleasure at all, but especially when they are not using their substance of choice. Over time, the reward center in the brain becomes less receptive and less functional. Once a person’s brain reaches this point, and they develop a tolerance to the substance in question, they will need more and more just to operate at baseline level and feel any type of normalcy.   

Again, some people are more susceptible to this process than others. This is where the idea of existing mental illness, genetics, and other biological factors, and how they pertain to the disease of addiction as a whole, begin coming into play.  

Genetics and epigenetics of addiction

Genetics is the study of genes, whereas epigenetics focuses on the intersection of environment and genetics. Overall, DNA sequences between humans are roughly the same (about 99 percent or more), however, that up to 1 percent variation accounts for the millions of differences we see in people throughout the world.  

The differences account for physical variations such as height, hair color, eye color, etc., as well as invisible traits including temperament, openness, conscientiousness, extroversion, agreeableness, and neuroticism. Additionally, genetic variations can increase the risk for, or provide protection from, certain diseases such as heart attack, stroke, diabetes, and yes, addiction. Doctors are now looking at certain gene mutations to determine a person’s likelihood of developing certain illnesses, such as the BRCA 1 and 2 mutations that are linked to a higher risk of breast and ovarian cancer.  

However, since most diseases, including addiction, are much more complex and a result of variations in many different genes rather than a mutation to a single one, it can be a bit more difficult to determine exactly which combinations heighten a person’s overall risk of becoming an addict.  

And this is where epigenetics come into play as well, to complicate things even further. The prefix “Epi-” means “above” or “in addition to”, so epigenetics is looking at anything outside the body that can alter our DNA. Numerous studies have shown that lifestyle and environmental factors can “mark” the DNA, or restructure it at the cellular level. These epigenetic marks can permanently alter DNA and they can even be passed on to children. For example, when a person uses cocaine, it can mark the DNA in a way that increases the production of certain proteins called histones that are common in addicts, and these can be transferred during pregnancy.  

The addictive personality  

Ah, the dreaded addictive personality. That fine line that separates the people who can hang casually from the ones who take everything to the next level. Who is more likely to have it? Can it be cured or prevented?   

The most recent study on this subject was published in the journal Nature in October of 2022. Researchers looked at 15,000 participants, many of whom were siblings including identical twins, step siblings, and adoptees, and found that up to 70 percent of addictive traits are heritable. “People with the highest level of risk were four times more likely to develop a substance use disorder than people with the lowest risk,” the study noted. Although they did acknowledge that societal and environmental risk factors can lead to addiction as well, genetics were an even bigger component.  

Most of the genes that have an impact on addiction are shared, meaning that people who have those genes are at risk for numerous different types of addictive disorders and substance use problems. But that is not always the case, as a handful of genes have been found to be substance-specific (for example, they influence problems with alcohol only, or only issues with methamphetamines, etc.) 

The study states that “a large part of the genetic risk is related to self-regulation, which reflects how differently wired brains process risk and reward. Some people have brains primed toward greater impulsivity than others, and this can put them at risk for numerous forms of addiction.” 

The study also examined the role of the environment on genetics and the overall relation between the two and addiction. For example, the combination of certain genes and lifestyle factors such as diet, physical activity, and stress, can all play into each other and make a person more primed to develop a substance use disorder. Conversely, certain activities can discourage drug-seeking behavior, like exercise, which seems to be a more pronounced effect in males than females. Interestingly, some studies also looked at how drug use is influenced by society, or peer pressure, and it was noted that animal’s drug abuse can be impacted by that of its cage mate. So if one of the animals in the cage is using drugs, it could influence the others to do the same.  

In addition, studies suggest that “drugs or stress in a person’s social or cultural environment can alter both gene expression and gene function, which, in some cases, may persist throughout a person’s life.” Genes can also play a role in how a person responds to their environment, adding another layer of complexity for people who are already at risk for developing an addiction.  

Final thoughts on the Addictive Personality

If ever there was evidence that addiction is a disease and not a moral failing, this is it. Now we know that genetics have a major part in forming the “addictive personality”. What’s possibly one of the best things about this piece of knowledge, is that it can be implemented in the treatment protocols of addicts, and will hopefully result in better outcomes for them and their families.

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New Study On Payment Info Shows Weed Might Lower Opioid Use




It’s a horrible topic that we can’t stop talking about because it doesn’t stop being a horrible topic. One of the biggest issues in the world of health and drugs is the opioid epidemic, and the large and growing number of overdose deaths from these doctor-prescribed medications. Research on different fronts point to the use of weed as a way to lower opioid use, with a recent study related to payments once again backing up that idea.

The research

The opioid issue is huge, and the medical industry is constantly commenting on it, and how to deal with it. In a recent study, investigators showed a monetary connection which indicates that places with legalized weed, also have lower opioid prescription and use rates. However, the study comes with some concerning points.

The study, entitled Using Penalized Synthetic Controls on Truncated data: A Case Study on Effect of Marijuana Legalization on Direct Payments to Physicians by Opioid Manufacturers, was put out by researchers from the University of Florida, University of Southern California, and Purdue University.

In the study, investigators assess data from drug transactions of direct payments from opioid manufacturers, directly to physicians. In this case, specifically between 2014-2017. The purpose? To identify if these payments are affected by the inclusion of medical cannabis policies. In order to do this, the researchers used a “a novel penalized synthetic control (SC) method that accommodates the zero-payment related latent structures inherent in these payments.”

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The paper makes this statement, “Physicians are the primary gatekeepers for deciding medication for patients needing pain management.” This is important to remember as death numbers spiral out-of-control. As medical marijuana is employed in more places and for more things, more doctors might be driven to switch up how and what they write for pain.

Study findings

The study results indicate a “a significant decrease in direct payments from opioid manufacturers to pain medicine physicians as an effect of [medical marijuana law] passage.” It found that “physicians in states with an MML are prescribing fewer opioids.” The thought is that this is “due to the availability of medical marijuana as a substitute.”

To get more specific, this “substitution effect is comparatively higher for female physicians and in localities with higher white, less affluent, and more working-age populations.” This could indicate that female doctors might be friendlier in general to the idea of medical marijuana, or it could speak to females having less powerful relationships with opioid producers. It’s hard to say which.

The study found that in 2015, doctor’s prescribed 49% more opioid treatments than non-opioid treatments in terms of 30 day prescriptions, as well as prescribing 49% more days of prescribed medication for opioid vs non-opioid treatments. In states where no legalization measure was applied, the ratio remained about the same for opioid vs non-opioid prescription, at about 1.38:1.

For states that did apply a medical marijuana legalization within the years 2015-2017, the study found that the same ratio decreased from 1.57:1 to 1.52:1. The same decrease in ratio was likewise seen when looking at the number of days of medication prescription when comparing opioid to non-opioid medications, in states that passed a medical legalization.

These numbers imply something weird though, which the researchers don’t talk about. They imply that states without medical weed policies, automatically prescribe less opioids. After all, a 1.38:1 ratio is lower than either 1.57:1 or 1.52:1, indicating non-legal states prescribe less before and after a legalization. This, to me, seems suspect, or at the very least, very much in need of some sort of explanation. Nothing of the sort is given.

Opioid medications
Opioid medications

Realistically, according to this data, researchers could say that states with medical weed policies, have uniformly higher opioid prescribing, and likely higher use. And that seems a big enough point that it deserves expansion, which it didn’t get. In fact, all the researchers say after presenting the information, is “We leave further analysis of the possible effect of MML passage on patient care for future research.” What this means, is impossible for me to say based on what is provided. But it’s an odd thing not to address.

Wait a second, how did they put this together?

The thing about a lot of research, is that its not exactly direct. Meaning its not about counting heads in a group. It can’t be when researchers want to study large populations. When trying to assess something on a country-wide level, it means making estimates about larger numbers, often using models to generalize information to a greater level. While this is necessary, it can create questions of effectiveness in specific situations.

In this case, the investigators created a “novel penalized synthetic control method.” They describe it as such: “This method estimates an average treatment effect from a longitudinal dataset on multiple treated and control individuals. We create a synthetic counterpart of each treated and control unit by closely matching on the target unit’s and their groups’ average pre-treatment outcome history using the pooled synthetic 27 control strategy. Further, we use a novel penalty so that the resulting estimators are adaptive to the latent groups in the data whose members have similar quarterly non-payment patterns.”

They go on to explain it further, but the point in me quoting it, is to show it’s a bit more complicated than counting up the prescriptions or payments by themselves. So can there be error in models? Of course. Am I saying there is one here? Not exactly. I’m just pointing out a strange piece of data, which was spoken about only partially, and which works to ask more questions than it answers.

Another reality to consider, is that researchers looked at payments from opioid manufacturers to physicians; something often looked at as a corrupt way to get more prescriptions written. The researchers in the study overlook this idea, and actually say “interactions between these manufacturers and physicians are critical to advance existing pain management protocols.” And that “Direct payments from opioid manufacturers to physicians are established conduits to facilitate such interactions.”

In fact, the researchers seem concerned about less money flowing from opioid producers to doctors. They say, “The finding that the opioid manufacturers in states that passed MML are stepping away from this particular form of interaction is concerning, for such activity can significantly affect the opioids ecosystem.”

Does medical weed affect opioid prescription and use?
Does medical weed affect opioid prescription and use?

Do we really want doctors taking payments from opioid manufacturers?!?

The researchers in the study sound concerned about a possible erosion of the opioid market. But…isn’t that we want? Something like weed to affect the current opioid eco-system and lower the amount of use? And don’t we want to see less of them prescribed, and doctors paying less attention to opioid manufacturers?

Perhaps the biggest issue with this study, beyond making an implication about legalized states uniformly prescribing more opioids vs non-opioids than non-legal states, is that it seems to be written by researchers who fully support payments made from opioid producers directly to the doctors who prescribe them. Which has already caused tons of controversy in that those who accept such payments, tend to write more prescriptions.

This can be seen in an investigation into pharmaceutical payments directly to doctors in the state of New York. In this 2018 report by New York Health Foundation, it found that among other things, “Physicians who received payments from opioid manufacturers prescribed more opioids to Medicare patients than physicians who did not receive any opioid-related payments.”

How much money are we talking about, and how frequently did it seem to have this effect? According to the report, “More than $3.5 million in opioid-related payments were made to physicians in New York State by pharmaceutical companies; about one in ten physicians who prescribed opioids to Medicare patients received a payment.”

It said that, “Moreover, a higher number of opioid prescriptions was associated with more opioid-related payments to physicians.” However, it also found that these payments were concentrated among a choice few doctors, “Opioid-related payments from industry were concentrated within a small proportion of physicians, who tended to prescribe a large quantity of opioids. The top 1% of physicians in New York, in terms of the amount received in opioid-related payments, received more than 80% of total payments.”

So perhaps the finding of the current report that less money is going to doctors from opioid producers, is actually an indication of a lessening of these seemingly corrupt payments, which have led to more prescribing. Which is technically what we want in this climate. And which therefore strongly calls into question the motives of the researchers and why this information makes them concerned.

Effects of legal weed on opioid payments to doctors
Effects of legal weed on opioid payments to doctors


I admit I’m slightly confused. The study talks about medical weed bringing down opioid use as seen through payments, which in the middle of a crisis like this, is optimal. Then it backhandedly turns this around and essentially questions if this is a good idea. Perhaps this study is an example of how research is often funded for a purpose, and not always with the best of intentions. I can’t say this for sure, as no funding information is given. Maybe a problem in and of itself.

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