COLUMBUS, Ohio -- Ohio lawmakers have spent the last five years tackling the state's opioid epidemic, making it harder to obtain addictive painkillers and easier for people to receive treatment for their addiction.

The same lawmakers have rebuffed efforts to legalize marijuana. One representative said last year that legalization would "be like pouring gasoline on the fire."

But the number of overdose deaths continues to climb -- nearly 2,000 people died from opioid overdoses in Ohio in 2014. And medical marijuana advocates point to a growing body of research that supports marijuana as a safer, less addictive alternative to those drugs.

Rep. Ryan Smith, a Gallia County Republican, said that point was raised several times during House GOP discussions about a bill legalizing medical marijuana.

"The thought is we're treating pain right now with various addictive opiates so if there's an opportunity to treat them with something else that's less addictive, why not?" Smith said.

The House will vote Tuesday on House Bill 523, which would establish a tightly regulated medical marijuana program where patients could buy and use marijuana with a doctor's recommendation. Smoking and growing at home would not be permitted.

Lawmakers hope the bill will halt two ballot measure efforts. Ohio would be the 25th state to legalize medical marijuana.

Marijuana helps manage pain

Clinical research doesn't support marijuana for most of the conditions states' laws allow, a study published last year in the Journal of the American Medical Association journal concluded.

But the study did find sufficient evidence that marijuana can alleviate chronic and neuropathic pain and muscle spasticity associated with Multiple Sclerosis and preliminary evidence that it can benefit patients with seizure disorders.

Harvard Medical School's Dr. Kevin Hill, who authored the study, said there's no question cannabis is safer than opioids.

"You may end up in the emergency room, but you're not going have a fatal overdose from marijuana," Hill said.

Greg Gerdeman, a pharmacologist and professor at Eckerd College in Florida, said the science is there, but federal laws placing marijuana in the same drug category as heroin has stifled research on American soil. Gerdeman researches the body's endocannabinoid system, which marijuana's myriad components interact with to trigger a response such as increased appetite or make the person feel "high."

For pain patients, Gerdeman said, marijuana helps in three ways:

Dampening pain signals traveling from the body to the brain, similar to opioids.

Turning down or preventing an inflammatory response.

Relieving "emotional pain" -- marijuana users spend less time thinking about their pain.

Patients develop tolerance much quicker to opioids than to marijuana, Gerdeman said, and using the two in concert could save lives.

"If you are able to suspend the fear of fakers and the stigmatization of doctors as being frauds and advocates as being drug dealers and move past that then there are people who are suffering and reporting they're getting relief from cannabis," Gerdeman said.

Marijuana may decrease opioid use

People who have become dependent on OxyContin, Percoset, or other prescription opioids but can't access them legally have been turning to heroin and fentanyl, a synthetic opiate that can be 100 times stronger than morphine.

A handful of separate studies show pain patients who use marijuana decrease their opioid use.

A 2014 study found states with medical marijuana laws had nearly 25 percent fewer opioid-related overdose deaths than those without.

A Canadian study

And

Researchers in each study warned cannabis should not be an automatic replacement for opioids. Hill said the idea needs to be studied further and it's premature to recommend marijuana to treat opioid addiction.

But patients say otherwise. Retired nurse Rhonda Agard of Toledo weaned herself off a pain pump, anxiety medication, and sleeping pills by switching to marijuana.

Agard had been on pain meds for 13 years after breaking her back. She overdosed at least 20 times by her count, including one time when her children found her on the floor, her heart beating only 15 beats per minute.

"I was no better than people on heroin except mine was legal -- head nodding, falling asleep, drooling -- thank God I'm not like that today," Agard said.

The idea of using marijuana to treat opioid addiction has become a hot topic in Maine. Medical marijuana advocates there are pushing state regulators to add opioid addiction to the list of qualifying medical marijuana conditions.

Massachusetts Democrat Sen. Elizabeth Warren asked the Centers for Disease Control and Prevention earlier this year to examine the effectiveness of medical marijuana as an alternative to opioids and the impact of marijuana legalization on overdose deaths.

Marijuana is no silver bullet for pain



People don't fatally overdose on marijuana, but about 17 percent of teens and 9 percent of adults who try it develop a dependence.

Dr. Jason Jerry, an addiction specialist at the Cleveland Clinic, said patients who move from opioids to marijuana are likely treating an underlying addiction stemming from opioid abuse.

"We've got high level sports figures who would give up millions of dollars because they won't give up marijuana," Jerry said. "That should be a billboard for patients who don't think marijuana is addictive."

Hill said cannabis should not be a first-line treatment and should be discussed between a patient and his doctor. Hill said opioid addiction should be treated first with evidence-based methods, and the evidence isn't there yet for marijuana.

If Ohio decides to legalize marijuana for medical use, it won't be covered by health insurance plans and might be more expensive than prescription medications. And critics of the proposed bill say it creates too much red tape and few doctors will register to recommend marijuana.

Dr. Amol Soin, a pain management doctor in Dayton, said the research is promising, but he and other physicians want to be able to prescribe compounds known to work instead of the whole plant.

"Given the scenario we have a compound vetted by the FDA and backed by studies, I think it will hold promise," Soin said.