19. Marijuana as an Opioid Alternative:Substantial Evidence, and More Substantial Need
There is substantial research – still mostly limited to real-world data – but substantial, suggesting medical marijuana may be a viable alternative and is likely an effective adjunct for opioid users treating chronic pain. Less opioid use equals less deaths – no doubt about it. Opioid use disorder is a recent addition to approved conditions for medical marijuana (check your state). “States that have approved medical cannabis saw a dramatic reduction in opioid use,” according to a new study at University of Georgia. There are four alternatives available for acute pain management — and one (Ketamine) is exploring secure subcutaneous delivery systems (like insulin pumps) for automated delivery and controlled dosing. There are sub-cutaneous electro-stimulators that block or interrupt pain impulses. And yet, there is available a non-lethal pain medicine that needs a few clinical trials to prove (or not) that is safe and effective. The Federal Government could, at least, allow clinical trials to proceed to inform patients and clinicians. Rick Doblin at MAPS got this done and patients with PTSD now have an effective treatment option.
Some of the recent literature continuing to build this huge catalogue of real-world evidence for cannabis-based medicine include:
"Patients with chronic pain reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 mths. following MC treatment initiation. At 1-year, average pain intensity declined from baseline by 20 percent with a decrease of 42% in daily dosage of opioids.” Medical cannabis treatment for chronic pain: Outcomes and prediction of response, European Journal of Pain, 2020 “At-least-daily cannabis use was associated with a decreased rate of injection. There was no significant association between at-least-daily cannabis use and injection relapse. This is the first longitudinal study to identify a positive association between cannabis use and cessation of injection drug use.” Frequent cannabis use and cessation of injection of opioids, Vancouver, Canada, 2005-2018, American Journal of Public Health, 2020
“This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by MC [medical cannabis] users, compared to people with no additional use of MC. There was 64–75% reduction in opioid dosage for MC users and complete stoppage of opioid use for chronic non-cancer pain by 32–59.3% of MC users, when compared to patients without additional use of MC. … Given the current opioid epidemic in the USA and medical cannabis’s recognized analgesic properties, MC could serve as a viable option to achieve opioid dosage reduction in managing non-cancer chronic pain.” Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review, Systematic Reviews, 2020
“Among our subjects, over 90 percent of CU [cannabis users] and PU [past users] reported “a little” or “great” relief from symptoms with MC [medical cannabis] and 61.20 percent claimed that MC had allowed them to reduce or discontinue use of other medications.” Utilization of medicinal cannabis for pain by individuals with spinal cord injury, Spinal Cord Series and Cases, 2020
“Depression among patients in the OP (opioids), MM (medical marijuana) and OPMM groups was 57.1%, 22.3% and 51.4%, respectively. Rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. … Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety.” Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana, Journal of Affective Disorders, 2017
There is substantial research – still mostly limited to real-world data – but substantial, suggesting medical marijuana may be a viable alternative and is likely an effective adjunct for opioid users treating chronic pain. Less opioid use equals less deaths – no doubt about it. Opioid use disorder is a recent addition to approved conditions for medical marijuana (check your state). “States that have approved medical cannabis saw a dramatic reduction in opioid use,” according to a new study at University of Georgia. There are four alternatives available for acute pain management — and one (Ketamine) is exploring secure subcutaneous delivery systems (like insulin pumps) for automated delivery and controlled dosing. There are sub-cutaneous electro-stimulators that block or interrupt pain impulses. And yet, there is available a non-lethal pain medicine that needs a few clinical trials to prove (or not) that is safe and effective. The Federal Government could, at least, allow clinical trials to proceed to inform patients and clinicians. Rick Doblin at MAPS got this done and patients with PTSD now have an effective treatment option.
Some of the recent literature continuing to build this huge catalogue of real-world evidence for cannabis-based medicine include:
"Patients with chronic pain reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 mths. following MC treatment initiation. At 1-year, average pain intensity declined from baseline by 20 percent with a decrease of 42% in daily dosage of opioids.” Medical cannabis treatment for chronic pain: Outcomes and prediction of response, European Journal of Pain, 2020 “At-least-daily cannabis use was associated with a decreased rate of injection. There was no significant association between at-least-daily cannabis use and injection relapse. This is the first longitudinal study to identify a positive association between cannabis use and cessation of injection drug use.” Frequent cannabis use and cessation of injection of opioids, Vancouver, Canada, 2005-2018, American Journal of Public Health, 2020
“This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by MC [medical cannabis] users, compared to people with no additional use of MC. There was 64–75% reduction in opioid dosage for MC users and complete stoppage of opioid use for chronic non-cancer pain by 32–59.3% of MC users, when compared to patients without additional use of MC. … Given the current opioid epidemic in the USA and medical cannabis’s recognized analgesic properties, MC could serve as a viable option to achieve opioid dosage reduction in managing non-cancer chronic pain.” Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review, Systematic Reviews, 2020
“Among our subjects, over 90 percent of CU [cannabis users] and PU [past users] reported “a little” or “great” relief from symptoms with MC [medical cannabis] and 61.20 percent claimed that MC had allowed them to reduce or discontinue use of other medications.” Utilization of medicinal cannabis for pain by individuals with spinal cord injury, Spinal Cord Series and Cases, 2020
“Depression among patients in the OP (opioids), MM (medical marijuana) and OPMM groups was 57.1%, 22.3% and 51.4%, respectively. Rates of anxiety were 48.4%, 21.5% and 38.7%, respectively. … Levels of depression and anxiety are higher among chronic pain patients receiving prescription opioids compared to those receiving MM. Findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, particularly among those at risk for depression and anxiety.” Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana, Journal of Affective Disorders, 2017