Cannabis, Opioids and Pain: An Update on the Research

In 2019, we published a piece exploring the correlation between increased access to medical cannabis and a decrease in opioid use. Two years is a long time when it comes to medical cannabis research, and since the last post there have been significant and timely developments in the field of cannabis research as it relates to the opioid crisis.

 

Several new studies, published since 2019, continue to support medical cannabis as a replacement or adjunct therapy to opioid pain prescriptions. Patients report ceasing or reducing opioid use when working with medical cannabis. There is also a profound indication that local legal access to cannabis has a direct impact on opioid-related mortality rates.

 

The new studies highlighted below serve as an important update on the conversation about medical cannabis for pain and as a replacement for opioids.

 

Patients Cease Opioid Use with Medical Cannabis

 

In late 2020, Cureus published a fascinating paper reporting the effects of medical cannabis on opioid use within a cohort of patients treating chronic pain. Authored by Kevin M. Takakuwa and Dustin Sulak, this study came from the survey responses of 525 patients at three medical cannabis clinics. Researchers selected these patients for the use of medical cannabis in conjunction with opioids to treat chronic pain.

 

The online survey included questions such as “How has your average pain level changed since you began using cannabis?” and “How has your opioid drug use changed since you started using cannabis?” The survey sought to determine how cannabis use affects chronic pain (as classified within the ICD-11 system of three months of “persistent or recurrent pain”).

 

Takakuwa and Sulak determined that a vast majority of respondents ceased opioid use through cannabis use. More than 40 percent, or 204 participants, indicated they no longer relied on opioids for pain. Another 45 percent reported reducing their opioid use by between 25 to 75 percent. Notably, the majority also reported sustaining this reduction for a year or more.

 

Most of the survey respondents confirmed that their ability to function had improved with medical cannabis, as well as their quality of life (80 and 87 percent, respectively).

 

Altogether, Takakuwa and Sulak’s study results tell us that medical cannabis helps patients reduce or cease opioid use completely. It also strongly suggests that medical cannabis is as effective as opioids for treatment of chronic pain and preferred by patients for improved quality of life and overall function.

 

Opioid-Related Mortality Rate Decreases with Local Access

 

A November 2020 publication in The BMJ crunched the numbers from 812 counties in the US on the “associations between the prevalence of medical and recreational cannabis stores (referred to as dispensaries) and opioid related mortality rates.”

 

In a way, this panel data study sought to clarify the confusion on how cannabis impacts opioid prescriptions and mortality rates. Since the 2014 publication of “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010,” which led to national headlines about the power of cannabis over opioids, there has been ongoing debate about what exactly the report symbolized, with a lot of back and forth in the research, both confirming and refuting the nature of the relationship between these two pain medications.

 

With the most recent publication by Hsu and Kovács, there is more evidence behind the argument that access to cannabis reduces the problems associated with opioid prescriptions.

 

Hsu and Kovács used a panel regression method to analyze the numbers from more than 800 counties in 23 states that allowed for legal cannabis sales. Working with mortality rates from US census data and dispensary information from Weedmaps, they determined that “higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl.”

 

Breaking it down by county, their data could not confirm a casual relationship but demonstrated a strong association. For example, a country with one to two dispensaries was “associated with an estimated 17% reduction in all opioid related mortality rates” and “an estimated 21% reduction in mortality rates associated with an increase from one to two dispensaries.”

 

In their call for more research, Hsu and Kovács highlight the effects medical cannabis supply seems to have over opioid use and abuse.

 

Patients Report Cannabis Lowers Severity of Opioid Withdrawal

 

One final new study worth discussing is “The impact of naturalistic cannabis use on self-reported opioid withdrawal,” published in the Journal of Substance Abuse Treatment. This study comes from the Johns Hopkins University School of Medicine and explores the benefit of medical cannabis for treating opioid use disorder. Already, four states have approved this application within the scope of their medical cannabis programs.

 

Out of the 200 participants recruited through a treatment center, each reporting both opioid and cannabis use within the previous month, 125 had relied on cannabis for withdrawal symptoms. Specifically, the researchers recorded for withdrawal symptoms like anxiety, tremors, and trouble sleeping. The authors note that a minority (12 participants) indicated cannabis worsened some symptoms, such as yawning, teary eyes, and runny noses.

 

This small survey suggests there is merit to the use of medical cannabis to lessen the symptoms of opioid withdrawal. As the authors conclude, the evidence is “clinically meaningful.”

 

Evidence in Support of Medical Cannabis Access in the Fight Against Opioid Misuse

 

With every passing year, there is increasing evidence behind the use of medical cannabis in the fight against opioid related mortality and misuse, especially for treating chronic pain.

 

As the new research suggests, patients experience real and lasting pain relief through medical cannabis—often to the extent they can cease or reduce opioid use. Furthermore, local access to medical cannabis dispensaries meaningfully reduces opioid-related deaths. Finally, medical cannabis is proving useful for some patients in reducing the impact of opioid withdrawal.

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