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Relationship Between Marijuana and Opioids

Cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, opioid-related traffic fatalities, opioid-related drug treatment admissions, and opioid-related overdose deaths

  • “In all, 178 patients with chronic pain were treated for a period of 366 days (median; range 31-2590 days). Median age was 72 years (26-96 years). 115 patients (65%) with CAM [medical cannabinoids] also received opioids a median 65 mg/day morphine equivalents. This opioid dosage was significantly reduced in course of time by 24 mg/day morphine equivalents or 50%. This reduction was independent on CAM dosage, age and gender. Patients with chronic pain profit from long-term CAM which safely and significantly lower the consumption of co-medicated opioids, even at low dosages (< 7.5 mg/day). Older patients benefit from CAM, and adverse effects do not limit the (chronic) use and prescription of CAM in the elderly.”Cannabinoids reduce opioid use in older patients with pain: A retrospective three-year analysis of data from a general practice, Schmerz, 2022
  • “The primary objective of this study was to evaluate the effects of long-term cannabis-based oil consumption on the distribution of patients with an opioid prescription, within patients with a chronic pain condition. … Analyses by subgroups showed a statistically significant difference in the proportion of female opioid non-users before and after cannabis-based oil treatment (34.1% to 56.1%), as well as in the proportion of under-65 years old opioid non-users before and after cannabis-based oil treatment (32.5% to 55%), in the proportion of opioid non-users with non-severe comorbidity (33.3% to 54.2%), and … in the proportion of opioid non-users with a chronic pain condition (32.6% to 59.2%).”Long-term cannabis-based oil therapy and pain medications prescribing patterns: An Italian observational study, European Review for Medical and Pharmacological Sciences, 2022
  • “Forty patients with chronic OA pain were certified for MC. Average morphine milligram equivalents (MME) per day of opioid prescriptions filled within the six months prior to MC certification was compared to that of the six months after. … Average MME/day decreased from 18.2 to 9.8. The percentage of patients who dropped to 0 MME/day was 37.5%. VAS scores decreased significantly at three and six months, and Global Physical Health score increased significantly by three months. … Our findings support the literature in that MC reduces the use of opioids for the treatment of chronic pain.”Medical cannabis use reduces opioid prescriptions in patients with osteoarthritis, Cureus, 2022
  • “In this study involving patients with chronic musculoskeletal noncancer back pain certified for MC, opioid prescriptions filled significantly decreased after MC [medicinal cannabis] certification. … [P]atients in the less than 15 MME/day group had over a 35% chance of eliminating opioid use. … These opioid reductions were also associated with improvements in pain scores and daily function. Our findings support the hypothesis that the introduction of MC for chronic low back pain is associated with a decrease in opioid prescriptions filled.”Medical cannabis use reduces opioid prescriptions in patients with chronic back pain, Cureus, 2022
  • “This study investigates a proposed clinical context in offering medical cannabis as a treatment for chronic pain for those already using chronic opioid therapy. It then details patients’ daily morphine milligram equivalent (MME) usage. … One hundred and fifteen patients met the inclusion criteria. … There was a 67.1% average decrease in daily MME/patient from 49.9 to 16.4 MME at the first follow-up. There was a 73.3% decrease in MME at second follow-up from 49.9 to 13.3 MME. … After discussing the risks, benefits, and potential side effects of chronic opioid therapy with the patient, the authors of this study present medical cannabis, used with the current study’s paradigm, as a potentially effective class of treatment for chronic pain.”Medical cannabis used as an alternative treatment for chronic pain demonstrates reduction in chronic opioid use — A prospective study, Pain Physician, 2022
  • “In this study, we examined individuals who were provided with legal; medical cannabis certifications in the state of Delaware between June 2018 and October 2019 and were concurrently being treated with opioid medications for chronic pain at a private pain management practice. … For non-outlier individuals with positive baseline opioid use before receiving medical marijuana certification (n=63), the average percent change in opioid use was found to be -31.3 percent. Examining subgroups based upon pain location, individuals with low back pain (n=58) displayed a 29.4 percent decrease in MME [morphine milligram equivalent] units, while individuals with neck pain (n=27) were observed to have a 41.5 percent decrease in opioid use. Similarly, individuals with knee pain (n=14) reduced their opioid use by 32.6 percent. … Since the underlying pathology and their source of pain in the individuals was unlikely to significantly change during the period examined, medical marijuana use could have played a large role in allowing the individuals to decrease their opioid use. … The results of this study indicate that medical marijuana certification is associated with a decrease in prescription opiate use for chronic pain treatment and supports greater use of this adjunct treatment modality. Given the significance of opioid addiction in American society, any treatment or additional resource to reduce opioid overuse can aid in the multifactorial management of chronic pain. Although marijuana use causes a variety of side effects, the findings here suggest that the use of medical cannabis as an adjunct treatment for chronic pain may be beneficial to public health.”Medical cannabis certification is associated with decreases opiate use in patients with chronic pain: A retrospective cohort study in Delaware, Cureus, 2021
  • “A retrospective cohort study was conducted using the medical files of 68 Israeli patients with chronic pain using MC [medical cannabis]. Number of prescription medications filled and healthcare services used were recorded separately for the baseline period (6 months prior to the start of MC treatment) and 6 months’ follow-up. … Patients filled less opioid prescription medication at follow-up compared with baseline. … MC may be related to a significant yet small reduction in opioid prescription medication. Further prospective studies with representative samples are warranted to confirm the potential small opioid-sparing effects of MC treatment, its clinical importance, if any, and potential lack of association with other healthcare-related services and medication use.”Opioid and healthcare service use in medical cannabis patients with chronic pain: a prospective study, BMJ Supportive & Palliative Care, 2021

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