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 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


Cannabis access is associated with reductions in overall prescription drug activity

  • “Data were collected between October 2014 and October 2020 from patients who were consulting the Canada-wide network of clinics of a medical cannabis provider and who were willing to answer questionnaires based on their medical status. The current study included older adults (≥ 65 years) who completed questionnaires at intake and first follow-up visits. … Data included that from 9766 older adult users at intake (mean ± SD age = 73.2 ± 6.8 years, females = 60.0%), among whom 4673 (females = 61.4%) returned for follow-up after 90.6 ± 58 days. … Doses of concomitant medications were reported to be unchanged by a majority of older adults although 35.6% and 19.9% reported reduced doses of opioids and benzodiazepines, respectively.”Medical use among older adults in Canada: Self-reported data on types and amount used, and perceived effects, Drugs & Aging, 2022
  • “[W]e sought to capture the medically relevant features of cannabis use in a population of patients with orthopedic pain and pair these data with objective measures of pain and prescription drug use. … Medical cannabis use was associated with clinical improvements in pain, function, and quality of life with reductions in prescription drug use; 73% either ceased or decreased opioid consumption and 31% discontinued benzodiazepines. … This work provides a direct relationship between the initiation of cannabis therapy and objectively fewer opioid and benzodiazepine prescriptions.”Perceived efficacy, reduced prescription drug use, and minimal side effects of cannabis in patients with chronic orthopedic pain, Cannabis and Cannabinoid Research, 2021
  • “Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 months following MC [medical cannabis] treatment initiation.. … 43% of the patients who had been using analgesic medications prior to MC treatment initiation were no longer using them. This was true for all classes of analgesic drugs including over the counter analgesics, non-steroidal anti-inflammatory drugs, anticonvulsants and antidepressants. As for opioid use, 24% and 20% of the participants who had been using weak or strong opioids, respectively, at baseline stopped using them by the time they reached the 12-month follow-up.”Medical cannabis treatment for chronic pain: Outcomes and prediction of response, European Journal of Pain, 2021


The adjunctive use of cannabis augments the analgesic properties of opioids


Patients often use cannabis as a substitute for other controlled substances, including prescription medications, alcohol, and tobacco


Chronic pain patients are less likely to abuse medicinal cannabis as compared to opioids

Chronic pain patients are less likely to become depressed using medical cannabis

Cannabis use is associated with greater rates of opioid use treatment retention and may mitigate opioid-related cravings

  • “A growing body of research has reported on the potential opioid-sparing effects of cannabis and cannabinoids, but less is known about specific mechanisms. The present research examines cannabis-related posts in two large online communities on the Reddit platform (“subreddits”) to compare mentions of naturalistic cannabis use by persons self-identifying as actively using opioids versus persons in recovery. We extracted all posts mentioning cannabis-related keywords (e.g., “weed”, “cannabis”, “marijuana”) from December 2015 through August 2019 from an opioid use subreddit and an opioid recovery subreddit. … The most frequent phrases from the recovery subreddit referred to time without using opioids and the possibility of using cannabis as a ‘treatment.’ … The most common motivations for using cannabis were to manage opioid withdrawal symptoms in the recovery subreddit, often in conjunction with anti-anxiety and GI-distress “comfort meds.” … Despite limitations in generalizability from pseudonymous online posts, this examination of reports of naturalistic cannabis use in relation to opioid use identified withdrawal symptom management as a common motivation.”Naturalistic cannabis use reported in online opioid and opioid recovery discussion forums, PLoS One, 2020
  • “Participants receiving pharmacological treatment for OUD (n = 2315) were recruited from community-based addiction treatment clinics in Ontario, Canada, and provided information on past-month cannabis use (self-report). Participants were followed for 3 months with routine urine drug screens in order to assess opioid use during treatment. We used logistic regression analysis to explore (1) the association between any cannabis use and opioid use during treatment, and (2) amongst cannabis-users, specific cannabis use characteristics associated with opioid use. … We found that amongst cannabis users, those who use cannabis daily are less likely to have opioid use than people who use cannabis occasionally. This association was present for both men and women. … Future studies should further examine specific characteristics and patterns of cannabis use that may be protective or problematic in MAT [medication-assisted treatment].”The association between cannabis use and outcome in pharmacological treatment for opioid use disorder, Harm Reduction Journal, 2021
  • “[W]e found that among more than 800 participants on OAT [opioid agonist therapy, e.g., methadone and/or naltrexone ) in Vancouver, Canada, use of cannabis was longitudinally associated with a substantially lower risk of being exposed to fentanyl. Given the magnitude of the overdose crisis in the U.S. and Canada and the substantial contributions of fentanyl to the burden of overdose morbidity and mortality, findings from this study support the experimental evaluation of cannabinoids as a potential adjunct therapy to OAT to improve clinical outcomes, particularly to reduce the risk of relapse to illicit opioid use (i.e., fentanyl) and associated risk of overdose and death.”Cannabis use is associated with reduced risk of exposure to fentanyl among people on opioid agonist therapy during a community-wide overdose crisis, Drug and Alcohol Dependence, 2020
  • “Two hundred individuals recruited through Amazon Mechanical Turk with past month opioid and cannabis use and experience of opioid withdrawal completed the survey. Participants indicated which opioid withdrawal symptoms improved or worsened with cannabis use and indicated the severity of their opioid withdrawal on days with and without cannabis. … 62.5% of 200 participants had used cannabis to treat withdrawal. Participants most frequently indicated that cannabis improved: anxiety, tremors, and trouble sleeping. … These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful.”The impact of naturalistic cannabis use on self-reported opioid withdrawal, Journal of Substance Abuse Treatment, 2020
  • “To fill the gap between efficacious OUD [opioid use disorder] treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. … The evidence summarized in this article demonstrates the potential cannabis has to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths. … The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.”Emerging evidence of cannabis’ role in opioid use disorder, Cannabis and Cannabinoid Research, 2020

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