medical marijuana

Physicians, pharmacists and patients have been hearing about the opioid epidemic for years. This makes everyone skittish about narcotic drugs. But what can people in severe chronic pain do to ease their misery? Many are at their wits end. A new study in JAMA Internal Medicine (online, April 2, 2018) suggests that when patients have access to medical marijuana for pain, opioid prescriptions go down.

When Medical Marijuana Is Legal Opioid Prescriptions Drop:

A new analysis of data from Medicare Part D prescription databases reveals that people in states where medical marijuana is legal are less likely to take narcotics such as hydrocodone (Lortab, Lorcet, Norco, Vicodin), morphine or oxycodone (OxyContin, Percocet). The investigators analyzed data from 2010 to 2015. They found that when states implemented medical cannabis laws, the number of prescriptions for opioids dropped significantly.

There was 14.4 percent decline in states with active cannabis dispensaries. When states simply permitted patients to grow their own marijuana, the reduction in opioid prescribing was 6.9 percent.

Key Points of the Study:

The authors write:

Findings

“This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened.”

Meaning

“Medical cannabis policies may be one mechanism that can encourage lower prescription opioid use and serve as a harm abatement tool in the opioid crisis.”

Medical Marijuana for Pain in Poor Patients:

Another study published in the same issue of JAMA Internal Medicine (April 2, 2018) also found that legalizing medical marijuana led to fewer opioid prescriptions. Instead of reviewing opioid prescriptions in older people on Medicare, the authors examined Medicaid enrollees. These are people who are economically disadvantaged or disabled.

The authors reported that:

“This study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws from 2011 to 2016 was associated with lower Medicaid-covered opioid prescribing rates and spending.

“Most opioid use disorder and overdose cases occurred in patients with legitimate prescriptions from health care professionals for pain management. Marijuana liberalization, therefore, may have benefited these patients by providing them with legal protection and access to marijuana as an alternative relief from their pain conditions.”

Why Does Access to Medical Marijuana for Pain Cut Down on Opioids?

Most health professionals are taught very little about the therapeutic benefits of cannabis. The historic uses of medical marijuana for pain and other health problems has pretty much disappeared from the curricula of medical schools, pharmacy schools and nursing schools.

For decades doctors prescribed opioids to treat all manner of pain. Whether it was major surgery, a tooth extraction or chronic back pain, opioids were the go-to drugs to diminish the discomfort. Hydrocodone and oxycodone were hugely popular and many patients came to depend on an opioid to get through the day.

Not much research was devoted to developing safer and more effective alternatives. Cannabis research was not considered a priority and there wasn’t a lot of federal funding to explore medical marijuana for pain. Drug companies had little incentive to spend research dollars on a plant that could not be patented.

The Science Behind Medical Marijuana for Pain:

The new study in JAMA Internal Medicine points out that:

“There is some evidence in the literature that MCLs [medical cannabis laws] are associated with reductions in opioid-related mortality. A recent state-level analysis found statistically significant and meaningful reductions in opioid mortality when any form of MCL was passed. There are mechanisms that would explain this association. Most opioid overdoses are associated with legitimate opioid prescriptions. Furthermore, a growing consensus suggests that cannabis can be used to effectively manage pain in some patients.”

Medical Marijuana for Pain:

It will doubtless come as a shock to many health professionals to learn that there is scientific support for the use of cannabis against pain. A systematic review in the Journal of Neuroimmune Pharmacology (June, 2015) concluded:

“This review adds further support that currently available cannabinoids are safe, modestly effective analgesics that provide a reasonable therapeutic option in the management of chronic non-cancer pain.”

An article in the journal Neurology (Sept. 27, 2005) concluded:

“Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated.”

Researchers writing in the Journal of Pain (June, 2016) write:

“Expanding evidence indicates that herbal cannabis has analgesic effects in neuropathic [nerve] and non-neuropathic pain. The most robust evidence exists for neuropathic pain and there are at least 5 high-quality randomized controlled clinical trials establishing analgesic efficacy of smoked cannabis.”

“In addition to pain, there is some evidence and ongoing study of potential therapeutic efficacy of cannabis for common symptoms and conditions associated with pain, including: spasticity associated with multiple sclerosis or stroke, anxiety and post-traumatic stress disorder, nausea and vomiting, cachexia, inflammatory bowel diseases, migraine, and sleep disturbance. Patients with pain may elect cannabis use for these symptoms as well.”

Medical Marijuana Is Not New

An article in the New England Journal of Medicine (Sept. 10, 2015) notes:

“Cannabis has been used medicinally for millennia and was used in the treatment of epilepsy as early as 1800 B.C.E. in Sumeria. Victorian-era neurologists used Indian hemp to treat epilepsy and reported dramatic success.”

You can learn more about this use in our article:

How Good is Medical Marijuana (Cannabidiol) Against Epilepsy?

Cannabis for Neuropathic (Nerve Pain)?

Nerve pain or neuropathy is notoriously hard to treat. Some of the most commonly prescribed drugs for this condition are gabapentin and pregabalin (Lyrica). Such medications are not without complications. Read about them here and here. That’s why there is considerable interest in cannabis for nerve pain.

Does Cannabis (Marijuana) Ease Nerve Pain or PTSD?

Medical Marijuana for Pain vs. Opioids?

Even though physicians are used to prescribing opioids for pain, they are starting to cut back. All the negative headlines are having an impact on prescribing patterns. That means many patients suffering with chronic pain are in terrible trouble. Hundreds have written to us expressing their anguish.

Medical marijuana will never replace opioids. People who have been in serious accidents, burn patients, terminal cancer patients and those who have experienced botched surgery will likely need some sort of opioid. But concern about the opioid epidemic has left many doctors searching for alternative ways to help patients in pain.

The authors of the study in JAMA Internal Medicine suggest that legalizing medical cannabis might be one tool in the policy arsenal to reduce the harm of prescription opioids. Of course marijuana can be abused just as opioids have been abused. This will no doubt pose problems in some communities.

You can learn much more about medical marijuana by listening to our one-hour interview with a physician who has thought long and hard about this topic. He presents the pros and cons of cannabis. We think you will find this conversation enlightening.

Show 1027: How One Doctor Changed His Mind about Medical Marijuana (Archive)

Share Your Thoughts:

Have you ever used cannabis or cannabidiol for pain? Do you think this is a good or a bad idea? Share your thoughts or your experience below in the comment section.

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  1. Don
    South Florida
    Reply

    I have been taking Vicodan for many years for chronic back pain. I would like to use Medical Marijuana to reduce and eventually stop Vicodan altogether. Is there a “best way” to titrate the doses of these?

  2. Beverly
    St. Petersburg, fl
    Reply

    I am on Norco and gabapentin for pain from a fall and hospitalization and also from back problems (neurotransmitter placed in back July 2018) and also Pulmonary embolism 2nd time.
    Have been on opioids from February 2018 to August -2018. Now I want to use medical marijuana, which is legal here in Florida, to help me taper of opioids. Is there anyone or any physician in the St. Petersburg, or any place else who can direct me to a facility or physician for guidance?

  3. Diana
    Spokane, WA
    Reply

    Please do some research on CBD oil or hemp oil which does not contain THC, the part of marijuana that produces the “high”. There are several different kinds of these products available on the market and they are legal in every state. I have done some research on these products and have found that CBD oil is the most expensive product. Hemp oil is not expensive and can be found on Amazon. The reason why there is not enough information on these products is the lack of studies and/or research which leads us back to the over abundance of opioids that are available and are prescribed by the medical profession. Also, so far, there is little information on whether or not CBD or hemp oil are addictive. This is information that should be available to the medical community as well.

  4. Len
    Israel
    Reply

    I have used Opiates including Fentanyl, Morphine by injection, Oxycodone etc. for 27 years.

    I consulted a Professor in Israel who is a pain expert. The fact is that after 6 months one is addicted; after that the brain makes up pain so as to keep taking the Opiates.
    Also, the doses I was on were huge and eventually would kill me.

    I decided to stop by tapering down the doses over 3 months. I am now free of all Opiates. I am 10 weeks free. I am having lidocaine infusions weekly and will take Marijuana oil with a high CBD rating, which does not make me feel stoned.

    I am now a different person. Opiates sap the will to live, to enjoy life and should never be used longer than 6 months unless a terminal illness is diagnosed. Withdrawal is a very hard path. The last 4 weeks were a nightmare. No sleep, restless legs, pain; it was just a blur. Now I am through it.

    It is the best decision I have made. Opiates are a cheap and easy way to camouflage a much bigger problem. Resist opiates, and find a true path. Long term use of Opiates damages your mind and body. To stop you need a good plan and help from a devoted partner, friend or relative.

  5. Donna
    34476
    Reply

    In as much as Medicare is noticing a reduction in Opioid Prescriptions, maybe there should be some pressure to encourage Health Insurance Companies to cover the Medical Marijuana. I know of people that would like to switch that can’t afford to. Why should this be offered and then be so expensive that it is not obtainable? Is this just another BIG Money Maker for the already prosperous industry?

    • Bev
      California
      Reply

      I have Ms and much pain. I was on fentynal patches 100 mc. That didn’t ease the pain and is very addictive. Was in the hospital twinge from fentynal. Methodone 4 times a day worked for pain but awful to take. Life became pills etc to survive. I can’t believe I got. Off methadone.

      Marijuana works so well for pain, spasms etc ands no side effects. Alcohol doesn’t help at all. Marajuana is a miracle non drug(just a plant) solution. I grew up in the 60’s and it was hard to get and rarely buds. It is expensive though and methodone almost free. Pollically it’s ridiculous.

  6. John
    Reply

    Time for feds to reclassify marijuana so it can be studied. To deny people safe ways to control pain is ridiculous.

  7. Doris
    Virginia
    Reply

    CBD oil has so far been a life saver for me – has cured my IBS symptoms and I now eat anything without any problems!! YEA! It has also helped me with insommia and I have been sleeping beautifully with no sleep aids!! Plus, has helped relieve my pain from Rhumatoid arthritis – I could not be happier and am taking no medicine. The meds my rhumatologist gave me made me so sick I had to run to heart Drs., lung Drs., throat Drs. and you name it. I am so very thankful I was given the info on CBD oil.

  8. Charles
    S. East
    Reply

    Thanks forever for this article. I have never used weed for pain and do not use it now. I would be one of the people who would use it. Physicians will hold your prescription “over your head” to make you do what they want.

    This is a dirty, filthy practice. and ought to be outlawed. My former next door neighbor was in desperate agony. His doctor ordered him around like a dog.

  9. Marie
    Oregon
    Reply

    I smoked a lot of marijuana in the 60s and 70s. I stopped mainly because I became a mother but I also found that it was causing me anxiety when I smoked. Fast forward several decades and I’m older and live with chronic pain. My doctor prescribes opioids for me and the last few times that I went to fill my prescription the pharmacy was out. This is most likely due to the fact that’s a DEA is forcing a cut back on the amount of opioids available.

    I would love to get off pain meds and substitute with marijuana but the few times I’ve tried it I found I still got anxiety from it. I also don’t like the feeling of being stoned. So, right now, I don’t see that it’s an option for me. I live in fear that at any moment I will be told I can no longer be prescribed opioids for my pain. If that happens, my quality of life will be greatly diminished.

    I don’t know what the solution is to the opioid crisis but I do know that punishing people who don’t abuse their meds isn’t the answer.

  10. Betty
    Alabama
    Reply

    Recently a friend was going through chemo and ended up with neuropathy in her feet and legs making it difficult to sleep. She would resort to sitting in a chair and rubbing her legs and feet and sometimes drift off to sleep only to repeat the process night after night. Her daughter obtained some marijuana brownies for her and it allows her pain to subside enough for her to sleep through the night.

    Unfortunately, the only way a person gets access to this helpful herb is through what I term the criminal element and risk losing their property by confiscation.

    This is a sad state of affairs. I have other stories of people out of state with genuine severe medical issues who can get relief with this herb but end up using Pain Management clinics once a month in another city because he is so disable to walk and drive that he must get someone else to drive him to the city about 50 miles away. He is also a veteran of the Korean conflict.

  11. Jim S
    Florida
    Reply

    The problem with medical marijuana is that insurance won’t pay for it and it’s NOT CHEAP while they will pay for my opioids!

  12. Ellie
    CT
    Reply

    I’m a classic example of a person who was prescribed opiods for several years for chronic back issues. I have referred pain down one leg.

    Although my pain management doctor didn’t recommend medical marijuana (MMJ), he was not at all opposed to my trying it. Here in CT, it’s legal. So I applied for & got my MMJ cerificate which is renewable yearly.

    What I found, however, was that CBD tincture & capsules worked well enough for daytime use. CBD is the non psychoactive part of MJ, & unknown to too many people, CBD made from hemp is legal in all 50 states. Finding companies that sell high quality CBD is the challenging part. It’s taken a year or more but I’ve got 3 or 4 companies that produce a CBD tincture which works for me. I’m never w/o pain but I can keep it pretty much under control. At night I use CBD which does have some THC in it (a 4:1 ration). And generally twice a week I add Aleve to the mix for even better pain control. I’ve used no opiods in almost two years. I do, however, have regular epidurals. And the total effect enables me to keep going.

    The drawbacks to using MMJ or CBD tinctures is the cost. It can get expensive & it’s not covered by insurance.

  13. Beth
    Seattle
    Reply

    Here is a blind study for you. We have a dog who had two surgeries for two different herniated discs with a 6inch bone graft with the last surgery. He had success with the first surgery and could walk again and the second surgery was more complex and he can walk but very lame in one leg. He had a lot of pain after surgery and was on gaba pentin and codiene for pain daily.

    Coincidentally he has extreme car phobia and we tried all sorts of treatments for that to no avail. So, our state approved medical marijuana and we found some for dogs with the THS removed which can be harmful to animals. This didn’t help his car phobia but we noticed an immediate improvement in how he moved and his mood. Eight years later, our 14 year old dog is still lame but no pain with one tablet a day. We’ve passed this information on to friends with older dogs with pain and arthritis issues and they report great help with their dogs.

  14. Peggy
    Ontario
    Reply

    I have had rheumatoid arthritis for many years but sadly my Dr.’s do not believe in medical cannabis, sad but things are changing.

  15. Mary
    Reply

    The US knows that cannabis has immense healing powers. That is why they patented it years ago. Cannabis is being saved for pharmaceuticals.

    The FDA makes noises about reducing opioids but they are making it harder for people to access CBD by Visa and Mastercard now refusing to allow payment for many vendors.

    CBD can reduce or even eliminate many symptoms and is not psychoactive.

    Come on, FDA. Actually help us by making it easier, not harder.

  16. Belle T.
    Reply

    What have you heard about cbd oil? Is it effective against pain?

  17. Bonnie
    Yes
    Reply

    I have Spina-Bifida, am a left leg amputee, and have had 86 major operations since birth. My pain care specialist has been consistently cutting my opioid pain meds, and my chronic pain has increased to the point where I’m spending day & night in my bed, suffering in relentless pain throughout my body. Thanks to this Opioid crisis I feel like a real victim here. I cannot afford medical marijuana even though it has helped me immensely in the past. I’m on the verge of giving up.

  18. Susan
    Reply

    Let’s hope this research continues, and cannabis can become legal in all states. I especially agree with the idea of using it to get away from the addicting habit of opioid pain meds. Cannabis will be heralded as a true medicine someday!

  19. Jack
    Reply

    Why is there the big hoopla about the use of marijuana? Distilled liquor, beer, and wine are consumed in massive amounts, and all provide the same effect of a ‘high,’ as does marijuana. There is no difference between them at all, except the first three are regulated and taxed. States that have legalized marijuana are seeing HUGE increases in tax revenues. Wake up, people.

    • Mary
      Reply

      To Jack who says liquor is the same at relieving pain as little marijuana caps: He wouldn’t feel pain if he passed out drunk.

    • Patty
      Reply

      In response to Jack – Many of those of us who are in severe pain do not wish to get high on THC or alcohol. Getting high on anything makes me feel nauseated and ill. We just wnat pauin releif, nothing additional. I do understand your point though that there is an unwarranted negative “knee jerk” reaction by many towards marijuana use for any reason.

      I’ll add the marijuana is less addictive and less damaging to the human body that alcohol. I’ve read that some of the new stronger strains have enough THC, as much as 70% more, and can make “weed” more addictive.

      It’s too bad that marijuana and it’s derivatives will likley be very expensive once legal. Like another said, I’d rather use CBC oil but my pills are far cheaper.

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