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:
“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.”
“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:
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.
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.
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.