The Impact of Medical Cannabis on Intermittent and Chronic Opioid Users with Back Pain: How Cannabis Diminished Prescription Opioid Usage

Abstract

Objective: To determine if cannabis may be used as an alternative or adjunct treatment for intermittent and chronic prescription opioid users. Design: Retrospective cohort study. Setting: A single-center cannabis medical practice site in California. Patients: A total of 180 patients who had a chief complaint of low back pain were identified (International Classification of Diseases, 10th Revision, code M54.5). Sixty-one patients who used prescription opioids were analyzed. Interventions: Cannabis recommendations were provided to patients as a way to mitigate their low back pain. Outcome Measures: Number of patients who stopped opioids and change in morphine equivalents. Results: There were no between-group differences based on demographic, experiential, or attitudinal variables. We found that 50.8% were able to stop all opioid usage, which took a median of 6.4 years (IQR = 1.75-11 years) after excluding two patients who transitioned off opioids by utilizing opioid agonists. For those 29 patients (47.5%) who did not stop opioids, 9 (31%) were able to reduce opioid use, 3 (10%) held the same baseline, and 17 (59%) increased their usage. Forty-eight percent of patients subjectively felt like cannabis helped them mitigate their opioid intake but this sentiment did not predict who actually stopped opioid usage. There were no variables that predicted who stopped opioids, except that those who used higher doses of cannabis were more likely to stop, which suggests that some patients might be able to stop opioids by using cannabis, particularly those who are dosed at higher levels. Conclusions: In this long-term observational study, cannabis use worked as an alternative to prescription opioids in just over half of patients with low back pain and as an adjunct to diminish use in some chronic opioid users.

Changes in cannabis use, exposure, and health perceptions following legalization of adult recreational cannabis use in California: a prospective observational study

“…While not tested in our study, it is possible those with depression or other mental illness experienced decreasing perceptions of risk of cannabis use. Despite the growing evidence of cannabis use as an effective treatment in chronic pain [ 3 , 26 ] and its use in mitigating side effects of cancer therapies, our study showed that those with pain and those with a history of cancer were not significantly more likely to use cannabis.…”

Opioid Use in Medical Cannabis Authorization Adult Patients from 2013-2018: Alberta, Canada

“…Collectively, there has been a growing body of literature acknowledging medical cannabis' therapeutic analgesic properties and its potential clinical association with pain reduction (12,13,22), however, gaps remain in the evidence. Takakuwa et al (2020) (25) reported that cannabis was effective as an alternative to opioids in over 60% of patients (out of 180) -however, this outcome did not predict whether the individuals eventually stopped taking opioids altogether. 20) also reported that medical cannabis was a viable substitute for opioids, although their study did not have a comparison group for opioid users alone.…”

“…Likewise, past systematic reviews (3,(21)(22)(23)(24) concur that cannabis use has shown bene ts in pain reduction. Recent observational studies (25)(26)(27) in the US further support the potential for cannabis to act as an adjunct for opioid medication. Other studies suggest that medical cannabis access laws may also contribute to the reduction of the number of opioids prescribed per year (4,28,29).…”

A Survey on the Effect That Medical Cannabis Has on Prescription Opioid Medication Usage for the Treatment of Chronic Pain at Three Medical Cannabis Practice Sites

“…One study of 176 treatment-resistant chronic pain patients found that pain and functional outcomes improved with medical cannabis and opioid use fell by 44% [ 14 ]. In a retrospective chart review study of 61 patients with chronic back pain who were taking prescription opioids and were using medical cannabis, 50.8% were able to stop opioid usage, which took a median of 6.4 years, while 31% of those who did not stop opioids were able to reduce usage [ 20 ]. A survey study of 244 chronic pain patients reported a 64% decrease in opioid use with medical cannabis [ 18 ].…”

“…Observational studies using self-reported measures have backed these findings [ 18 , 19 ]. One retrospective study found that half of the patients on opioids were able to stop, aided by the use of medical cannabis [ 20 ], and two studies reported that surveyed respondents used cannabis as a substitute for prescription opioids [ 21 , 22 ]. Other benefits provided by the addition of cannabis to opioids may be improved functional outcomes such as improved sleep [ 14 ] and quality of life [ 15 , 16 , 18 ], decreased side effects of medications [ 12 , 18 ], and reduced opioid tolerance and dependence [ 11 ].…”