Medical marijuana significantly reduced opioid prescriptions for patients with chronic pain, according to a study led by scientists from the New York State Department of Health and published this week in the Journal of the American Medical Association. In order to determine whether or not there was a correlation between participation in New York’s medical cannabis program and a decrease in opioid prescriptions, researchers analyzed data from over 8,000 individuals.
The study found that opioid use dropped by nearly half among pain patients who used marijuana for longer than 30 days. The study was hailed as “additional proof that medicinal cannabis has the potential to minimize the amount of opioid-based drugs needed to manage chronic pain” by New York’s interim health commissioner James McDonald.
“Patients’ daily opioid dosages were reduced by 47% to 51% of the baseline dosages after 8 months.” He stated in a statement that the study’s results “may help to educate health care practitioners and legislators in New York and other jurisdictions where medical cannabis is not yet legalized or used to its full potential.”
Researchers from the Health Department, the state’s Office of Cannabis Management, and the CUNY Graduate School of Public Health and Health Policy collaborated on a new peer-reviewed study that was published in the January 30 issue of the Journal of the American Medical Association (JAMA) Network Open. “Receiving medical cannabis for a longer duration was associated with prescription opioid dosage reduction.”
According to the study’s principal author, Dr. Trang Nguyen of the Department of Health, “our study demonstrated considerable decreases among patients using medical cannabis for 30 days or longer.” Over the course of eight months, “patients’ daily opioid dosages were reduced by 47% to 51% of the baseline dosages.”
On the other hand, just 4%-14% of patients who used cannabis for fewer than 30 days reported any improvement. The study compared patient records from the state’s medicinal cannabis program (which operated between 2017 and 2019) with official logs of prescribed opioids, as reported to the state’s prescription monitoring program registry.
As #DrJamesMcDonald said: its findings are “further evidence that medical cannabis has the potential to reduce the amount of opioid-based medications needed to treat chronic pain.” https://t.co/FlZLHftIAu
— NYSDOH (@HealthNYGov) February 1, 2023
Chronic pain patients who had been recommended cannabis treatment and who were also taking at least one opioid prescription were included. In the study, 8,165 patients were divided into two groups: those who continued to receive cannabis for more than 30 days following their initial dispensation, and those who joined the registry but seemingly stopped making purchases after less than a month.
Prior to obtaining medical cannabis, patients were also classified into one of three groups depending on their average daily opioid prescription dose. After eight months, patients who had first received medical marijuana were compared to individuals who had initially received a placebo.
Records from the state showed that both groups were prescribed lower doses of opioids, but the drop was over five and a half times greater for patients who received cannabis for a longer duration. Medical marijuana “is typically not covered by insurance and was thus unaffordable.”
As expected, those who have prescribed the most opioids before using medical cannabis showed the greatest decreases in their opioid use. The authors note that there was a lack of data on patients’ comorbidities and the underlying reasons for their chronic pain, as well as information on patient’s race and ethnicity. Nor is there an evaluation of different cannabis doses or products included in the research.
Additionally, researchers were unable to ascertain whether or whether patients’ decisions to use medical marijuana were motivated by a desire to reduce their use of opioids. There is also no way to determine if patients actually utilized any or all of the amounts provided, or if they augmented those amounts with medications from other sources, even while the study looks at whether patients were given medical cannabis or were prescribed opioids.
In spite of this, the authors claim theirs is the first large-scale study “that investigated the connection between the length of receiving [medical cannabis] and reduction in daily opioid doses.” Earlier studies typically used survey data from patients themselves or were conducted on small sample size. According to the study, 1 in 5 adults experience chronic pain, and more than 22% of those have recently used prescription opioids for relief.
“These findings contribute robust evidence for clinicians regarding the potential benefits of [medical cannabis] in reducing the opioid burden for patients,” the authors write. More stringent criteria for prescribing the drugs have led to “discontinuation and lower commencement of opioid prescriptions,” they observe, which is encouraging given the crisis level of mortality caused by opioids.
Patients who have come to rely on opioids to manage their chronic pain may find themselves in a precarious position if they are suddenly cut off. Some people choose to buy drugs on the black market, where the risks, such as fentanyl poisoning, are far higher. According to the report, “many of them are at significant risk of overdose (by resorting to the illegal market) and of suicide without humane tapering of opioids and appropriate alternatives for patients receiving long-term opioid therapy.”
There is a significant financial gradient in medical care, according to the study’s authors, who cite statistics demonstrating that Medicaid enrollees are more likely to be prescribed opioids and undergo long-term opioid therapy than privately insured individuals. Medicaid coverage was low among the research population, and many individuals who started using cannabis for medical purposes eventually stopped.
The main reason for this is that “[medical cannabis] is not covered by insurance and is therefore prohibitively expensive.” New York’s Office of Cannabis Management co-author Nicole Quackenbush accepted patients’ longstanding claims that cannabis aids in effective pain management. She said, “Since the beginning of the Medical Cannabis Program in New York State.
we’ve heard anecdotal evidence from patients, caregivers, and healthcare providers suggesting that medical cannabis can reduce the amount of opioids patients take to manage pain, and now we have the study demonstrating a statistically and clinically significant reduction for those patients who were on medical cannabis for a longer duration.”
Supporters of marijuana legalization hailed the latest study as further proof that the drug is effective in relieving pain, often more so and with fewer side effects than conventional painkillers. NORML said in a blog post that this study’s results are “consistent with multiple other studies indicating that patients commonly use cannabis for pain mitigation and that many patients either reduce or discontinue usage of opioids and other drugs following cannabis therapy.”
Paul Armentano, the deputy director of NORML, has remarked that the link between marijuana and opioid abuse is one of the most well-documented parts of marijuana policy. The research concludes that medical marijuana is an acceptable alternative to opioid painkillers and that patients who have access to it are less likely to use these drugs overall.
Some people use cannabis as an alternative to conventional prescription treatments including opioid-based painkillers and sleep pills, as has been suggested by numerous anecdotal stories, data-based research, and observational analyses. The current study adds to the expanding amount of literature looking into the potential of cannabis as a treatment for chronic pain, and more specifically as an alternative to opioids.
A similar analysis published last month also linked state-level legalization of cannabis for adult use to “reductions in opiate demand.” Using information from the Drug Enforcement Administration’s (DEA) surveillance of prescription opioid shipments, the study reported a “26% reduction in retail pharmacy-based codeine distribution” in legal states.
The American Medical Association (AMA) published a study showing that about one-third of people with chronic pain utilize marijuana as a therapy option, with the vast majority of those people substituting cannabis for other pain drugs, including opioids. A separate AMA study found that among specific cancer patients, opioid prescriptions and consumption significantly decreased when medicinal marijuana was legalized at the state level.
In September, researchers discovered that patients may safely reduce or quit using opioid medicines if they had legal access to medical cannabis. Another study published in the same month indicated that when states legalize marijuana, the pharmaceutical business suffers significant economic losses, on average losing approximately $10 billion in market value following each legalization event.
Legalizing marijuana for adults is linked to “substantial reductions” in the usage of prescription medications for the treatment of different diseases, according to a study published last year that studied Medicaid data on prescription drugs.
