Pills to Pot: Observational Analyses of Cannabis Substitution Among Medical Cannabis Users With Chronic Pain

Analyses of Cannabis Substitution

Analyses of Cannabis Substitution

Abstract

Analyses of Cannabis Substitution, Chronic pain is common, costly, and challenging to treat. Many individuals with chronic pain have turned to cannabis as an alternative form of pain management. We report results from an ongoing, online survey of medical cannabis users with chronic pain nationwide about how cannabis affects pain management, health, and pain medication use.

We also examined whether and how these parameters were affected by concomitant recreational use, and duration of use (novice: <1 year vs experienced: ≥1 year). There were 1,321 participants (59% female, 54% ≥50 years old) who completed the survey. Consistent with other observational studies, approximately 80% reported substituting cannabis for traditional pain medications (53% for opioids, 22% for benzodiazepines), citing fewer side effects and better symptom management as their rationale for doing so.

Medical-only users were older (52 vs 47 years old; P < .0001), less likely to drink alcohol (66% vs 79%, P < .0001), and more likely to be currently taking opioids (21% vs 11%, P < .0001) than users with a combined recreational and medical history. Compared with novice users, experienced users were more likely to be male (64% vs 58%; P < .0001), take no concomitant pain medications (43% vs 30%), and report improved health (74% vs 67%; P = .004) with use.

Given that chronic pain is the most common reason for obtaining a medical cannabis license, these results highlight clinically important differences among the changing population of medical cannabis users. More research is needed to better understand effective pain management regimens for medical cannabis users.

Perspective: This article presents results that confirm previous clinical studies suggesting that cannabis may be an effective analgesic and potential opioid substitute. Participants reported improved pain, health, and fewer side effects as rationale for substituting. This article highlights how use duration and intentions for use affect reported treatment and substitution effects.

Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use

Impact Of Medical Marijuana Legalization

Impact Of Medical Marijuana Legalization

Abstract

Objective

Impact Of Medical Marijuana Legalization, To determine the association of medical marijuana legalization with prescription opioid utilization.

Methods

A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006–2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test.

Results

The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94–0.96), chronic opioid use: OR = 0.93 (0.91–0.95), and high-risk opioid use: OR = 0.96 (0.94–0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99–1.01) or antihypertensives (OR = 1.00; CI 0.99–1.01).

Conclusions

In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.

What does the ecological and epidemiological evidence indicate about the potential for cannabinoids to reduce opioid use and harms?

Evidence Cannabinoids Reduce Opioid Use

Evidence Cannabinoids Reduce Opioid Use

Abstract

Evidence Cannabinoids Reduce Opioid Use, Pre-clinical research supports that cannabinoids reduce opioid dose requirements, but few studies have tested this in humans. This review evaluates ecological and epidemiological studies that have been cited as evidence that medical cannabis use may reduce opioid use and opioid-related harms.

Medline and Embase were searched for relevant articles. Data were extracted on study setting, analyses approach, covariates, and outcomes. Eleven ecological and 14 epidemiological studies were found. In ecological studies, states that allow medical cannabis laws have reported a slower rate of increase in opioid overdose deaths compared with states without such laws. These differences have increased over time and persisted after controlling for state sociodemographic characteristics and use of prescription monitoring programmes.

Few studies have controlled for other potential confounders such as opioid dependence treatment and imprisonment rates. Some epidemiological studies provide evidence that cannabis availability may reduce opioid use, but are limited by selection bias, cross-sectional designs, and self-reported assessments of the opioid-sparing effects of cannabis. Some epidemiological and ecological studies suggest that cannabis may reduce opioid use and harms, although important methodological weaknesses were identified.

Well-designed clinical studies may provide more conclusive evidence on whether cannabinoids can reduce opioid use and related harm.

An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia

Cannabis Against Fibromyalgia Pain

Cannabis Against Fibromyalgia Pain

Abstract

Cannabis Against Fibromyalgia Pain, In this experimental randomized placebo-controlled 4-way crossover trial, we explored the analgesic effects of inhaled pharmaceutical-grade cannabis in 20 chronic pain patients with fibromyalgia.

We tested 4 different cannabis varieties with exact knowledge on their ∆9-tetrahydrocannabinol (THC) and cannabidiol (CBD) content: Bedrocan (22.4-mg THC, <1-mg CBD; Bedrocan International BV, Veendam, the Netherlands), Bediol (13.4-mg THC, 17.8-mg CBD; Bedrocan International BV, Veendam, the Netherlands), Bedrolite (18.4-mg CBD, <1-mg THC; Bedrocan International BV, Veendam, the Netherlands), and a placebo variety without any THC or CBD.

After a single vapor inhalation, THC and CBD plasma concentrations, pressure and electrical pain thresholds, spontaneous pain scores, and drug high were measured for 3 hours. None of the treatments had an effect greater than placebo on spontaneous or electrical pain responses, although more subjects receiving Bediol displayed a 30% decrease in pain scores compared to placebo (90% vs 55% of patients, P = 0.01), with spontaneous pain scores correlating with the magnitude of drug high (ρ = −0.5, P < 0.001). 

Cannabis varieties containing THC caused a significant increase in pressure pain threshold relative to placebo (P < 0.01). Cannabidiol inhalation increased THC plasma concentrations but diminished THC-induced analgesic effects, indicative of synergistic pharmacokinetic but antagonistic pharmacodynamic interactions of THC and CBD. This experimental trial shows the complex behavior of inhaled cannabinoids in chronic pain patients with just small analgesic responses after a single inhalation.

Further studies are needed to determine long-term treatment effects on spontaneous pain scores, THC–CBD interactions, and the role of psychotropic symptoms on pain relief.

This experimental highly controlled trial in 20 patients with fibromyalgia shows that the cannabinoid THC, but not CBD, is effective in the treatment of fibromyalgia pain.

Impact of recreational and medicinal marijuana on surgical patients: A review

Recreational And Medicinal Marijuana Impact

Recreational And Medicinal Marijuana Impact

Abstract

Background

Recreational And Medicinal Marijuana Impact, As medicinal and recreational marijuana use broadens across the United States, knowledge of its effects on the body will become increasingly important to all health care providers, including surgeons.

Data sources

We performed a literature review of Pubmed for articles discussing the basic science related to cannabinoids, as well as articles regarding cannabinoid medications, and cannabis use in surgical patients.

Conclusions

The primary components in the cannabis plant, tetrahydrocannabinol (THC) and cannabidiol (CBD), have been made available in numerous forms and formulations to treat multiple medical conditions, and recreational access to marijuana is increasing. Of particular importance to the surgeon may be their effects on prolonging intestinal motility, decreasing inflammation, increasing hunger, mitigating pain, and reducing nausea and vomiting. Perioperative use of medicinal or recreational marijuana will become increasingly prevalent, and the surgeon should be aware of the positive and negative effects of these cannabinoids.

Pressure-Based Pain Tolerance and Cannabis: A Neuropsychological Assessment of Pain Processing in Recreational Cannabis Users

Pain Processing In Recreational Cannabis Users

Pain Processing In Recreational Cannabis Users

Abstract

Pain Processing In Recreational Cannabis Users, Chronic pain, including pain associated with medical diagnoses, is an ever-growing concern in the United States. Pain-related healthcare costs, lost labor, and medication overdoses cost Americans more $600 billion every year. From a pharmaco-therapy perspective, cannabis represents a promising pain treatment option. Although acute cannabis administration has been associated with anti-pain effects across pain populations, whether such effects endure remains unclear.

Characterizing therapeutic windows is one important step towards providing enhanced understanding about if/how cannabis may be used to treat pain. Here, I used an MR-compatible pressure-based pain apparatus to examine mean pain ratings and mean maximum pain tolerance among recreational cannabis users and age- and sex-matched non-users. I found that mean pain ratings were lower among recreational cannabis users than among non-users.

Moreover, I found that mean maximum pain tolerance was greater among recreational cannabis users than among non-users. Furthermore, comparing accuracy and reaction times during a color/word interference task (i.e., “Stroop” task) revealed no differences between users and non-users. Enhanced understanding about cannabinoid-induced pain modulations is important for informed decision-making regarding therapeutic potential.

Recreational marijuana legalization and prescription opioids received by Medicaid enrollees

Marijuana Reduces Opioid Harm

Marijuana Reduces Opioid Harm

Abstract

Objectives

Marijuana Reduces Opioid Harm, Medical marijuana use may substitute prescription opioid use, whereas non medical marijuana use may be a risk factor of prescription opioid misuse. This study examined the associations between recreational marijuana legalization and prescription opioids received by Medicaid enrollees.

Methods

State-level quarterly prescription drug utilization records for Medicaid enrollees during 2010–2017 were obtained from Medicaid State Drug Utilization Data. The primary outcome, opioid prescriptions received, was measured in three population-adjusted variables: number of opioid prescriptions, total doses of opioid prescriptions in morphine milligram equivalents, and related Medicaid spending, per quarter per 100 enrollees. Two difference-in-difference models were used to test the associations: eight states and DC that legalized recreational marijuana during the study period were first compared among themselves, then compared to six states with medical marijuana legalized before the study period. Schedule II and III opioids were analyzed separately.

Results

In models comparing eight states and DC, legalization was not associated with Schedule II opioid outcomes; having recreational marijuana legalization effective in 2015 was associated with reductions in number of prescriptions, total doses, and spending of Schedule III opioids by 32% (95% CI: (−49%, −15%), p = 0.003), 30% ((−55%, −4.4%), p = 0.027), and 31% ((−59%, −3.6%), p = 0.031), respectively. In models comparing eight states and DC to six states with medical marijuana legalization, recreational marijuana legalization was not associated with any opioid outcome.

Conclusions

No evidence suggested that recreational marijuana legalization increased prescription opioids received by Medicaid enrollees. There was some evidence in some states for reduced Schedule III opioids following the legalization.

The Effect of Medical Cannabis Dispensaries on Opioid and Heroin Overdose Mortality

Effect Of Cannabis Dispensaries On Overdose

Effect Of Cannabis Dispensaries On Overdose

Abstract

Opioid overdose is the most common cause of accidental death in the United States and no policy response has been able to contain this epidemic to date. We examine whether local access to medical cannabis can reduce opioid-related mortality. Using a unique data set of medical cannabis dispensaries combined with county-level mortality data, we estimate the effect of dispensaries operating in a county on the number of overdose deaths. We find that counties with dispensaries experience 6% to 8% fewer opioid-related deaths among non-Hispanic white men. Mortality involving heroin declines by approximately 10% following the opening of a dispensary.

Survey shows decrease in opioid usage, increase in marijuana use

Decrease In Opioid Increase In Marijuana Use

Decrease In Opioid Increase In Marijuana Use

Abstract

Decrease In Opioid Increase In Marijuana Use, Opioid usage was down in 2017 compared to prior years, but usage of marijuana — particularly among Americans aged 18 to 25 — had increased in 2017 over prior years, according to a study from the National Survey on Drug Use and Health. In 2017, approximately 11.4 million people misused opioids, with nearly 60 percent indicating that the main reason they misused opioids was to combat physical pain. That number represents half as many Americans trying opioids in 2017 as they did in 2016.

New York State Department of Health Announces Opioid Replacement Now a Qualifying Condition for Medical Marijuana

Medical Marijuana Now Opioid Replacement

Medical Marijuana Now Opioid Replacement

Medical Marijuana Now Opioid Replacement, ALBANY, NY (July 12, 2018) – The New York State Department of Health today announced the filing of emergency regulations adding any condition for which an opioid could be prescribed as a qualifying condition for medical marijuana.

Effective immediately, registered practitioners may certify patients to use medical marijuana as a replacement for opioids, provided that the precise underlying condition for which an opioid would otherwise be prescribed is stated on the patient’s certification. This allows patients with severe pain that doesn’t meet the definition of chronic pain to use medical marijuana as a replacement for opioids.

In addition, the regulation adds opioid use disorder as an associated condition. This allows patients with opioid use disorder who are enrolled in a certified treatment program to use medical marijuana as an opioid replacement.

Plans to add opioid replacement as a qualifying condition for medical marijuana were first announced last month.

“Medical marijuana has been shown to be an effective treatment for pain that may also reduce the chance of opioid dependence,” said New York State Health Commissioner Dr. Howard Zucker. “Adding opioid replacement as a qualifying condition for medical marijuana offers providers another treatment option, which is a critical step in combatting the deadly opioid epidemic affecting people across the state.”

Opioid replacement joins the following 12 qualifying conditions under the state’s Medical Marijuana Program: cancer; HIV infection or AIDS; amyotrophic lateral sclerosis (ALS); Parkinson’s disease; multiple sclerosis; spinal cord injury with spasticity; epilepsy; inflammatory bowel disease; neuropathy; Huntington’s disease; post-traumatic stress disorder; and chronic pain.

These emergency regulations went into effect on a temporary basis on July 12, 2018. The Department also filed a Notice of Proposed Rulemaking on July 12, 2018, commencing the process of permanently adopting the regulations. The permanent regulations will be published in the New York State Register on August 1, 2018, and will be subject to a 60-day public comment period.

In addition, within the next week, certified patients and designated caregivers will be able to print temporary registry ID cards. This will allow them to purchase medical marijuana products more quickly after registering for the program. Patients may use the temporary registry ID card in conjunction with a government issued photo identification to purchase medical marijuana products from a registered organization’s dispensing facility. Prior to this enhancement to the Medical Marijuana Data Management System, it could take 7 to 10 days for patients and their caregivers to receive their registry identification cards after their registration was approved.

Other recent enhancements to New York’s Medical Marijuana Program include adopting new regulations to improve the program for patients, practitioners and registered organizations; authorizing five additional registered organizations to manufacture and dispense medical marijuana; adding chronic pain and PTSD as qualifying conditions; permitting home delivery; and empowering nurse practitioners and physician assistants to certify patients.

As of July 10, 2018, there are 62,256 certified patients and 1,735 registered practitioners participating in the program.

For more information on New York’s Medical Marijuana Program, visit: https://www.health.ny.gov/regulations/medical_marijuana/.