Marijuana to Reduce Opioid Usage

[Aether2000]

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PLoS One. 2017 Nov 16;12(11):e0187795. doi: 10.1371/journal.pone.0187795. eCollection 2017.
Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study.
Vigil JM1, Stith SS2, Adams IM3, Reeve AP3.
Author information

Abstract
BACKGROUND:
Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.

PURPOSE:
A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.

METHODS:
Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioidprescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.

RESULTS:
By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).

CONCLUSIONS:
The clinically and statistically significant evidence of an association between MCP enrollment and opioidprescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.

 

[willabeast]

Seems reasonable although big pharma will attack anything that affects their bottom line, as this will. As a result, most studies in the future will be funded by pharma and be slanted accordingly negative.

 

[Ducttape]

interesting article, but...

historical.
cohort.
not blinded.
a survey...

how much of the opioid reduction was driven by the patient and how much was driven by the prescribers who did not want to risk their license?

(for example, in my patient population, there is roughly a 1000:1 likelihood of opioid cessation if someone decides to use medical marijuana - the 1 being the rare patient with a palliative cancer diagnosis)

 

[lobelsteve]

Hmm. Instead of opiate rotation, this is addiction substitution to a safer drug. Again, the person and not the drug.

 

[Aether2000]

True- low level medical evidence, but under the rules of EBM, it is valid since there are no higher level studies of which I am aware that contradict this study. EBM is employing the highest level of evidence available in order to make medical decisions. Certainly we need better studies to confirm or refute the assertions, but the very high odds of successfully eliminating opioids in this study is worth consideration or at least further evaluation.

 

[DrCommonSense]

Hmm. Instead of opiate rotation, this is addiction substitution to a safer drug. Again, the person and not the drug.

Most patients with opioid issues that I encounter will also test positive for THC on their UDS screens. Yet somehow they still want narcotics despite taking THC.

Maybe the "medical" variety will be superior but I somehow doubt it.

 

[Blitz2006]

Thats hilarious. Just today in the print issue of American Journal of Psychiatry (January Issue), this study was published:

Marijuana use is associated with an increased risk of prescription opioid misuse and use disorders

"New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. "

EDIT: I found the E-Publication:

https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.17040413

 

[Aether2000]

The plot thickens!! 🙂

 

[hyperalgesia]

Thats hilarious. Just today in the print issue of American Journal of Psychiatry (January Issue), this study was published:

Marijuana use is associated with an increased risk of prescription opioid misuse and use disorders

"New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. "

This report seems to confirm the obvious and previously known ASSOCIATION between illegal MJ use and illegal other drug use. There is nothing that suggests MJ use CAUSES other drug use. I think the conclusion is a bit misleading.

OPs study OTOH suggests the introduction of MJ changed the trajectory of (decreases) opioid use.

 

[Blitz2006]

This report seems to confirm the obvious and previously known ASSOCIATION between illegal MJ use and illegal other drug use. There is nothing that suggests MJ use CAUSES other drug use. I think the conclusion is a bit misleading.

OPs study OTOH suggests the introduction of MJ changed the trajectory of (decreases) opioid use.

Straight from the results section:

"cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23–7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95–12.16) at wave 2."

 

[hyperalgesia]

Straight from the results section:

"cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23–7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95–12.16) at wave 2."

Still no causal relationship suggested here. People who use MJ are more likely to be the same people who abuse opioids. This does not mean the MJ caused them to abuse opioids. The MJ may have had a deterrent effect. Maybe if MJ had not been available to these same people, the incident nonmedical prescription opioid use would have increased by twice as much as it did with MJ. You can't tell from this study without an RCT what effect, if any the MJ had on these people.

 

[Blitz2006]

Still no causal relationship suggested here. People who use MJ are more likely to be the same people who abuse opioids. This does not mean the MJ caused them to abuse opioids. The MJ may have had a deterrent effect. Maybe if MJ had not been available to these same people, the incident nonmedical prescription opioid use would have increased by twice as much as it did with MJ. You can't tell from this study without an RCT what effect, if any the MJ had on these people.

I know...thats why I posted the direct quote. It clearly says "associated"....

The point of this study is too show there is strong association between cannabis and non-prescription opioid use. While maybe not as impressive as showing "causal", I still will take this into consideration with regards to medical marijuana prescribing..

 

[lobelsteve]

The plot thickens!! 🙂

The pot thickens.

 

[drusso]

Thats hilarious. Just today in the print issue of American Journal of Psychiatry (January Issue), this study was published:

Marijuana use is associated with an increased risk of prescription opioid misuse and use disorders

"New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. "

EDIT: I found the E-Publication:

https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.17040413

This is why you can't depend upon population data for decision-making within the doctor-patient relationship. Every patient/circumstance is unique.

"A number of recent papers suggest that marijuana may reduce prescription opioid addiction and overdoses by providing an alternate or complementary pain relief option. That suggestion is partly based on comparisons of aggregate data from states that legalized marijuana for medical use vs. those that didn’t. In contrast, the current study focuses on individual marijuana users vs. nonusers and their trajectories with regard to opioid misuse and disorders. These findings are in-line with previous research demonstrating that people who use marijuana are more likely than non-users to use other drugs and develop problems with drug use."

 

[DrCommonSense]

Thats hilarious. Just today in the print issue of American Journal of Psychiatry (January Issue), this study was published:

Marijuana use is associated with an increased risk of prescription opioid misuse and use disorders

"New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. "

EDIT: I found the E-Publication:

https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2017.17040413

Definitely makes sense.

Drug addicts rarely just abuse opioids in isolation.

 

[DrCommonSense]

I know...thats why I posted the direct quote. It clearly says "associated"....

The point of this study is too show there is strong association between cannabis and non-prescription opioid use. While maybe not as impressive as showing "causal", I still will take this into consideration with regards to medical marijuana prescribing..

Nah the hippies tell me that moo shoo medicine and smoking weed all day will "fix" this "opiate crisis".

This cant be true!