Researchers are calling for formal clinical trials into the efficacy of marijuana for treating opioid use disorder after a newly published study found that cannabis may ease many common symptoms of opioid withdrawal.
The study, conducted by researchers at the Johns Hopkins University School of Medicine and published in the forthcoming issue of the Journal of Substance Abuse Treatment, asked 200 people with past-month opioid and marijuana use whether their symptoms of opioid withdrawal improved or worsened when they consumed cannabis.
Of the 125 respondents who used marijuana to treat their withdrawal, nearly three-quarters (72 percent) said it eased their symptoms, while only 6.4 percent said it made them worse. Another 20 percent reported mixed results, and three people (2.4 percent) said cannabis didn’t seem to have an obvious effect either way.
“These results show that cannabis may improve opioid withdrawal symptoms and that the size of the effect is clinically meaningful.”
At least four states already include opioid use disorder (OUD) as a qualifying condition for medical marijuana, but critics have complained that there’s little evidence to support that policy. In the introduction to their new paper, the researchers acknowledge that “these approvals are concerning because of the limited and conflicting evidence suggesting cannabis can both improve and worsen opioid withdrawal and treatment retention.”
The results of their new study, however, suggest that cannabis is doing far more to ease opioid withdrawal symptoms than to make them worse. Of 18 common symptoms the researchers examined, participants on average said that cannabis helped ease every single one.
“Across all symptoms, more participants indicated that symptoms improved with cannabis compared to those that indicated symptoms worsened with cannabis,” the study found. “Ratios reflecting the participants who experienced improved versus worsened symptoms indicated that more individuals found cannabis to improve rather than worsen all evaluated symptoms.”
“Anxiety is the most common opioid withdrawal symptom improved with cannabis.”
The most frequently reported improved symptoms were anxiety (76.2 percent of respondents), tremors (54.1 percent), trouble sleeping (48.4 percent), bone and muscle aches (45.9 percent), restlessness (45.1 percent), nausea (38.5 percent) and opioid cravings (37.7 percent).
The most common symptoms reportedly made worse were yawning (7.4 percent), runny nose (6.6 percent), teary eyes (6.6 percent), restlessness (5.7 percent), vomiting (5.7 percent) and hot flashes (5.7 percent).
Women reported a significantly greater degree of symptom relief from marijuana than did men.
“On average, withdrawal severity scores nearly doubled on days cannabis was not used,” the study found. The results also inducted that people with “greater cannabis and opioid use experience greater reductions in opioid withdrawal when using cannabis.”
Participants were recruited using the Amazon Mechanical Turk (AMT) platform, a task-based crowdsourcing market.
“One limitation of this study,” the researchers acknowledged, “is that it was conducted using a crowdsourcing platform and, therefore, in-person validation of substance use was not possible.” Nevertheless, they noted that “studies have validated the use of AMT for substance use–related research by comparing MTurk data with data collected in in-person laboratory settings.”
Another limitation of the study is the subjectivity of the self-reported “Subjective Opiate Withdrawal Scale” (SOWS), which asks participants to evaluate the severity of their symptoms on a rubric, from 0 (not at all) to 4 (extremely severe).
“The SOWS has not been specifically evaluated for use as a retrospective measure,” the Johns Hopkins researchers wrote. “However, given the paucity of the data on this topic, the approach provided a feasible way to identify whether specific withdrawal symptoms may be differentially affected by cannabis use and the perceived magnitude of the effect of cannabis use on symptom severity.” Together, those variables “can be used to support prospective evaluation of this topic.”
The researchers don’t quite conclude that cannabis is beneficial for people going through opioid withdrawal, but they acknowledge that their data points to the need for further, more rigorous studies.
“These data suggest that the co-users of opioids and cannabis endorse cannabis as a method for reducing opioid withdrawal therapy,” the study says. “Given the shifting legal landscape, prospectively designed clinical trials that assess whether cannabis or its components can effectively treat opioid withdrawal are warranted.”
Though the matter is far from settled science, a number of other studies in recent years have suggested that cannabis may help reduce opioid use or dependency. Among them, a study published in December found that states with legal marijuana saw decreases in opioid prescriptions. A separate study from November of last year concluded that everyday cannabis use reduced opioid consumption among chronic pain patients.
The federal government is urging researchers to further investigate the role of cannabinoids in providing safer painkilling alternatives to opioids by making funding available for such studies.
Photo courtesy of Carlos Gracia.