A number of studies have shown that people dealing with chronic pain issues find themselves substituting medical marijuana for prescription painkillers. And according to new research out this week, they’re also using cannabis to replace opioids that weren’t prescribed by a doctor, such as heroin.
“We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among [people who use drugs, or PWUD] with chronic pain,” the authors write. “These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain.”
Patients who have under-treated or undiagnosed pain often turn to substances outside of their prescribed medications to help them manage. Because this population is at serious risk for opioid overdose, researchers at the University of British Columbia and McGill University in Canada, as well as the University of California, Los Angeles, set out to use individual-level data to understand whether marijuana serves as a potential substitute for these illicit substances.
For their analysis, which was published in PLOS Medicine, the study’s authors used information from two open prospective cohort studies of people who consume drugs in Vancouver, Canada, and included 1,152 individuals who reported feeling serious or persistent pain at some point between 2014 and 2017.
“We found that people who used cannabis every day had about 50% lower odds of using illicit opioids every day compared to cannabis non-users.”
Over the study period, 455 people reported using heroin or other illicit pharmaceuticals daily throughout at least one of the six-month follow-up periods in the cohort studies. Meanwhile, 410 said they used cannabis daily. At the time of their initial interview when chronic pain was first reported, 583 participants said they were using marijuana either daily or occasionally, while 269 said they were using non-medical opioids every day.
Using a statistical model, researchers found that “daily cannabis use was significantly and negatively associated with daily illicit opioid use.”
“In this longitudinal study examining patterns of past-6-month frequency of cannabis and illicit opioid use,” the paper states, “we found that the odds of daily illicit opioid use were lower (by about half) among those who reported daily cannabis use compared to those who reported no cannabis use. However, we observed no significant association between occasional cannabis use and daily opioid use, suggesting that there may be an intentional therapeutic element associated with frequent cannabis use.”
In fact, a significant number of participants said they used cannabis regularly to address pain (148), sleep (144), stress (127) and nausea/loss of appetite (123).
The findings support a long-held belief by legalization advocates: Increasing access to marijuana could help mitigate the opioid crisis. “In the context of the current opioid crisis and the recent rollout of a national regulatory framework for cannabis use in Canada, frequent use of cannabis among PWUD with pain may play an important role in preventing or substituting frequent illicit opioid use,” the study points out.
Is cannabis a silver bullet for pain management and harm reduction among people who are in pain and at high risk of overdose? Nope. Are opioids bad? No. Should we consider cannabis-based strategies as one of many tools to reduce harm? Yes.
— Stephanie Lake (@s_l_lake) November 19, 2019
Of course, it’s not as simple as it sounds. Underscoring the nuance of these complex issues, lead author Stephanie Lake, a PhD candidate at the University of British Columbia’s school of population and public health, tweeted on Tuesday: “Our study adds to the mix of findings about this ‘substitution’ effect. Formal clinical trials using cannabinoid-based therapies in the mgmt of pain, including among people who use drugs, are needed to further elucidate the effectiveness and feasibility of cannabis for pain.”
She continued: “Is cannabis a silver bullet for pain management and harm reduction among people who are in pain and at high risk of overdose? Nope. Are opioids bad? No. Should we consider cannabis-based strategies as one of many tools to reduce harm? Yes.”
Photo courtesy of Brian Shamblen.
FDA Clears Researchers To Study MDMA Use By Therapists Being Trained In Psychedelic Medicine
The Food and Drug Administration (FDA) has already authorized clinical trials into the therapeutic potential of MDMA for patients with post-traumatic stress disorders—but now it’s given the green light to a psychedelics research institute to expand its studies by administering the substance to certain therapists.
Volunteer therapists who are being trained to treat people with PTSD will be able to participate in the Phase 1 trials to gain personal experience with the treatment option. This is a complementary research project that comes as the Multidisciplinary Association for Psychedelic Studies (MAPS) is in the process of conducting Phase 3 trials involving people with the disorder.
The development comes months after Canadian regulators announced that certain therapists would be allowed to take psilocybin in order to gain a better understanding of the psychedelic when treating patients.
MAPS sought permission to proceed with the therapist-specific trials in 2019, but FDA placed them on a 20-month hold because of concerns about the merits, risks and credentials of investigators. MAPS appealed that hold, providing evidence about the study’s scientific value and ability of its staff, and FDA cleared them on Tuesday.
— MAPS (@MAPS) May 13, 2021
The organization “chose to dispute” FDA’s hold not just because of the impact it had on the planned studies, “but in an attempt to resolve an ongoing issue with the FDA regarding investigator qualifications across studies,” it said in a press release on Wednesday.
“While the term ‘dispute’ may seem adversarial, this process can actually strengthen the relationship and trust between us and our review Division and ensures the Division has support on this project from the [FDA] Office of Neuroscience,” MAPS Public Benefit Corporation (PBC) CEO Amy Emerson said. “This decision demonstrates how our strategic, data-driven strategy in challenging the FDA rulings can be successful.”
Now MAPS is able to launch the Phase 1 clinical trials into MDMA-assisted therapy for therapists.
It will be designed to “measure development of self-compassion, professional quality of life, and professional burnout among clinicians delivering the treatment to patients,” the association said.
Getting personal experience with the substance “is widely considered to be an important element in preparation and training to deliver psychedelic-assisted therapies.”
This will “support the goals of the MDMA Therapy Training Program to provide comprehensive training to future providers,” and it “builds capacity to deliver quality, accessible care to patients, pending approval of MDMA-assisted therapy as a legal prescription treatment,” MAPS PBC Director and Head of Training and Supervision Shannon Carlin said.
FDA first granted MAPS’s request for an emergency use authorization for MDMA in PTSD in 2017. The organization expects to complete its Phase 3 trails in 2022.
The scientific expansion move also comes as the psychedelics decriminalization movement continues to build in the U.S.
Frequent Marijuana Consumers Are Actually More Physically Active Than Non-Users, Study Finds, Smashing Stereotypes
In a stereotype-busting new study, researchers found that frequent marijuana consumers are actually more likely to be physically active compared to their non-using counterparts.
For decades, anti-cannabis propaganda has cast marijuana consumers as unmotivated couch potatoes. This government-funded ad is a perfect example:
But a study published in the Harm Reduction Journal on Thursday found the opposite to be true. A nationally representative analysis of accelerometer-measured sedentary behavior showed that people who frequently use marijuana—particularly those aged 40 and older—spend more time engaging in physical activity than non-users do.
“Our findings do not support the mainstream perception of cannabis users as living sedentary lifestyles,” the researchers concluded.
In general, they found that “there’s no significant differences between non-current cannabis users and light, moderate, or frequent cannabis users in minutes per day spent in [sedentary behavior].” The difference came down to the average minutes that each group spent in physical activity.
“After controlling for all covariates, frequent cannabis users engaged in significantly greater amounts of light [physical activity] and [moderate-to-vigorous physical activity] compared to non-current users,” the study states. “In the unadjusted model, moderate cannabis use predicted more minutes spent in [moderate-to-vigorous physical activity] compared to non-current use, but this association was not significant upon controlling for all covariates. Light cannabis users did not significantly differ from non-current users in time engaged in [physical activity.”
“The results suggest that frequent cannabis users engaged in more [physical activity] than non-current users, but spent similar amounts of time in [sedentary behavior],” the researchers said.
While the study indicated that light marijuana use is not associated with a statistically significant difference in time being physically active, those who infrequently use cannabis were more likely to self-report more moderate physical activity compared to non-users.
“In a national, population-based US sample, current cannabis use was significantly associated with accelerometer-measured [physical activity], such that frequent cannabis users engaged in greater minutes of light PA and [moderate-to-vigorous physical activity] compared to non-current users.”
The researchers also looked at the relationship between marijuana use, activity and age, finding that people over 40 who consumed cannabis moderately spent an average of 16 more minutes engaged in moderate physical activity each day than non-users.
To explain that trend, the study suggests that cannabis “is being used for exercise-induced pain recovery, since [physical activity] brings about pain and muscle soreness, and a decreased pain threshold and muscle hypersensitivity have been documented with increasing age.”
These findings “add to the cannabis and physical behavior literature by incorporating objective accelerometer measures,” the researchers concluded. “Further understanding of the association between cannabis use and health behaviors is essential to fully addressing the public health concerns associated with cannabis use.”
Legal Marijuana States See Reduced Workers’ Compensation Claims, New Study Finds
Legalizing marijuana for adult use is associated with an increase in workforce productivity and decrease in workplace injuries, according to a new study partly funded by the federal government.
In a working paper published by the National Bureau of Economic Research, researchers looked at the impact of recreational cannabis legalization on workers’ compensation claims among older adults. They found declines in such filings “both in terms of the propensity to receive benefits and benefit amount” in states that have enacted the policy change.
Further, they identified “complementary declines in non-traumatic workplace injury rates and the incidence of work-limiting disabilities” in legal states.
These findings run counter to arguments commonly made by prohibitionists, who have claimed that legalizing marijuana would lead to lower productivity and more occupational hazards and associated costs to businesses. In fact, the study indicates that regulating cannabis sales for adults is a workplace benefit by enabling older employees (40-62 years old) to access an alternative treatment option.
“We offer evidence that the primary driver of these reductions [in workers’ compensation] is an improvement in work capacity, likely due to access to an additional form of pain management therapy,” the study, which received funding from the National Institute on Drug Abuse, states.
The implementation of adult-use legalization seems to “improve access to an additional channel for managing pain and other health conditions, suggesting potential benefits on populations at risk of workplace injuries,” it continues.
The study is based on an analysis of data on workers’ compensation benefit receipt and workers’ compensation income from
2010 to 2018 as reported in the Annual Social and Economic Supplement of the Current Population Survey.
“Our results show a decline in workers’ compensation benefit propensity of 0.18 percentage points, which corresponds to a 20 percent reduction in any workers’ compensation income, after states legalize marijuana for recreational use. Similarly, we find that annual income received from workers’ compensation declines by $21.98 (or 20.5%) post-[recreational marijuana legalization]. These results are not driven by pre-existing trends, and falsification exercises suggest that observing estimates of this magnitude is statistically rare.”
Researchers said that they’ve found evidence that cannabis use increases post-legalization among the age cohort they studied, but no such spike in misuse. Further, they found a decline in post-legalization prescriptions for medications used to treat chronic pain, indicating that some people are using marijuana as a substitute for traditional painkillers.
“We hypothesize that access to marijuana through [recreational marijuana laws] increases its medical use and, in turn, allows better management of symptoms that impede work capacity—e.g., chronic pain, insomnia, mental health problems, nausea, and so forth,” the study says. “Chronic pain management is likely to be particularly important in our context as this is the health condition most commonly reported among medical marijuana users.”
Beyond decreasing workers’ compensation claims and costs, legalization also is a boon to the economy by adding jobs in legal states.
The cannabis industry added more than 77,000 jobs over the past year—a 32 percent increase that makes the sector the fastest in job creation compared to any other American industry, according to a report released by the cannabis company Leafly last week.