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Marijuana Seems To Reduce Opioid Use Among Chronic Pain Patients, Meta-Study Finds

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Legalization advocates have long argued that marijuana represents a potentially effective treatment option for chronic pain and could serve as an alternative to opioid-based painkillers—and according to a new scientific meta-analysis, they may be onto something.

Analyzing nine published studies on the subject, a team of graduate students at the University of Arizona’s College of Public Health found that patients reported a 64-75 percent reduction in opioid dosage when used in combination with medical cannabis.

“This review found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by [medical cannabis] users, compared to people with no additional use of [medical cannabis],” the authors wrote.

“There was 64%-75% reduction in opioid dosage for MC users, and complete stoppage of opioid use for chronic non-cancer pain by 32%- 59.3% of MC users, when compared to patients without additional use of MC.”

They noted, however, that design flaws and other limitations of the available research make it impossible to draw more detailed conclusions. Of nine available observational studies on the issue, the team wrote, many had “serious risk” of bias due to missing data or poor outcome measurement and the reliance on patient self-reports, while others failed to adequately describe their research methods or “had no clear study objectives.”

“Included cohort studies were assessed as having serious or critical risk of bias overall,” authors noted, underscoring “the need for caution in interpretation of findings.”

A preliminary version of the new meta-analysis—“Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: A systematic review”—was posted online late last month. It has not yet been peer reviewed or published in a scientific journal.

In addition to the big reduction in opioid dosage when combined with medical cannabis, the review found that 32-59 percent of patients with non-cancer chronic pain reported marijuana as a substitute for opioids.

“One study reported a slight decrease in mean hospital admissions in the past calendar year and decreased mean emergency department visits in the past calendar year for patients who received [medical cannabis] as an adjunct to opioids in the treatment of non-cancer chronic pain compared to those who did not receive [medical cannabis],” the study states.

Despite the shortcomings in data, the research team concluded that evidence is “somewhat promising” that cannabis may reduce opioid use among chronic pain patients, noting marijuana’s “recognized analgesic properties” and the generally positive findings of past studies.

“The nine available studies included in this review suggest that cannabis was effective as an adjunct to opioid in reducing the dosage of opioids in study participants,” they wrote. “However, the design of included studies provides a limited basis on which to make a rational, evidence-based recommendation.”

Among the biggest unknowns remaining, researchers said, is the appropriate dosage of medical cannabis, which in some studies varied between 1.5 milligrams and 2,000 milligrams. Another concern is side-effects: “None of the included studies discussed potential adverse effects of using (medical cannabis) as an adjunct to opioids,” the new paper noted.

To address the gaps in research, the University of Arizona authors called for more experimental research into using medical marijuana in conjunction with, or as a replacement for, opioids, noting the potential to help avoid thousands of opioid-related overdose deaths.

“As the U.S. grapples with the opioid abuse epidemic and searches for less addictive alternatives, experimental studies are urgently needed to assess the effects of cannabis on non-cancer chronic pain as well as its potential to reduce the need for opioids,” the authors wrote. “If cannabis is found to be effective in reducing non-cancer chronic pain, it could serve as a viable substitute for prescription opioids, thus mitigating the opioid epidemic.”

“The availability of, and access to, [medical cannabis] in states with [medical cannabis] laws implies that patients with non-cancer chronic pain who do not obtain relief with common medications might consider [a medical cannabis] prescription. Patient caregivers might suggest trialing [medical cannabis] to relieve pain or avoid the undesirable side effects of long-term opioid use, including dependence and addiction.”

Another study released earlier this month found that cannabis can mitigate symptoms of opioid withdrawal.

In December, researchers determined that states with legal marijuana access experience decreases in opioid prescriptions, and a separate study released the previous month showed that daily marijuana consumption is associated with reduced opioid consumption among chronic pain patients.

Cannabis May Ease Opioid Withdrawal Symptoms, Johns Hopkins Study Finds

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Ben Adlin is a Seattle-based writer and editor. He has covered cannabis as a journalist since 2011, most recently as a senior news editor for Leafly.

Politics

FDA Clears Researchers To Study MDMA Use By Therapists Being Trained In Psychedelic Medicine

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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.

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.

Nebraska Activists Relaunch Medical Marijuana Ballot Campaign After Legislative Filibuster Blocks Bill

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Science & Health

Frequent Marijuana Consumers Are Actually More Physically Active Than Non-Users, Study Finds, Smashing Stereotypes

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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.”

Minnesota Marijuana Legalization Bill Clears Another House Committee, For A Total Of Ten So Far

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Business

Legal Marijuana States See Reduced Workers’ Compensation Claims, New Study Finds

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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.

Starting A Business? Study Finds Marijuana May Help—And Hinder

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