People who shop at recreational marijuana dispensaries aren’t just using cannabis to have a good time. In fact, a new study reports that many adult-use customers consume marijuana for the same reasons medical cannabis patients do: to help with pain and sleep.
A growing body of research has shown the health benefits of legal medical marijuana access, including an association with lower use of opioids. The problem with these laws, however, is that they usually require a physician’s recommendation and/or registration with the state’s medical cannabis program in order to get access. That means many people who live in states where medical marijuana is legal and face barriers to health care are still unable to access cannabis to help alleviate their symptoms.
New research published in the Journal of Psychoactive Drugs this week, however, shows some people in areas where broader adult-use legalization is in effect are side-stepping these requirements to get the relief they need from cannabis retail shops.
“In a survey of adult use customers,” the study states, “we found that the majority reported taking cannabis to relieve pain or to promote sleep. In addition, most respondents taking cannabis for pain or sleep reported substituting cannabis for prescription or over-the-counter analgesics or sleep aids.”
Researchers surveyed 1,000 people who shopped at two Colorado dispensaries and were not certified to access marijuana for medical purposes. The study’s goal was to get a better understanding of how these customers use cannabis to treat their symptoms as a substitute for prescription and over-the-counter medications (OTC).
In addition to gathering sociodemographic information, researchers asked participants about their health status, how cannabis had changed their use of OTC and prescription drugs and if and how cannabis impacted their pain and sleep.
The majority of respondents said they used marijuana to relieve pain (65 percent) and help them sleep (74 percent).
“Among respondents taking over-the-counter pain medications, 82% reported reducing or stopping use of those medications,” the study states. “Among respondents taking opioid analgesics, 88% reported reducing or stopping use of those medications.” Additionally, more than 80 percent of participants who had taken sleep aids, including those obtained with a prescription, also said they reduced or stopped using those medications altogether.
“[T]he majority reported that cannabis decreased their medication use. Adult use cannabis laws may broaden access to cannabis for the purpose of symptom relief.”
“Our findings suggest that de facto medical use may be highly prevalent among adult use customers, and that access to an adult use cannabis market may influence individuals’ use of other medications,” the study’s authors wrote. Despite the fact that adult-use laws are often called “recreational,” the findings suggest that many customers are more interested in consuming cannabis for its therapeutic benefits.
NORML Deputy Director Paul Armentano said he wasn’t surprised by the results.
“Several prior studies similarly show that the use of cannabis by qualified patients is associated with the reduction, or even the elimination, of certain other prescription drugs — specifically opioids — over time,” he said. “These findings speak not only to the therapeutic efficacy of cannabis as an alternative analgesic option, but also to its potential role as a harm reduction agent.”
In a statement, Dr. Gwen Wurm, an assistant professor of clinical pediatrics at the University of Miami Miller School of Medicine and study co-author, explained the significance of the findings: “Approximately 20% of American adults suffer from chronic pain, and one in three adults do not get enough sleep. In states where adult use of cannabis is legal, our research suggests that many individuals bypass the medical cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary.”
She cautioned, however, that more research is needed to understand the benefits and side effects of cannabis, as well as the ramifications of substituting cannabis for pharmaceuticals.
“The challenge is that health providers are far behind in knowing which cannabis products work and which do not,” Wurm said. “Until there is more research into which cannabis products work for which symptoms, patients will do their own ‘trial and error,’ experiments, getting advice from friends, social media and dispensary employees.”
Photo courtesy of Ndispensable.
Hemp-Derived CBD Helps Chronic Pain Patients Reduce Opioid Use, Study Finds
Chronic pain patients consuming hemp-derived cannabidiol, or CBD, on a daily basis for eight weeks reported a decrease in the opioid medications they needed, a new study reports.
“This is a prospective, single-arm cohort study for the potential role of cannabinoids as an alternative for opioids,” the paper states. “The results indicate that using the CBD-rich extract enabled our patients to reduce or eliminate opioids with significant improvement in their quality of life indices.”
The study, published this month in Postgraduate Medicine, sheds new light on the potential benefits of CBD extracted from hemp, a crop that became federally legal under the 2018 Farm Bill, although the Food and Drug Administration has yet to issue finalized guidelines that would allow CBD to be sold in dietary supplements and food products.
Researchers recruited 131 patients who obtain their care from the same pain clinic; 97 completed the eight-week follow-up period. All had been diagnosed with chronic pain and were taking opioid medications for relief.
For the study, participants were given a 60-count bottle of hemp-derived, CBD-rich soft gels. Each gel, according to the study, contained 15.7 mg CBD, 0.5 mg THC, 0.3 mg cannabidivarin, 0.9 mg cannabidiolic acid, 0.8 mg cannabichrome, and less than 1 percent of a botanical terpene blend. Nearly all (91) took two gel caps a day, totaling 30 mg of CBD; three participants opted not to use the hemp extract at all.
“CBD could significantly reduce opioid use and improve chronic pain and sleep quality among patients who are currently using opioids for pain management.”
Researchers asked participants to complete a series of questionnaires to access various factors at the onset of the study, at the four-week mark and at the eight-week point. Among them: their pain intensity level, how much their pain disrupted their lives, the quality of their sleep and how willing they were to cut back on opioids.
Of the total 94 participants who took CBD regularly, 50 reported they were able to reduce opioid medications at week 8. The authors also note: “Additional reductions in polypharmacy on the medication receipt were noted; six participants reported reducing or eliminating their anxiety medications, and four participants reported reducing or eliminating their sleep medication.”
Overall, 89 participants reported their quality of life had improved over the study period. Two measures changed significantly: patients’ self-rating of sleep quality and pain intensity and interference.
At baseline, the study’s authors calculated respondents’ scores regarding sleep quality to an average of 12.09—the higher the score, the poorer the quality of sleep. At the four-week and eight-week check-in points, the score decreased to 10.7 and 10.3, respectively. Similarly, another scale the authors used to measure pain and how it interferes with the enjoyment of life found the mean score value change from 6.5 at baseline to 5.9 at week 4 and 5.7 at week 8.
“The results of this study suggest that using CBD-rich hemp extract oil may help reduce opioid use and improve quality of life, specifically in regards to pain and sleep, among chronic pain patients,” the study concludes. “This is consistent with emerging literature on the topic, which has concluded that CBD is an effective analgesic, and one that helps reduce barriers to opioid reduction, such as physiological withdrawal symptoms.”
In an interview with Appalachian News Express, the study’s lead author Alex Capano said that outside of survey studies, her research is “the largest study on the use of CBD to reduce the use of opioids in the treatment of chronic pain.”
“It’s also the first study on CBD and opioid reduction to identify key data points, such as hemp extract doses, delivery method, and specific cannabinoid content,” she continued. “Most participants used a relatively low dose of 30mg of CBD per day, whereas other studies on CBD have tested very large doses, 10x or 20x that amount. Lower doses of CBD mean reduced risk of side effects and improved outcomes.”
Problematic Marijuana Use Is Declining Among People Who Consume Every Day, Study Finds
Contrary to the expectations of public health experts, the rate of frequent marijuana consumers who are diagnosed with cannabis use disorder (CUD) is not increasing, a new study reports. In fact, it’s actually decreasing, and that may be due to the growing number of states that have legalized access to marijuana.
According to the paper, “CUD prevalence decreased significantly across all ages reporting daily/almost daily cannabis use between 2002-2016. Cannabis dependence prevalence decreased for adolescents and young adults and was stable only among adults ages 26+ reporting daily/almost daily cannabis use.”
Recent studies have had mixed results on the prevalence of CUD—a diagnosis that includes either misuse and/or dependence—in the last two decades. Because people who consume marijuana every day or almost every day are the most at risk for problematic use, researchers at Columbia University’s Mailman School of Public Health set out to get a better understanding of this group’s general health.
Their findings were published last month in the journal Drug and Alcohol Dependence.
The study’s authors used data from the National Surveys on Drug Use and Health for the years 2002-2016. The final sample, totaling 22,651 people, included participants who were 12 and older and reported using marijuana at least 300 days in the past year.
To measure problematic marijuana use, the authors used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for cannabis dependence and cannabis abuse, such as:
- Spent a great deal of time over a period of a month obtaining, using, or getting over the effects of marijuana
- Unable to keep set limits
- Unable to cut down cannabis use
- Recurrent use resulting in failure to fulfill major role obligations
- Continued use despite persistent or recurrent social or interpersonal problems
Other factors considered in the research asked whether participants had a perceived need for mental health treatment, whether a doctor had indicated they had other health issues and whether or not they’d driven under the influence of illegal drugs with and without alcohol.
Over the study period, the authors found that the prevalence of CUD decreased among their sample in all age groups: For adolescents ages 12 to 17, the rate fell by 26.8 percent; for 18- to 25-year-olds, by 29.7 percent; and for adults 26 and older, by 37.5 percent.
“Among those with past-year daily/almost daily cannabis use, there were reductions in the prevalence of DSM-IV cannabis abuse across all age groups, with reductions observed for all individual abuse items in adolescents and young adults,” the study states. “There were also reductions in the prevalence of DSM-IV cannabis dependence among adolescents and young adults, but not in adults ages 26+. Reductions in most DSM-IV dependence items were observed in young adults while reductions in only a few dependence items were found for adolescents and older adults.”
Researchers offer several possible explanations for the declining rates, many of which point to the influence of legalization. “First, the new national cannabis policy environment, with 33 states legalizing medical use and 10 states allowing recreational use of cannabis may have played a role in reducing stigma and perceptions of risk associated with cannabis use,” Silvia Martins, one of the study’s authors, said in a statement. “Secondly, increasing legalization may also be associated with changes in social attitudes resulting in fewer conflicts with relatives and friends around cannabis use.”
As a result, according to the paper, “[t]his could explain reductions in the abuse item ‘Continued use despite persistent or recurrent social or interpersonal problems,’ which reflects difficulties in interactions with others due to cannabis use.”
It’s also possible that “a sector of the population that is healthier overall” is starting to use marijuana more because of legal access, which “may have diluted the prevalence of cannabis abuse/dependence over time.” They may use “less potent” cannabis or in lower daily amounts, researchers note. Additionally, more people may feel less afraid to admit on a federal survey that they use marijuana frequently.
Ultimately, Martins said, the study’s results “contradict the predominating hypothesis that the prevalence of DSM-IV CUD would be stable, or increase, among those using with this regularity.”
Photo courtesy of Sharon McCutcheon on Unsplash
Marijuana Use Tied To Lower Rates Of Depression And Suicidal Ideation Among PTSD Patients
People suffering from post-traumatic stress disorder (PTSD) who consume marijuana experience significantly fewer depressive episodes and lower rates of suicidal ideation compared to non-users, according to a new study.
The research, published in the Journal of Psychopharmacology on Tuesday, analyzed nationally representative health data from Statistics Canada’s 2012 Community Health Survey and found that people with PTSD who have not reported past-year marijuana use are much more likely to have suicidal thoughts and go through depressive phases.
“This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states.”
Among the more than 24,000 people who were eligible for the study, with was conducted by researchers at the the British Columbia Centre on Substance Use and University of British Columbia, 420 were clinically diagnosed with PTSD. Of those, 106 individuals with PTSD (28.2 percent) said they used cannabis in the past year. That’s markedly higher than the average of those who don’t have PTSD (11.2 percent).
“We know that with limited treatment options for PTSD, many patients have taken to medicating with cannabis to alleviate their symptoms,” Stephanie Lake, lead author of the study, said in a press release. “However, this is the first time that results from a nationally representative survey have shown the potential benefits of treating the disorder with cannabis.”
Those suffering from PTSD who didn’t report past-year cannabis use were about seven times as likely to have experienced a recent major depressive episode, the study found. They were also 4.3 times as likely to have contemplated suicide.
“Among cannabis-using respondents, PTSD was not associated with a recent depressive episode or suicide ideation.”
While the study only looked at Canadian respondents, the findings are relevant to U.S. patients as well, as members of the military stateside also experience higher rates of PTSD compared to the general population.
A former secretary of the U.S. Department of Veterans Affairs (VA), David Shulkin, has said recently that he’s in favor of having the department conduct clinical research into the therapeutic benefits of marijuana for veterans with PTSD, stating that the suicide rate among the population demonstrates that ignoring the treatment option comes at the “peril” of service members.
While VA declined to support research initiatives into cannabis for medical conditions that commonly afflict veterans under his leadership, Shulkin said this week that the department “should be involved and should be open to research for anything that will help veterans improve their lives, including medical cannabis.”
“We’re only just beginning to understand what the therapeutic potential of cannabis may be for a variety of health conditions,” M-J Milloy, senior author of the new study, said. “These findings are promising, and merit further study in order to fully understand the benefits of cannabis for people living with PTSD.”
Photo by davide ragusa on Unsplash.