Two new studies out this month offer additional evidence that chronic pain patients are skipping addictive pharmaceuticals and using marijuana instead to help them find relief.
The findings are just the latest in an ever-growing body of research revealing cannabis’s potential to help address the country’s opioid crisis.
The first study, published in the International Journal of Drug Policy, aimed to investigate whether it’s “plausible” that people are substituting marijuana for opioids to help them with pain. Researchers from Florida International University used data from the National Survey on Drug Use and Health to evaluate whether people who live in states where medical cannabis is legal were less likely to turn to opioids for pain relief than those who lived in states where medical marijuana was not an option.
The researchers focused on several variables: whether respondents used or misused any prescription pain relievers during the past year, what states they lived in and whether those states had legalized cannabis for medicinal purposes, among other factors. The responses of 120,764 participants were analyzed for the years 2015 through 2017 of the survey.
According to the authors, “the results generated from the multivariate logistic regression equations show that [medical marijuana laws] are associated with a lower likelihood of opioid pain reliever use, but not misuse.”
“Results provide evidence that MMLs may be effective at reducing opioid reliance as survey respondents living in states with medical cannabis legislation are much less apt to report using opioid analgesics than people living in states without such laws, net other factors.”
These results, the study states, support other research that shows patients prefer to consume medical marijuana over opioids.
“In addition, cannabis enabled patients to reduce their reliance on opioids with a significant proportion indicating that cannabis was equal to opioids for pain relief and preferring cannabis over opioids if it were an available alternative,” it concludes. “Such subjective appraisals by patients are important in this context as the success of a treatment plan is in part determined by the patient’s perceptions of treatment efficacy and tolerance of side effects.”
The second study, published in PLoS ONE, took the question of whether or not patients substituted marijuana for prescription painkillers directly to the people. In a nationally representative survey of 16,280 adults, researchers from the San Francisco Veterans Affairs Medical Center asked participants to share information about their opioid and marijuana use. They also asked if they’d noticed a change in the amount of opiate medications they needed for pain because of marijuana use, and why patients who substituted cannabis for their prescription pain killers did so.
More than half of the people queried responded to the survey. Of the 9,003 respondents, 486 (5 percent) reported using marijuana and opioids in the past year; 43 percent said they took opioids daily and 23 percent reported consuming marijuana within the past month.
According to the study’s findings, 41 percent of that sample decreased or stopped using opioids because of marijuana use, while 46 percent reported no change in opioid use and 8 percent said they increased their opioid intake.
“We found that a substantial number of US adults reported that they substituted marijuana for opioids.”
“The most commonly reported reasons for substitution were better pain management (36%) and fewer side effects (32%) and withdrawal symptoms (26%), compared to the non-medical reasons for use: cheaper (13%) and more social acceptance from marijuana use (13%),” the study’s authors write.
“More research on this topic is clearly needed,” the study states. “Nonetheless, our findings suggest that even if objective measures do not support that marijuana is substitutive for opioid use, patients perceive that marijuana use has reduced their opioid use. Perhaps the commercialization of marijuana and the favorable media coverage surrounding the health effects of marijuana are fostering such a perception.”
Ultimately, both studies reveal the importance of patient-centered care in efforts to mitigate opioid use and misuse. That’s exactly what the Department of Health & Human Services (HHS) Pain Management Inter-Agency Task Force called for earlier this year.
Photo courtesy of Martin Alonso.
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.
Calling It ‘Cannabis’ Instead Of ‘Marijuana’ Doesn’t Boost Legalization Support, Study Finds
Some legalization proponents believe it’s important to stop using the term “marijuana” and instead refer to the substance only by its scientific name, “cannabis.” In order to appeal to more people, they argue, it’s better to stick with a term that isn’t controversial and doesn’t come with ugly historic baggage. A new study, however, suggests that reframing the drug as such doesn’t make much difference to the average person.
“Throughout each of our tests, we find no evidence to suggest that the public distinguishes between the terms ‘marijuana’ and ‘cannabis,'” the study’s authors wrote last week in the journal PLOS-ONE.
Many people believe “marijuana” has racist origins: The term was adopted in the 20th century by prohibitionists in part because it sounded foreign enough to scare white people away from using it. Others, however, point out that the term predates its use by anti-drug officials and doing away with it now erases its complex history.
To assess public attitudes about “marijuana” vs. “cannabis,” researchers at Vanderbilt University partnered with YouGov to survey 1,600 adults in the U.S. The survey asked participants a broad range of questions to get their opinions on one of four randomly assigned terms: “marijuana,” “cannabis,” “medical marijuana” or “medical cannabis.” Topics included legalization, moral acceptability, tolerance of drug activities, perceptions of harms and stereotypes of users.
According to the survey, 50.1 percent and 50.3 percent support the legalization of marijuana and cannabis, respectively. The authors note there is a “slight uptick” in how much they support cannabis legalization, though: 34.3 percent strongly support “cannabis legalization,” compared to 26 percent who strongly support “marijuana legalization.” Support for legalization also increases when the term “medical” is attached.
“In each and every test, the name frame (‘marijuana’ versus ‘cannabis’) has no impact on opinion toward the drug.”
In short, the authors write, “calling the drug ‘cannabis’ does not boost public support for legalization of the drug.”
When they analyzed the answers in other categories, researchers found similar results:
- 43.8 percent found marijuana “morally acceptable” while 44.3 percent said the same about cannabis.
- Roughly the same number of respondents said they’d be bothered by the opening of a dispensary in their neighborhood, public use, and knowing that a teacher consumed when not working, whether the substance was referred to as “marijuana” or “cannabis.
- There was also “no noticeable difference” in responses when the survey asked participants about claims of potential harms of “marijuana” vs. “cannabis,” including addiction, that it leads to other drug use, that it is personally harmful to one’s health and that it significantly impairs driving.
- As for stereotypes, researchers found that the characteristics participants used to describe users fell in two clusters: “medical marijuana/medical cannabis” and “marijuana/cannabis.” For example, users of medical marijuana/medical cannabis were seen as “sick” and “honest” while marijuana/cannabis consumers were described as “teenaged” and “lazy.”
“Even though the name attached to the drug appears to have no influence on public opinion, we find consistent support for the notion that the public views the drug more favorably when told it is for medical versus unspecified purposes,” the study states. “The public is much more supportive of legalization of medical use, more morally accepting of it, less bothered by activities involving it, less convinced that it is harmful, and more likely to attribute positive traits to its users when told that the drug is ‘medical.’”
Ultimately, the authors write, their findings “undermine the notion — widely espoused by policy advocates — that abandoning the word ‘marijuana’ for ‘cannabis’ by itself will boost the prospects for reform or soften public attitudes toward the drug.”
“We find no support for the notion that changing the name of the drug from ‘marijuana’ to ‘cannabis’ affects public opinion on the drug or the policies governing it.”
“For many years,” NORML Deputy Director Paul Armentano told Marijuana Moment, “this issue has been a source of passionate debate within marijuana law reform circles. There now exists some data to better focus this discussion and to provide some important insight.”
“Changing the hearts and minds of the public with regard to marijuana has always been about substance, not terminology,” Armentano continued. “Reformers are winning the legalization debate on the strength of our core arguments — namely, the fact that legalization and regulation is better for public health and safety than is criminalization — and not because of any particular change in the lexicon surrounding the cannabis plant.”
Photo courtesy of Margo Amala