Substitution of marijuana for opioids in a national survey of US adults. JH Ishida et al. PLOS ONE. 2019. Article
Kelly Hughes​
Tags: Marijuana; opioids; substitution; pain management.
The problem: In recent years, opioid use and its associated complications have risen dramatically in the US. Opioid overdose deaths have quadrupled since 1999, leading to an increased interest in alternatives to managing pain.
Why do this study? A growing number of studies have looked at the efficacy of cannabinoids for managing pain. At the same time, data suggest that the legalization of medical cannabis in some states has been associated with lower opioid overdose mortality.
The study: This study used an internet-based survey of a nationally representative population of American adults, and asked about cannabis use and opioids. Of a representative sample of 16,280 people, 9,003 (55.3%) responded. Of these 5% reported using both cannabis and opioids. Of those who used cannabis and opioids, 43% used opioids daily and 23% reported current cannabis use. Of the respondents with concomitant cannabis and opioid use, 41% reported a decrease or cessation of opioid use due to cannabis use, 46% reported no change, and 8% reported an increase. For those who reported substituting cannabis for opioid use, the most common reasons for substitution were medical: better pain management (36%), fewer side effects (32%) and fewer withdrawal symptoms (26%). However, non-medical reasons were also reported from some users: 13% substituted cannabis because it was cheaper, and an equal number where influenced by the more socially acceptable perception of marijuana.
Conclusions: This study found that a substantial proportion of adults in the US reported substituting cannabis for opioids, and approximately 20% of these discontinued opioid use all together.
What does this study add? This study adds to the growing evidence that cannabis may have a role in reducing or eliminating opioids. Its chief strength is the fact that it purports to be nationally representative and that it examines the frequency and reasons for opioid substitution.
Funder: National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases
Author conflicts: The authors report no conflicts
Commentary: (David Casarett MD)
This study is important for a couple of reasons. First, the survey itself was very carefully designed and pilot tested with a small sample to ensure the questions were understandable. That’s a step in survey development that not all researchers take the time to do. Second, it’s a nationally-representative sample, which is uncommon in cannabis research. The response rate of 55% is also quite good. Overall, these results suggest that a significant minority of people find that cannabis can be effective as a substitute for opioids. Of course, given this cross-sectional study, it’s difficult to draw firm conclusions, as the authors acknowledge. For instance, we don’t know whether cannabis was able to keep pain controlled to a comfortable level, only that people were able to reduce their opioid use. Nevertheless, this adds to the growing descriptive evidence base suggesting that at least for some people, cannabis can reduce or even eliminate opioid use.