Tags:  Opioid use disorder; Cannabis use; Addiction, Chronic lumbar pain.

 

Thumbnail: More than half of patients with chronic back pain who used cannabis decreased their opioids, especially those who consumed higher amounts of cannabis/day.

 

The problem: Opioid abuse is a major public health concern in the USA, affecting nearly 12 million adults in the United States alone. Recent studies have raised the possibility that cannabis might help decrease opioid consumption and could, in turn, reduce the risk of addiction.

 

The study: A retrospective review of clinical records at a cannabis medical practice was performed. Patients with a chief complaint of lower back pain (ICD Code M54.5) were included. Patients taking opioids were classified as “short-term intermittent” “long-term intermittent” and “chronic” users. The amount of cannabis and opioids consumed was recorded, and differences were measured between the initial and last visit to the clinic (or until opioids were discontinued). Prescription opioid use was standardized to morphine equivalents (ME) and cannabis consumption was recorded as grams of cannabis consumed/day.

 

Main results:

• 61 patients were enrolled in the study: 49% chronic users (n=30) and 51% intermittent users (n=31). Of the intermittent users, 64.5% were short term (n=20) and 35.5% long-term intermittent (n=11)

• 52.5% of patients (n=32) stopped using opioids

• The median time to discontinuation of consumption = 6.4 years (range 0.4-15.7)

• No predictive factors for opioid use discontinuation were identified.

• Patients on larger doses of cannabis were more likely to discontinue opioids: Median 1.4g (IQR= 0.64-1.89) vs. median 0.64g (IQR=0.25-0.98); p=0.019.

 

Conclusions:  Cannabis appears to be a suitable alternative to decrease opioid use, especially in higher doses. 

 

Why this is a good study:

• Long follow up period for a study of cannabis use in patients with prescription opioid use.

• Standardized opioid use into morphine equivalents (ME) for consistency.

 

Why this isn’t a perfect study:

• Cannabis preparations have different concentrations of cannabis, as well as different bioavailability depending on the consumption method. Even though the study attempted to account for this, the high degree of variation among preparations creates some degree of uncertainty in the results. 

• Relatively small sample size (n=61). Larger, prospective, randomized studies are required to confirm findings.

 

What this study adds:

• This study provides additional evidence that cannabis can be used as adjunct therapy in order to reduce opioid consumption.

• It identifies an interesting treatment alternative for the treatment of chronic back pain, which minimizes the dependence on opioids for management, and decreases the risk of patients developing an opioid use disorder.

 

What it doesn’t:

• Even though this study highlights an association, the mechanism of which cannabis can reduce opioid use remains unclear.

• With a small sample size, this study was not able to identify any predictors of successful cannabis consumption decrease other than higher dosages.

 

 

Funder:  The Society of Cannabis Clinicians paid for the IRB review of this project and statistical analysis.

 

Author conflicts:  K.M.T has a financial interest in the medical cannabis company MMG LLC that did not exist when this study was performed.