Study Suggests That Opioid Prescriptions Drop in Medical Cannabis States
October 6, 2020 in General News
Drug overdoses in the US are still happening at alarming rates and are considered a major cause of injury-related death. The pandemic is making the crisis even worse. According to the data from The Centers for Disease Control and Prevention (CDC), 68% of drug overdoses are the result of the use of illegal or prescription opioids. A new study from Columbia University found that prescription rates for opioids by orthopaedic surgeons were reduced by almost 20% in states with medical cannabis programs when compared to those without programs. In this article I will discuss this study and a second study about cannabis usage and opioid withdrawal symptoms.
The study, State Medical Cannabis Laws Associated With Reduction in Opioid Prescriptions by Orthopaedic Surgeons in Medicare Part D Cohort, was published in the Journal of the American Academy of Orthopaedic Surgeons in May, 2020. It was conducted at the Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.
Researchers examined the correlation between the prescribing patterns for opioids by orthopaedic surgeons in states with medical cannabis programs compared to those without programs. The data was collected between 2013-17 from Medicare Part D patients who were given prescriptions for opioids by their orthopaedic surgeons.
Researchers measured the annual number of daily doses of all opioid medications prescribed by orthopaedic surgeons in each US state and Washington, DC, plus the total daily doses of opioid medications by generic name. They examined the relationship between states with medical cannabis regulations, which included state medical cannabis programs, dispensary or home cultivation and recreational cannabis legalization, and the total annual daily doses of opioid medications.
- In states with medical cannabis laws (MCLs), there was a significant reduction in the prescribing of 144,000 daily doses annually, a 19.7% reduction.
- In states with MCLs which allowed access to in-state dispensaries, there was a significant reduction in the prescribing of 96,000 daily doses annually, a 13.1% reduction.
- Researchers made a correlation between states with MCLs and a significant reduction of 72,000 daily doses annually of hydrocodone
- There was no significant correlation between the prescribing of opioids and recreational cannabis legalization
- In states with very restrictive MCLs which only allowed low-THC products, there was an insignificant increase in opioid prescriptions.
With orthopaedic surgeons among the highest group of opioids prescribers, this study highlighted the importance of providing a non-opioid, pain-reduction alternative to patients in order to reduce opioid use. It is the first study to investigate any correlation between MCLs and the prescribing habits of opioids by orthopaedic surgeons for Medicare patients.
The study authors wanted to make it clear that the data did not support a direct cause and effect relationship. They did acknowledge that patient access to medical cannabis dispensary products may be associated with the reduction of opioid prescriptions by orthopaedic surgeons. This may be due to the increase in the availability of alternative pain management options for patients.
However, the authors did agree that more research studies on the use of cannabis for pain relief and opioid reduction is warranted. Furthermore, the results of this study can be added to the already existing body of research that suggests that access to medical cannabis significantly reduces opioid use and even opioid deaths. Patients in MCLs are likely to choose cannabis over opioids to manage their pain.
Johns Hopkins Study on Cannabis To Ease Opioid Withdrawal Symptoms
After a new study found that cannabis may reduce many symptoms of opioid withdrawal, researchers are making a case to begin formal clinical human trials.
The study, The Impact of Naturalistic Cannabis Use on Self-Reported Opioid Withdrawal, was conducted by researchers at the Johns Hopkins University School of Medicine. It was published in the June 2020 issue of the Journal of Substance Abuse Treatment.
Participants were recruited for the study through a crowdsourcing platform, Amazon Mechanical Turk (AMT).
200 people who used both opioids and cannabis in the preceding month and who experienced symptoms of opioid withdrawal were given a survey to complete. They were asked which of their symptoms improved or worsened when they consumed cannabis and to rate the severity of their withdrawal on days with and without cannabis.
125 or 62.5% of the 200 participants had used cannabis to treat opioid withdrawal. Participants reported experiencing improvement for the following symptoms:
- Anxiety 76.2%
- Tremors 54.1%
- Trouble sleeping 48.4%
- Bone and muscle aches 45.9%
- Restlessness 45.1%
- Nausea 38.5%
- Opioid cravings 37.7%
12 or 6% of participants reported experiencing a worsening of the following symptoms:
- Yawning 7.4%
- Teary eyes 6.6%
- Runny nose 6.6%
- Restlessness 5.7%
- Vomiting 5.7%
- Hot flashes 5.7%
- Withdrawal severity scores almost doubled, on average, on days without cannabis usage.
- Those who had more experience using both cannabis and opioids reported a bigger reduction in opioid withdrawal symptoms with cannabis usage.
Taking into account all symptoms, more participants found that cannabis improved their symptoms compared to those who found it made them worse. Women reported that cannabis provided greater relief from withdrawal symptoms than did men.
Limitations of the Study
- Due to the use of the AMT crowdsourcing platform, it was not possible to verify the use of opioids and/or cannabis by participants
- Take into account the subjective nature of self-reporting the severity of their symptoms on the Subjective Opiate Withdrawal Scale (SOWS)
While researchers are not ready to conclude that cannabis is a beneficial alternative treatment option for opioid withdrawal, they do agree that the collected data indicates the need for further studies through more comprehensive clinical trials.
marijuanamoment.net, States With Medical Marijuana Laws Saw 20% Drop in Some Opioid Prescriptions, Ben Adin, May 28, 2020
marijuanamoment.net, Cannabis May Ease Opioid Withdrawal Symptoms, John Hopkins Study Finds, Ben Adin, April 20, 2020
journals.lww.com, State Medical Cannabis Laws Associated With Reduction in Opioid Prescriptions by Orthopaedic Surgeons in Medicare Part D Cohort, May 11, 2020