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Medical Cannabis and Opioid Use

There is evidence that medical cannabis use is associated with a decrease in opioid use and overdose death. The following is a summary of the results of a systematic review of over 7000 patients. There is a significant decrease in opioid use associated with the use of Medical Cannabis.

 

Nine studies involving 7222 participants were included. There was a 64–75% reduction in opioid dosage when used in combination with Medical Cannabis.

 Use of Medical Cannabis for opioid substitution was reported by 32–59.3% of patients with non-cancer chronic pain.

 One study reported a slight decrease in mean hospital admissions in the past calendar year (P = .53) and decreased mean emergency department visits in the past calendar year (P = .39) for patients who received Medical Cannabis as an adjunct to opioids in the treatment of non-cancer chronic pain. (Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review, Babasola O. Okusanya,1 Ibitola O. Asaolu,1John E. Ehiri,1,2 Linda Jepkoech Kimaru,1Abidemi Okechukwu,1 and  Cecilia RosalesSyst Rev 2020; 9: 167.)

This research has demonstrated that the use of cannabis is associated with a decrease in the use of opioids and overdose deaths.  This is most likely due to the effect of cannabis on pain control as cannabis has been successfully used for this.

The dosages of medical cannabis varied widely and no comments were made about CBD.  The authors state is there is a chance that this could be a coincidence that cannabis decreases the use of opioids.  The benefit of using cannabis instead of opioids is that cannabis does not cause overdose death no matter how much is taken.  There is also evidence that opioids do not work well for chronic pain when taken chronically.

There is a great deal of effort going into fighting the war against opioid use in general and specifically in chronic pain patients.  There are alternatives to opioid use such as physical therapy, topical medications, mindfulness, transcutaneous nerve stimulators, nonnarcotic pain medications and injections of joints and trigger points among others.  When these alternatives fail there is little left to offer the patient.  That is when medical cannabis comes in.  Medical cannabis generally contains CBD and THC.  CBD alone has shown to decrease chronic pain. 

I believe that medical cannabis is appropriate for some patients with chronic pain.  It will help with sleep and anxiety as well as pain.  In the face of opioid overdose epidemic medical cannabis may be part of the answer.


Walter Brodis MD

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