Cannabis May be Viable Alternative to Reduce Opioid Dependence

A program designed to discuss strategies to engage, support, and protect cannabis users with chronic pain may be of value, particularly in older patients and those who only want to use cannabis for medical purposes, according to a study published in Cannabis.¹ Cannabis may also be a viable option for patients to reduce the risk of prescription opioid misuse, dependence, and side effects. Investigators stated the findings can also inform clinicians and policymakers on how cannabis may reduce harmful outcomes in patients with chronic pain who are prescribed opioids.

“While there certainly is reason to be concerned that co-occurring use of cannabis and prescription opioids may contribute to increased rates of substance misuse and other undesirable outcomes, it is difficult to overlook the benefits many persons reportedly derive when taking cannabis to manage chronic pain with or without prescription opioids,” wrote Julie Bobitt, PhD, University of Illinois Chicago, Department of Medicine, Center for Dissemination and Implementation Science, and colleagues.

Opioids are the most common approach to managing moderate-to-severe chronic pain, a condition which affects as many as 50 million Americans. However, opioids are linked to a significant number of side effects, including constipation, dizziness, sedation, and dependence. In recent years, opioid overdoses and the number of opioid-related deaths are at epidemic levels.² Therefore, increasing numbers of Americans with chronic pain are turning to cannabis as an alternative or supplemental management tool, numbers of which are only increasing as state legislation for both medical and recreation use continue to expand.³

Patients with chronic pain enrolled in the Opioid Alternative Pilot Program (OAPP), the state of Illinois’ opioid diversion program, were asked to participate in a 49-question electronic survey between February 2019 and August 2019. OAPP was designed to give adults (aged ≥21 years) an alternate pathway to access medical cannabis if they had or were eligible to receive a prescription for opioids.

Questions included individual characteristics, health status, current pain levels, and attitudes towards cannabis and opioids. Data from the cross-sectional survey compared patients who used only cannabis with patients who used both cannabis and opioids.

A total of 450 respondents were included in the study, with an average age of 51.1 years and approximately half (n =227) were female. Most (84%, n = 377) of respondents were co-users of opioids and cannabis, while 16% (n = 73) used cannabis only.

The attitude towards cannabis did not differ between groups. However, both groups largely considered opioid use risky (100% in the cannabis-only cohort; 89% in the co-users cohort). Further, 73% of patients expressed they sought to completely stop or never start using opioids for their chronic pain.

Patients in the cannabis-only group reported lower pain levels when compared with co-users. Respondents in the co-user cohort were more likely to have a cannabis-certifying physician when compared with the cannabis-only cohort (85% vs 69%, respectively).

Investigators noted the OAPP may not be generalizable to other states; for example, those with legal access to recreational cannabis. The cross-sectional design, small sample of volunteers, and the possibility of self-reporting bias also limited the study. Investigators urge future research to include a greater number of participants, a wider variety of patient data, and observation over an extended period to evaluate the impacts of cannabis on opioid use.

“The procedures the state of Illinois put in place for their OAPP may be illustrative for other states to consider as the opioid epidemic requires an array of public health responses,” investigators concluded. “If anything, our findings affirm that some individuals and their providers are willing to do so.”

References

1. ^{Bobitt J, Kang H, Arora K, Bhagianadh D, Milavetz G, Kaskie B. Offering an Alternative to Persons with Chronic Pain: How Access to Cannabis May Provide an Off-Ramp from Undesired Prescription Opioid Use. Cannabis. 2023;6(2):113-122. Published 2023 Jul 5. doi:10.26828/cannabis/2023/000125}
2. ^{Cullinan, S., Raae Hansen, C., Byrne, S., O’Mahony, D., Kearney, P., & Sahm, L. (2017). Challenges of deprescribing in the multimorbid patient. European Journal of Hospital Pharmacy,24(1), 43–46. https://doi.org/10.1136/ejhpharm-2016-000921}
3. ^{Carliner, H., Brown, Q. L., Sarvet, A. L., & Hasin, D. S. (2017). Cannabis use, attitudes, and legal status in the U.S.: A review. Preventive Medicine, 104, 13–23. https://doi.org/10.1016/j.ypmed.2017.07.008}