Cannabis use is associated with improved outcomes in opioid-dependent subjects undergoing outpatient treatment, according to data published online ahead of print in the journal Drug and Alcohol Dependence.
Researchers at Columbia University assessed the use of cannabinoids versus placebo in opioid-dependent subjects undergoing in-patient detoxification and outpatient treatment with naltrexone, an opiate receptor antagonist. Investigators reported that the administration of oral THC (dronabinol) during the detoxification process lowered the severity of subjects’ withdrawal symptoms compared to placebo, but that these effects did not persist over the entire course of treatment. By contrast, patients who consumed herbal cannabis during the outpatient treatment phase were more readily able to sleep, were less anxious, and were more likely to complete their treatment as compared to those subjects who did not.
“One of the interesting study findings was the observed beneficial effect of marijuana smoking on treatment retention,” authors concluded. “Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo.”
The findings replicate those of two prior studies, one from 2001 and another from 2009, reporting greater treatment adherence among subjects who consumed cannabis intermittently during outpatient therapy.
Population data from states where medicinal cannabis is permitted report lower rates of opioid-abuse and mortality as compared to those states where the plant is prohibited. Clinical data and case reports also indicate that the adjunctive use of cannabis may wean patients from opiates while successfully managing their pain. Survey data of state qualified medical cannabis patients demonstrates that subjects with access to the plant often substitute it for opioids because they perceive it to possess fewer adverse side effects.
Overdose deaths involving opioids have increased dramatically in recent years. While fewer than 4,100 opiate-induced fatalities were reported for the year 1999, by 2010 this figure rose to over 16,600 according to an analysis by the US Centers for Disease Control.
An abstract of the study, “The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone,” appears online here.
Cannabinoids are safe and effective for the treatment of chronic pain, according to the results of a systematic review of randomized controlled trials published in the Journal of Neuroimmune Pharmacology.
Investigators from Dalhousie University in Halifax, Nova Scotia and McGill University in Montreal evaluated the results of 11 placebo-controlled trials conducted between the years 2010 and 2014. Trials assessed the use of various types of cannabinoid preparations, including herbal cannabis, liquid and oral cannabis extracts, and nabilone (a synthetic analog of THC), in pain treatment.
Cannabinoids possessed “significant analgesic effects” and were “well tolerated” in the majority of studies reviewed.
Authors concluded, “The current systematic review provides further support that cannabinoids are safe, demonstrate a modest analgesic effect and provide a reasonable treatment option for treatment chronic non-cancer pain.”
A 2011 review of 18 separate randomized trials evaluating the safety and efficacy of cannabinoids for pain management similarly reported, “[C]annabinoids are a modestly effective and safe treatment option for chronic non-cancer (predominantly neuropathic) pain.”
In September, Canadian researchers reported that pain patients who consumed herbal cannabis daily for one-year experienced decreased analgesia and no increase in serious adverse side effects compared to matched controls.
An abstract of the study, “Cannabinoids for the treatment of chronic non-cancer pain: An updated systematic review of randomized controlled trials,” appears online here.
Current consumers of cannabis are 50 percent less likely to suffer from metabolic syndrome as compared to those who have never used the substance, according to findings published online ahead of print in The American Journal of Medicine. Metabolic syndrome is a group of risk factors, including high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat, which are linked to increased risk of heart disease and/or type 2 diabetes, among other serious health consequences.
Investigators from the University of Miami Leonard M. Miller School of Medicine analyzed the association between cannabis use and metabolic syndrome in a cohort of nearly 8,500 subjects aged 20 to 59 who participated in the 2005-2010 National Health and Nutrition Examination Surveys. Researchers classified subjects as suffering from metabolic syndrome if they possessed more than three of the following symptoms: elevated fasting glucose levels, high triglycerides, low HDL cholesterol, elevated systolic/diastolic blood pressure, and increased waist circumference.
Among subjects with no history of cannabis use, 19.5 percent met the criteria for metabolic syndrome. By contrast, 17.5 percent of former users and only 13.8 percent of current users met the criteria.
“Among emerging adults, current marijuana users were 54 percent less likely than never users to present with metabolic syndrome,” investigators reported. Specifically, mean fasting glucose levels were significantly lower among current marijuana users when compared to never users, while waist circumference was significantly lower among males who reported current marijuana use when compared to those with no cannabis use history.
“These findings have important implications for the nation as marijuana use becomes more accepted and we simultaneously face multiple epidemics of obesity, cardiovascular disease and diabetes,” authors concluded.
The findings are consistent with those of previous observational studies showing an inverse relationship between cannabis use and diabetic markers, and support previous population data showing that those who use cannabis typically possess smaller waist circumference and lower body mass index than those who do not.
An abstract of the study, “Metabolic Syndrome among Marijuana Users in the United States: An Analysis of National Health and Nutrition Examination Survey Data,” is online here.
Marijuana smoke exposure is not positively associated with the development of cancers of the head or neck, according to the results of a systematic literature review published online ahead of print in the journal Archives of Oral Biology.
Investigators from the Federal University of Minas Gerais in Brazil reviewed nine case-control studies to assess whether marijuana smoking favored the development of head and neck cancer. Authors reported that subjects who used cannabis were no more likely to develop the disease than were subjects with no history of use, after researchers controlled for potential confounding such as age, gender, race, and the use of tobacco and alcohol.
“The result of this study indicated no association between lifetime marijuana use and the risk for development of head and neck cancer,” authors concluded.
A separate analysis of six case-control studies published last year in the International Journal of Cancer similarly identified no positive association between cannabis smoke exposure and lung cancer, while a 2009 case-control trial published in the journal Cancer Prevention Research reported that the moderate levels of marijuana use were associated with a reduced risk of head and neck cancer.
Investigators from the University of Victoria in British Columbia assessed the influence of medical marijuana access on other drug-taking behaviors in a cohort of 473 Canadian adults licensed to engage in cannabis therapy.
“Substituting cannabis for one or more of alcohol, illicit drugs or prescription drugs was reported by 87 percent of respondents, with 80.3 percent reporting substitution for prescription drugs, 51.7 percent for alcohol, and 32.6 percent for illicit substances,” they reported.
Rates of substitution were highest among respondents between the ages of 18 and 40. Patients using cannabis for pain were most likely to use pot as a substitute for prescription drugs.
Authors concluded, “The finding that cannabis was substituted for alcohol and illicit substances suggests that the medical use of cannabis may play a harm reduction role in the context of use of these substances, and could have implications for substance use treatment approaches requiring abstinence from cannabis in the process of reducing the use of other substances.”
Evaluations of patients enrolled in state-specific medical marijuana programs, including those in Arizona, California, and Rhode Island, yield similar results — finding that patients are particularly likely substitute cannabis for opioids. According to a recently published National Bureau of Economic Research report, states that permit qualified patients to access medical marijuana via dispensaries possess lower rates of opioid addiction and overdose deaths as compared to states that do not.
An abstract of the study, “Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors,” appears online here.