The enactment of medicinal marijuana laws is associated with significantly lower state-level opioid overdose mortality rates, according to data published online today in the Journal of the American Medical Association (JAMA) Internal Medicine.
A team of investigators from the University of Pennsylvania, the Albert Einstein College of Medicine in New York City, and the Johns Hopkins Bloomberg School of Public Health in Baltimore conducted a time-series analysis of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010 — a period during which 13 states instituted laws allowing for cannabis therapy.
Researchers reported, “States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.” Specifically, overdose deaths from opioids decreased by an average of 20 percent one year after the law’s implementation, 25 percent by two years, and up to 33 percent by years five and six.
They concluded, “In an analysis of death certificate data from 1999 to 2010, we found that states with medical cannabis laws had lower mean opioid analgesic overdose mortality rates compared with states without such laws. This finding persisted when excluding intentional overdose deaths (ie, suicide), suggesting that medical cannabis laws are associated with lower opioid analgesic overdose mortality among individuals using opioid analgesics for medical indications. Similarly, the association between medical cannabis laws and lower opioid analgesic overdose mortality rates persisted when including all deaths related to heroin, even if no opioid analgesic was present, indicating that lower rates of opioid analgesic overdose mortality were not offset by higher rates of heroin overdose mortality. Although the exact mechanism is unclear, our results suggest a link between medical cannabis laws and lower opioid analgesic overdose mortality.”
In a written statement to Reuters Health, lead author Dr. Marcus Bachhuber said: “Most of the discussion on medical marijuana has been about its effect on individuals in terms of reducing pain or other symptoms. The unique contribution of our study is the finding that medical marijuana laws and policies may have a broader impact on public health.”
Added co-author Colleen L. Barry in USA Today: “[The study's findings] suggest the potential for many lives to be saved. … We can speculate … that people are completely switching or perhaps supplementing, which allows them to lower the dosage of their prescription opioid.”
Nationwide, overdose deaths involving opioid analgesics have increased dramatically over the past decade. 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 JAMA study, “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010,” appears online here.
Study: Marijuana Use Associated With Decreased Symptoms Of Opiate Withdrawal In Methadone Maintenance Treatment SubjectsJuly 16, 2013
Cannabis consumption is associated with mitigated symptoms of opiate withdrawal in subjects undergoing methadone maintenance treatment, according to the findings of a new study published online in The American Journal on Addictions.
Investigators at the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia assessed the use of cannabis in 91 opiate-dependent subjects undergoing methadone maintenance treatment. Researchers found that subjects seeking methadone treatment who acknowledged a history of cannabis use reported “significantly less daily expenditure on acquisition of opiates.”
Authors additionally reported that subjects’ use of cannabis during treatment was associated with less severe symptoms of withdrawal on the clinical opiate withdrawal scale (COWS), an index designed to serve as an objective measure of opiate withdrawal. “[I]ncreased cannabis use was found to be associated with lower severity of [opiate] withdrawal in a subset of the sample with available chart data,” authors wrote. “These results suggested a potential role for cannabis in the reduction of withdrawal severity during methadone induction.”
They concluded, “The present findings may point to novel interventions to be employed during treatment for opiate dependence that specifically target cannabinoid–opioid system interactions.”
A 2009 study published in the same journal previously reported that moderate cannabis use and improved retention in naltrexone treatment among opiate-dependent subjects.
Full text of the study, “Impact of cannabis use during stabilization on methadone maintenance treatment,” appears online in The American Journal on Addictions.
Investigators at the University of California, Davis Medical Center conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in 39 subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Subjects inhaled cannabis of either moderate THC (3.53 percent), low dose THC (1.29 percent), or zero THC (placebo). Subjects continued to take all other concurrent medications as per their normal routine during the 3- to 4-week study period. Spontaneous pain relief, the primary outcome variable, was assessed by asking participants to indicate the intensity of their current pain on a 100-mm visual analog scale (VAS) between 0 (no pain) and 100 (worst possible pain).
Researchers reported: “Both the low and medium doses proved to be salutary analgesics for the heterogeneous collection of neuropathic pain conditions studied. Both active study medications provided statistically significant 30% reductions in pain intensity when compared to placebo.”
They concluded: “Both the 1.29% and 3.53% vaporized THC study medications produced equal antinociception at every time point. … [T]he use of low doses could potentially be prescribed by physicians interested in helping patients use cannabis effectively while minimizing cognitive and psychological side effects. Viewed with this in mind, the present study adds to a growing body of literature supporting the use of cannabis for the treatment of neuropathic pain. It provides additional evidence of the efficacy of vaporized cannabis as well as establishes low-dose cannabis (1.29%) as having a favorable risk-benefit ratio.”
Previous clinical trials have indicated that inhaled cannabis can safety and effectively relieve various types of pain, particularly neuropathy — a hard-to-treat nerve condition often associated with cancer, HIV, spinal cord injury, diabetes, multiple sclerosis, and other conditions. These include the following double-blind, placebo-controlled (FDA gold-standard) studies:
Ware et al. 2010. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ 182: 694-701.
Wilsey et al. 2008. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain 9: 506-521.
Ellis et al. 2008. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacology 34: 672-80.
Abrams et al. 2007. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 68: 515-521.
Wallace et al. 2007. Dose-dependent Effects of Smoked Cannabis on Capsaicin-induced Pain and Hyperalgesia in Healthy Volunteers Anesthesiology 107: 785-796.
Separate clinical trial data also reports that inhaled “cannabis augments the analgesic effect of opioids” and therefore “may allow for opioid treatment at lower doses with fewer side effects.”
Since 1999, US sales of opiate drugs have tripled in number and in 2010, a record-setting 254 million prescriptions for opioids were filled in the United States — enough to medicate every American adult around the clock for a month. (In particular, the manufacturing of the drug Oxycodone has increased from 8.3 tons in 1997 to 105 tons in 2011, an increase of 1,200 percent.) Overdose deaths from the use of prescription painkillers are also now at record levels, totaling some 15,000 annually — more than triple the total a decade ago.
Full text of the study, “Low-dose vaporized cannabis significantly improves neuropathic pain,” appears in The Journal of Pain.
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Physicians who prescribe opioid drugs to patients with neuropathy (nerve pain) ought to consider recommending cannabis as an alternative therapy, according to a peer-reviewed paper published online this week in the Harm Reduction Journal.
“There is sufficient evidence of safety and efficacy for the use of (cannabis/cannabinoids) in the treatment of nerve pain relative to opioids,” the commentary states. “In states where medicinal cannabis is legal, physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. … Prescribing cannabis in place of opioids for neuropathic pain may reduce the morbidity and mortality rates associated with prescription pain medications and may be an effective harm reduction strategy.”
The author notes that between the years 1999 and 2006, “approximately 65,000 people died from opioid analgesic overdose.” By contrast, he writes “[N]o one has ever died from an overdose of cannabis.”
In November, clinical investigators at the University of California, San Francisco reported that vaporized cannabis augments the analgesic effects of opiates in subjects prescribed morphine or oxycodone. Authors of the study surmised that cannabis-specific interventions “may allow for opioid treatment at lower doses with fewer [patient] side effects.”
Neuropathy affects between five percent and 10 percent of the US population. The condition is often unresponsive to conventional analgesic medications such as opiates and non-steroidal anti-inflammatory drugs.
Full text of the paper, “Prescribing cannabis for harm reduction” is available online here.