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  • by Paul Armentano, NORML Deputy Director July 11, 2018

    The enactment of medical cannabis access laws is associated with significant reductions in prescription opioid use among Medicaid enrollees, according to just-published data in the journal Addiction.

    Investigators with the University of California at San Diego assessed the relationship between medical cannabis legalization and opioid use among Medicaid enrollees over a period of 21 years (1993 to 2014).

    Authors reported, “For Schedule III opioid prescriptions, medical cannabis legalization was associated with a 29.6 percent reduction in number of prescriptions, 29.9 percent reduction in dosage, and 28.8 percent reduction in related Medicaid spending.” This correlation remained after authors controlled for potential confounders, such as the establishment of prescription drug monitoring programs and variations in patients’ income.

    By contrast, authors did not report similar changes in enrollees’ use of Schedule II opioid drugs, like Oxycodone. Authors speculated that this result may be because physicians are more reticent to recommend medical cannabis options to these patients.

    They concluded: “In this study, we found that statewide medical cannabis legalization implemented in 1993-2014 in the US was associated with close to 30 percent reductions in Schedule III opioids received by Medicaid enrollees.. … It was estimated that, if all the states had legalized medical cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars.”

    Their findings are similar to those of numerous other observational studies – such as those here, here, and here – finding that medical marijuana regulation is correlated with reductions in overall opioid-related use, drug spending, abuse, hospitalization, and mortality. Separate data evaluating prescription drug use trends among individual patients enrolled in state-licensed medical marijuana programs is consistent with this conclusion, finding that many subjects reduce or eliminate their use of opioids following enrollment.

    The abstract of the new study, “Medical cannabis legalization and opioid prescriptions: Evidence of US Medicaid enrollees during 1993-2014,” appears online here.

  • by NORML June 22, 2018

    KY NORML is passionate about education. And with the opioid epidemic consuming our state, we feel that it is our duty to share valuable information regarding the relationship between cannabis and opioids. Cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, traffic fatalities, drug treatment admissions, and overdose deaths. We strongly believe, based on research, first-hand accounts, and testimonials that cannabis is truly the answer to combating this crisis that is killing thousands of Kentuckians each year.

    According to a study by the Journal of Headache and Pain, “the most common prescription medications replaced by medicinal cannabis in this study were opiates/opioids in a large percentage within every pain group, up to 72.8% of patients in the chronic pain as primary illness group. … This is notable given the well-described “opioid-sparing effect” of cannabinoids and growing abundance of literature suggesting that cannabis may help in weaning from these medications and perhaps providing a means of combating the opioid epidemic.”

    Investigators assessed opioid use patterns in patients registered with Health Canada to access medical cannabis products. Among those patients who acknowledged using opioids upon enrollment in the trial, 51 percent reported ceasing their opiate use within six-months. “The high rate of cannabis use for the treatment of chronic pain — and subsequent substitution for opioids — suggests that cannabis may play a harm-reduction role in the ongoing opioid dependence and overdose crisis. While the cannabis substitution effect for prescription drugs has been identified and assessed via cross-sectional and population-level research, this study provides a granular individual-level perspective of cannabis substitution for prescription drugs and associated improvement in quality of life over time.”

    Cannabis access is associated with reductions in overall prescription drug spending. JAMA Internal Medicine “found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened. … Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.”

    The Mental Health Clinician  “investigated medical cannabis’ effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. … After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. … These results are consistent with previous reports demonstrating MC’s effectiveness in neuropathic pain.”

    There are tons more information out there on this topic and the above research barely scratches the surface. We encourage you to see what’s out there for yourself. Knowledge is power and the better armed we are with that knowledge the more effective we can be in getting legislation passed. The opioid crisis that is plaguing our state has harmed so many of our citizens, and if cannabis is able to help, the legislators should get out the way and pass a comprehensive bill to deal with the problems our state is facing.

    High Regards,
    Matthew Bratcher
    Executive Director, KY NORML

    To support KY NORML you can DONATE HERE and follow us on Facebook and Twitter! Your donations help pay the bills and allow us to function and continue to make a difference in our state! Can you kick in $5, $10 or $20 to help us keep going?

  • by Paul Armentano, NORML Deputy Director June 5, 2018

    More than two-thirds of chronic pain patients registered to legally access medical cannabis products substitute marijuana for prescription opioids, according to data published in The Journal of Headache and Pain.

    Investigators from the United States and Canada assessed the use of medical cannabis and prescription drugs in a cohort of over 2,000 Canadian patients licensed to access marijuana products. Among those patients with a primary diagnosis of chronic pain, 73 percent reported substituting cannabis in place of opioids. Among those patients diagnosed specifically with headache/migraine, cannabis was frequently reported as a substitute for other medications – including opiates (43 percent), anti-depressants (39 percent), NSAIDS (21 percent), triptans (8 percent), and anti-convulsants (8 percent).

    “Most patients in the pain groups reported replacing prescription medications with medicinal cannabis, the most common of which were opiates/opioids across all patient groups,” authors concluded. “This is notable given the well-described ‘opioid-sparing effect’ of cannabinoids and growing abundance of literature suggesting that cannabis may help in weaning from these medications and perhaps providing a means of combating the opioid epidemic.”

    The study’s findings are consistent with those of numerous others finding that patients in medical cannabis access programs significantly reduce or eventually eliminate their use of opioid analgesics over the long-term.

    Full text of the study, “Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort,” appears online here.

  • by Paul Armentano, NORML Deputy Director April 2, 2018

    The enactment of marijuana legalization laws is associated with a significant reduction in the number of opioids prescribed and filled, according to a pair of studies published online today in the journal JAMA Internal Medicine.

    In the first study, investigators from the University of Kentucky and Emory University assessed the association between medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees. They reported:

    “State implementation of medical marijuana laws was associated with a 5.88 percent lower rate of opioid prescribing. Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38 percent lower rate of opioid prescribing. … [T]he further reductions in opioid prescribing associated with the newly implemented adult-use marijuana laws suggest that there were individuals beyond the reach of medical marijuana laws who may also benefit from using marijuana in lieu of opioids. Our finding that the lower opioid prescribing rates associated with adult-use marijuana laws were pronounced in Schedule II opioids further suggest that reaching these individuals may have greater potential to reduce the adverse consequences, such as opioid use disorder and overdose.”

    The full text of the study, “Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees,” is available here.

    In the second study, University of Georgia researchers evaluated the association between the enactment of medical cannabis access laws and opioid prescribing patterns under Medicare Part D. They reported:

    “This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened. … Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.”

    The full text of the study, “Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population,” is available here.

    Both findings are consistent with those of numerous prior studies finding that cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, mortality, and overall prescription drug spending. A compilation of these studies is available in the NORML fact-sheet here.

  • by Paul Armentano, NORML Deputy Director March 1, 2018

    Patients routinely reduce or eliminate their use of prescription opiates following the use of medical cannabis; two recently published studies reaffirm this relationship.

    In the first study, published by the Minnesota Department of Health, investigators assessed the prescription drug use patterns of 2,245 intractable pain patients participating in the state’s medical cannabis access program. Among those patients known to be taking opiates for pain upon enrollment in the program, 63 percent “were able to reduce or eliminate opioid usage after six months.” The findings are similar to those of registered patients in other states’ medical cannabis programs, including Illinois, Michigan, and New Mexico, among others.

    In the second study, Israeli researchers assessed the safety and efficacy of cannabis in a cohort of over 1,200 cancer patients over a period of six months. Ninety-six percent of patients “reported an improvement in their condition.” Nearly half of respondents reported either decreasing or eliminating their use of opioids during the treatment period.

    A third recently published clinical trial provides insight into explaining this relationship. Investigators from the United States and Australia and assessed the efficacy of inhaled cannabis and sub-therapeutic doses of oxycodone on experimentally-induced pain in a double-blind, placebo-controlled model. Researchers assessed subjects’ pain tolerance after receiving both substances separately or in concert with one another. While neither the administration of cannabis nor oxycodone alone significantly mitigated subjects’ pain, the combined administration of both drugs did so effectively.

    Authors determined, “Both active cannabis and a low dose of oxycodone (2.5 mg) were sub-therapeutic, failing to elicit analgesia on their own; however, when administered together, pain responses … were significantly reduced, pointing to the opioid-sparing effects of cannabis.” They concluded, “Smoked cannabis combined with an ineffective analgesic dose of oxycodone produced analgesia comparable to an effective opioid analgesic dose without significantly increasing cannabis’s abuse liability.”

    The new studies add to the growing body of research finding that cannabis access is associated with reduced rates of opioid use and abuse, opioid-related hospitalizations, opioid-related traffic fatalities, opioid-related drug treatment admissions, and opioid-related overdose deaths.

    Additional information regarding the association between cannabis and opioids is available from NORML’s fact-sheet here.

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