• 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.

  • by Paul Armentano, NORML Deputy Director September 19, 2016

    oil_bottlesThe implementation of medical marijuana programs is associated with a decrease in the prevalence of opioids detected among fatally injured drivers, according to data published in the American Journal of Public Health.

    Researchers at Columbia University in New York and the University of California at Davis performed a between-state comparison of opioid positivity rates in fatal car accidents in 18 states. Authors reported that drivers between the ages of 21 and 40 who resided in states that permitted medical marijuana use were approximately half as likely to test positive for opioids as were similar drivers in jurisdictions that did not such programs in place.

    They concluded, “Operational MMLs (medical marijuana laws) are associated with reductions in opioid positivity among 21- to 40-year-old fatally injured drivers and may reduce opioid use and overdose.”

    Prior comparisons have determined that medical cannabis access is associated with lower rates of opioid use, abuse, and mortality. Most recently, a 2016 study published in the journal Health Affairs reported a significant decrease in the use of prescription medications following the implementation of medical marijuana programs.

    An abstract of the study, “State medical marijuana laws and the prevalence of opioids detected among fatally injured drivers,” appears online here.

  • by Paul Armentano, NORML Deputy Director June 9, 2016

    for_painRising rates of medical cannabis use among Canadian military veterans is associated with a parallel decline in the use of prescription opiates and benzodiazepenes, according to federal data recently provided to The Globe and Mail.

    According to records provided by Veterans Affairs Canada, the number of veterans prescribed benzodiazepines (e.g. Xanax, Ativan, and Valium) fell nearly 30 percent between 2012 and 2016, while veterans’ use of prescription opiates declined almost 17 percent. During this same period, veterans seeking federal reimbursements for prescription cannabis rose from fewer than 100 total patients to more than 1,700.

    Canadian officials legalized the use of cannabis via prescription in 2001.

    While the data set is too small to establish cause and effect, the trend is consistent with data indicating that many patients substitute medical cannabis for other prescription drugs, especially opiates.

    Prior assessments from the United States report that incidences of opioid-related addiction, abuse, and mortality are significantly lower in jurisdictions that permit medicinal cannabis access as compared to those states that do not.

  • by Paul Armentano, NORML Deputy Director April 26, 2016

    pills_v_potRates of prescription opioid abuse are significantly lower in jurisdictions that permit medical marijuana access, according to data reported by Castlight Health, an employee health benefits platform provider.

    Investigators assessed anonymous prescription reporting data from over one million employees between the years 2011 and 2015.

    In states that did not permit medical marijuana access, 5.4 percent of individuals with an opioid prescription qualified as abusers of the drug. (The study’s authors defined “abuse” as opioid use by an individual who was not receiving palliative care, who received greater than a 90-day cumulative supply of opioids, and received an opioid prescription from four or more providers.) By contrast, only 2.8 percent of individuals with an opioid prescription living in medical marijuana states met the criteria.

    The findings are similar to those reported by the RAND Corporation in 2015, which determined, “[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.”

    Data published in 2014 in the Journal of the American Medical Association (JAMA) Internal Medicine also reported that the enactment of statewide medicinal marijuana laws is associated with significantly lower state-level opioid overdose mortality rates, finding, “States with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.”

    Full text of the new study, “The opioid crisis in America’s workforce,” appears online here.

  • by Paul Armentano, NORML Deputy Director November 30, 2015

    cannabis_pillsCannabis 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.

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