Rising 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.
Rates 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.
Chronic pain patients with legal access to medicinal cannabis significantly decrease their use of opioids, according to data published online ahead of print in The Journal of Pain.
Investigators at the University of Michigan, Ann Arbor conducted a retrospective survey of 244 chronic pain patients. All of the subjects in the survey were qualified under Michigan law to consume medicinal cannabis and frequented an area dispensary to obtain it.
Authors reported that respondents often substituted cannabis for opiates and that many rated marijuana to be more effective.
“Among study participants, medical cannabis use was associated with a 64% decrease in opioid use, decreased number and side effects of medications, and an improved quality of life,” they concluded. “This study suggests that many chronic pain patients are essentially substituting medical cannabis for opioids and other medications for chronic pain treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications.”
About 40 people die daily from opioid overdoses, according to the US Centers for Disease Control.
Clinical trial data published last month in The Clinical Journal of Pain reported that daily, long-term herbal cannabis treatment is associated with improved pain relief, sleep and quality of life outcomes, as well as reduced opioid use, in patients unresponsive to conventional analgesic therapies.
The results of a 2015 Canadian trial similarly concluded that chronic pain patients who consumed herbal cannabis daily for one-year experienced reduced discomfort and increased quality of life compared to controls, and did not possess an increased risk of serious side effects.
Separate data published in 2014 in The Journal of the American Medical Association determined that states with medical marijuana laws experience far fewer opiate-related deaths than do states that prohibit the plant. Investigators from the RAND Corporation reported similar findings in 2015, concluding, “States permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.” Clinical data published in 2011 in the journal Clinical Pharmacology & Therapeutics previously reported that the administration of vaporized cannabis “safely augments the analgesic effect of opioids.”
An abstract of the University of Michigan study, “Medical cannabis associated with decreased opiate medication use in retrospective cross-sectional survey of chronic pain patients,” appears online here.
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.
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.