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.
States that permit qualified patients to access medical marijuana via dispensaries possess lower rates of opioid addiction and overdose deaths, according to a study published by the National Bureau of Economic Research, a non-partisan think-tank.
Researchers from the RAND Corporation and the University of California, Irvine assessed the impact of medical marijuana laws on problematic opioid use, as measured by treatment admissions for opioid pain reliever addiction (compiled from the years 1992 to 2012) and by state-level opioid overdose deaths (compiled from the years 1999 to 2013).
“[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not,” authors reported. They found that women over the age of 40 showed the most significant decrease in problematic opioid use.
Data published last year in the Journal of the American Medical Association (JAMA) Internal Medicine reported that the enactment of statewide medicinal marijuana laws is associated with significantly lower state-level opioid overdose mortality rates. “States with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws,” investigators reported.
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 study, “Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?”, is available online here.
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.