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Opioids

  • by NORML July 2, 2019

    Marijuana and OpioidsAdults who purchase retail cannabis typically report using it to mitigate pain and to improve sleep, and often use it in place of conventional medications, according to data published online today in the Journal of Psychoactive Drugs.

    A team of investigators from the Albert Einstein College of Medicine in New York and the University of Miami assessed marijuana use trends among 1,000 adult use customers in Colorado.

    Seventy-four percent of those surveyed said that they consumed cannabis to promote sleep, while 65 percent reported using cannabis to alleviate pain. Among those respondents with a history of taking prescription sleep aids, 83 percent reported either reducing or ceasing their use of those medicines. Among those respondents with a history of consuming prescription opioids, 88 percent reported mitigating or stopping their use.

    “Our findings suggest that de facto medical use may be highly prevalent among adult use customers, and that access to an adult use cannabis market may influence individuals’ use of other medications,” authors concluded. “Our findings … suggest that adult use customers may be similar to medical cannabis patients in their use of cannabis as a substitute for prescription analgesics and sleep aids. … While adult use laws are frequently called ‘recreational,’ … our findings suggest that many customers use cannabis for symptom relief.”

    NORML Deputy Director Paul Armentano said that the study’s findings are significant, though not altogether surprising. “Several prior studies similarly show that the use of cannabis by qualified patients is associated with the reduction, or even the elimination, of certain other prescription drugs — specifically opioids — over time,” he said. “These findings speak not only to the therapeutic efficacy of cannabis as an alternative analgesic option, but also to its potential role as a harm reduction agent.”

    Longitudinal studies assessing the use of prescription drugs following patients’ enrollment in state-sanctioned medical cannabis access programs frequently report a decline in the use of conventional medicines, specifically opioids, anti-anxiety drugs, and sleep aids.

    The abstract of the study, “Use of cannabis to relieve pain and promote sleep by customers at an adult use dispensary,” appears online here.

  • by Paul Armentano, NORML Deputy Director June 11, 2019

    Patients diagnosed with chronic pain and other debilitating conditions typically reduce, or in some cases, eliminate their use of opioids following their enrollment in state-sanctioned medical cannabis access programs.

    Several peer-reviewed studies now document this trend. In contrast to observational, population-based studies — which only seek to identify whether an association exists between the passage of medical cannabis laws and opioid use trends in the general population — these papers explicitly assess individual patients’ relationship with opioids following their registration in state-sponsored access programs.

    For example, researchers writing in the May edition of the journal Annals of Pharmacotherapy evaluated the use of opioids in 77 intractable pain patients newly enrolled in the Minnesota Medical Cannabis Program. Researchers reported “a statistically significant decrease in MME (milligram morphine equivalents) from baseline to both three and six months.”

    A 2018 study assessing prescription drug use trends among patients enrolled in New York state’s medical cannabis program yielded similar results. On average, subjects’ monthly analgesic prescription costs declined by 32 percent following enrollment, primarily due to a reduction in the use of opioid pills and fentanyl patches. “After three months treatment, medical cannabis improved [subjects’] quality of life, reduced pain and opioid use, and lead to cost savings,” authors concluded.

    These conclusions are hardly unique. A study of 244 state-registered chronic pain patients enrolled in Michigan’s medical cannabis program reported: “[M]edical cannabis use was associated with a 64 percent decrease in opioid use, decreased number and side effects of medications, and an improved quality of life. This study suggests that many CP [chronic pain] patients are essentially substituting medical cannabis for opioids and other medications for CP treatment.”

    A separate review of over 2,000 chronic pain patients in Minnesota reported that 63 percent of those who used opioids at the time of admission into the program “were able to reduce or eliminate their opioid use after six months.”

    Yet another study, this time evaluating the prescription drug use patterns of patients enrolled in Illinois’ medical access program, similarly revealed: “[O]ur results indicate that MC (medical cannabis) may be used intentionally to taper off prescription medications. These findings align with previous research that has reported substitution or alternative use of cannabis for prescription pain medications due to concerns regarding addiction and better side-effect and symptom management, as well as complementary use to help manage side-effects of prescription medication.”

    Perhaps most notably, a 2017 study published in the journal PLoS ONE compared prescription drug use patterns among pain patients enrolled in the New Mexico medical access program versus similarly matched control patents who were not. Compared to non-users, over a 21-month period medical cannabis enrollees “were more likely either to reduce daily opioid prescription dosages between the beginning and end of the sample period (83.8 percent versus 44.8 percent) or to cease filling opioid prescriptions altogether (40.5 percent versus 3.4 percent).” Enrollees were also more likely to report an improved quality of life.

    Authors concluded, “The clinically and statistically significant evidence of an association between MCP (medical cannabis program) enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.”

    Additional information on the relationship between cannabis and opioids is available from the NORML fact-sheet here.

  • by NORML May 21, 2019

    The administration of oral CBD reduces cue-induced cravings and anxiety in subjects with a history of heroin use, according to clinical data published in The American Journal of Psychiatry.

    Investigators at The Mount Sinai Health System in New York City assessed the effect of CBD versus placebo in 42 drug-abstinent participants with a history of heroin use. In contrast to placebo, CBD dosing of either 400mg or 800mg “significantly reduced both the craving and anxiety induced by drug cues … in the acute term. CBD also showed significant protracted effects on these measures seven days after the final short-term exposure.”

    Researchers concluded, “CBD’s potential to reduce cue-induced craving and anxiety provides a strong basis for further investigation of this phytocannabinoid as a treatment option for opioid use disorder.”

    In observational models, patients with legal access to cannabis typically reduce or eliminate their use of opioids. In clinical models, CBD administration has been shown to reduce cravings for tobacco. CBD dosing has also been associated with reduced cravings for methamphetamine in preclinical models.

    Commenting on the study’s findings, NORML Deputy Director Paul Armentano said, “These conclusions add to the growing body of evidence that cannabis and its constituents represent an exit away from the use or abuse of other controlled substances rather than a supposed ‘gateway.'”

    The abstract of the study, “Cannabidiol for the reduction of cue-induced craving and anxiety in drug-abstinent individuals with heroin use disorder: A double-blind randomized placebo controlled trial,” appears online here. Additional information is available in NORML’s fact-sheet, “Relationship between marijuana and opioids.”

  • by Josh Kasoff, Nevada NORML May 20, 2019

    Even though cannabis has been recreationally legal in the Battle Born State for nearly two years and Sin City has become a greenish gold mine of legal cannabis, many problems and societal penalties still arise with the use of it; no social consumption lounges being among the most glaring. Yet unlike the consumption lounges, people’s lives are directly being negatively impacted by laws surrounding pre-employment drug testing and previous cannabis convictions in the Prohibition years.

    Assembly Bill 132, a bill still being discussed in the Nevada Legislature, could benefit medical patients across the state from employment discrimination simply because they test positive for cannabis. Whereas a marijuana-positive drug test from an applicant would likely mean more immediate professional rejection than showing up to an interview in a neon bro tank and American flag Chubbies, AB 132 would provide cannabis users with a rebuttal if a pre-employment drug test is failed.

    Quoted exactly, the bill authorizes “an employee to rebut the results of a screening test under certain circumstances; creating a presumption that the ability of an employee to perform his or her job and that the safety of other employees is not adversely affected if an employee has certain levels of certain prohibited substances in his or her blood.”              

    Without exception, The War on Drugs was a bigger critical failure than Fyre Festival could’ve ever dreamed about. Millions now carry harmful convictions for harmless offenses that still haunt their lives and deeply hinder their access to everything from housing, financial assistance and employment opportunities. Even if they aren’t drug-related, a misdemeanor conviction can still have drastic social consequences.

    Partially as a legislative apology for the frivolous and unnecessary wrongs of the War on Drugs and partially to boost possible employment opportunities to past “offenders”, Assembly Bill 192 would create a program for anyone with permanent criminal charges to apply for the records of those crimes to be sealed. While this bill certainly applies to the unfortunately large demographic of people who have low-level cannabis charges, AB 192 applies concurrently to other charges that once were illegal in Nevada but have been decriminalized through either prior or current legislation.

    Medical marijuanaAnother frank reality of medical cannabis in modern America, apart from the increase of Taco Bell consumption, is the mountains of research behind the number of conditions that the plant treats. PTSD, cachexia and muscle spasms are among the nearly never ending list of conditions that cannabis has been proven to treat in most cases. With Nevada Senate Bill 430, the list of qualifying conditions would be expanded dramatically with specific wordings in the bill to define which condition could legally be treated with medical cannabis. With the broadening power of SB 430, conditions from anxiety and AIDS to cancer and opioid dependency would be considered qualifying conditions by the Silver State, greatly expanding the spectrum of conditions eligible for medical cannabis from the currently extremely restrictive list.

    The aforementioned bills could be historic for the constantly debated subject of cannabis patient rights and would have an extremely positive impact for both medical and recreational cannabis users alike and would surely lead to further de-stigmatization and medical cannabis patient reform that is leaps and bounds ahead of states that subscribe to stricter cannabis-related policies.

    As there’s still a small window of time in the Nevada Legislature’s 2019 session, now is the appropriate time to contact your respective representative and let your voice be heard. Please visit NORML’s Action Center at https://norml.org/act for information on specific bills.

    Follow Josh Kasoff on Twitter and Instagram @CaptainKasoff.

  • by Paul Armentano, NORML Deputy Director February 1, 2019

    Patients authorized to legally use medical cannabis frequently substitute it in place of benzodiazepines, according to a pair of new studies published this week. Benzodiazepines are class of drugs primarily used for treating anxiety. According to data compiled by the US Centers for Disease Control, the drug was attributed to over 11,500 overdose deaths in 2017.

    In the first study, Canadian researchers assessed the relationship between cannabis and benzodiazepines in a cohort of 146 patients enrolled in the nation’s medical marijuana access program. They reported that 30 percent of participants discontinued their use of anti-anxiety medications within two-months of initiating cannabis therapy, and that 45 percent did so by six-months. “Patients initiated on medical cannabis therapy showed significant benzodiazepine discontinuation rates after their first follow-up visit to their medical cannabis prescriber, and continued to show significant discontinuation rates thereafter,” authors concluded.

    In the second study, investigators at the University of Michigan surveyed over 1,300 state-registered medical cannabis patients with regard to their use of opioids and benzodiazepines. They reported that 53 percent of respondents acknowledged substituting marijuana for opioids, and 22 percent did so for benzodiazepines.

    These findings are consistent with numerous other papers — such as those here, here, here, and here — documenting patients’ use of cannabis in place of a variety of prescription drugs, particularly opioids and anti-anxiety medications.

    Full text of the study, “Reduction of benzodiazepine use in patients prescribed medical cannabis,” appears in the journal Cannabis and Cannabinoid Research here.

    An abstract of the study, “Pills to pot: Observational analyses of cannabis substitution among medical cannabis users with chronic pain,” appears in The Journal of Pain here.

    Additional information is available in NORML’s fact-sheet, “Relationship between marijuana and opioids,” here.

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