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  • 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 Paul Armentano, NORML Deputy Director June 10, 2019

    Marijuana and OpioidsMilitary veterans who participate in a state’s medical marijuana access program frequently report substituting cannabis for alcohol and other controlled substances, according to data published in The American Journal of Drug and Alcohol Abuse.

    A team of investigators from Palo Alto University in California, Harvard University, and the Perelman School of Medicine in Philadelphia surveyed marijuana use patterns in 93 US military veterans participating in a medical cannabis collective.

    Nearly 80 percent of respondents reported using cannabis “to treat both physical and mental health symptoms.” Respondents were most likely to report using cannabis therapeutically to mitigate symptoms of chronic pain (69 percent), anxiety (66 percent), post-traumatic stress (59 percent), and depression (56 percent).

    Over 60 percent of respondents said that they consumed cannabis as a substitute for other illicit or licit substances, particularly alcohol. Nearly half of all respondents said that they use medical cannabis in place of other prescription medications.

    Authors concluded, “The current study also confirms the findings of previous studies that have documented a trend in substitution behavior, where cannabis is substituted for other drugs, which, if associated with reduced harm, could be beneficial for overall health.”

    Under existing federal regulation, physicians affiliated with the Department of Veterans Affairs may not legally provide the paperwork necessary for veterans to obtain medical cannabis in states that regulate its access.

    The abstract of the study, “A cross-sectional examination of choice and behavior of veterans with access to free medicinal cannabis,” is online here. Additional information is available in the NORML fact-sheet “Marijuana and Veteran Issues.”

  • 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.

  • by Paul Armentano, NORML Deputy Director June 28, 2017

    medical_mj_shelfPain patients report successfully substituting cannabis for opioids and other analgesics, according to data published online in the journal Cannabis and Cannabinoid Research.

    Researchers from the University of California, Berkeley and Kent State University in Ohio assessed survey data from a cohort of 2,897 self-identified medical cannabis patients.

    Among those who acknowledged having used opioid-based pain medication within the past six months, 97 percent agreed that they were able to decrease their opiate intake with cannabis. Moreover, 92 percent of respondents said that cannabis possessed fewer adverse side-effects than opioids. Eighty percent of respondents said that the use of medical cannabis alone provided greater symptom management than did their use of opioids.

    Among those respondents who acknowledged having recently taken nonopioid-based pain medications, 96 percent said that having access to cannabis reduced their conventional drug intake. Ninety-two percent of these respondents opined that medical cannabis was more effective at treating their condition than traditional analgesics.

    Authors concluded: “[M]ore people are looking at cannabis as a viable treatment for everyday ailments such as muscle soreness and inflammation. … [T]his study can conclude that medical cannabis patients report successfully using cannabis along with or as a substitute for opioid-based pain medication.”

    The study’s conclusions are similar to those of several others, such as these herehereherehere, and here, finding reduced prescription drug use and spending by those with access to cannabis. Separate studies report an association between cannabis access and lower rates of opioid-related abuse, hospitalizations, traffic fatalities, and overdose deaths.

    Full text of the study, “Cannabis as substitute for opioid-based pain medication: patient self-report,” appears online here.

  • by Paul Armentano, NORML Deputy Director May 3, 2017

    Medical marijuanaAdults often substitute cannabis for the use of prescription medications, according to data published in the Journal of Pain Research.

    Investigators from the Bastyr University Research Institute assessed the frequency of drug substitution among a self-selected national sample of 2,774 self-identified marijuana consumers.

    Just under half of respondents (46 percent) reported using cannabis in place of prescription medications. Respondents were most likely to use cannabis in lieu of narcotics/opioids (36 percent), anxiolytics/benzodiazepenes (14 percent), and antidepressants (13 percent).

    Women were more likely than men to report drug substitution, as were older respondents. Those who identified as medical cannabis patients were more than four times as likely as non-medical users to report drug substitution.

    “These data contribute to a growing body of literature suggesting cannabis, legal or otherwise, is being used as a substitute for prescription drugs, particularly prescription pain relievers,” authors concluded.

    The study’s conclusions are similar to those of several others, such as these here, here, here, and here, finding reduced prescription drug use and spending by those with access to cannabis.

    Full text of the study, “Cannabis as a substitute for prescription drugs — a cross sectional study,” appears in the Journal of Pain Research here.

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