A brand new examine, led by researchers at New York’s Division of Well being and printed this week by the American Medical Affiliation, discovered that continual ache sufferers who obtained medical marijuana for longer than a month noticed important reductions in prescribed opioids.
The evaluation checked out information from greater than 8,000 sufferers registered in New York’s medical hashish program, monitoring how their opioid prescriptions modified over time. It concluded that amongst ache sufferers who obtained marijuana for greater than 30 days, opioid quantities fell by practically half.
“Sufferers’ every day opioid dosages have been lowered by 47% to 51% of the baseline dosages after 8 months.”
New York’s appearing well being commissioner, James McDonald, referred to as the examine “additional proof that medical hashish has the potential to scale back the quantity of opioid-based drugs wanted to deal with continual ache.”
“These findings have the potential to additional inform well being suppliers and policymakers right here in New York in addition to in different jurisdictions the place medical hashish just isn’t but legalized or used to its fullest potential,” he mentioned in a statement.
The brand new peer-reviewed study, co-authored by researchers on the Well being Division, the state’s Workplace of Hashish Administration and the Metropolis College of New York (CUNY) Graduate College of Public Well being and Well being Coverage, was printed within the January 30 problem of the Journal of the American Medical Affiliation (JAMA) Community Open.
“Receiving medical hashish for an extended period was related to prescription opioid dosage discount.”
“This examine discovered significant reductions amongst sufferers receiving medical hashish for 30 days or longer,” mentioned lead creator Dr. Trang Nguyen, of the Division of Well being. “Sufferers’ every day opioid dosages have been lowered by 47 p.c to 51 p.c of the baseline dosages after eight months.”
Sufferers who obtained hashish for lower than 30 days, in the meantime, noticed reductions of simply 4 p.c to 14 p.c.
As #DrJamesMcDonald mentioned: its findings are “additional proof that medical hashish has the potential to scale back the quantity of opioid-based drugs wanted to deal with continual ache.” https://t.co/FlZLHftIAu
— NYSDOH (@HealthNYGov) February 1, 2023
Researchers examined information from the state’s medical hashish program between 2017 and 2019 and linked affected person information with official logs of prescribed opioids, that are reported to the state’s prescription monitoring program registry. They included sufferers with medical hashish suggestions for continual ache and a minimum of one opioid prescription on the time they have been first distributed marijuana.
The 8,165 sufferers within the examine have been break up into two teams: those that, information confirmed, obtained hashish for greater than 30 days after first being distributed hashish, and those that joined the registry however apparently stopped making purchases after lower than a month. Sufferers have been additionally divided into three teams based mostly on their prescribed opioid dosage previous to receiving medical hashish.
Researchers then in contrast the quantity of opioids prescribed to the teams throughout the eight months after sufferers first obtained medical marijuana.
Whereas state information confirmed that each teams have been prescribed decrease doses of opioids, the discount was greater than 5.6 occasions higher for sufferers who obtained hashish for the longer period. And sufferers who have been initially being prescribed bigger quantities of opioids noticed higher reductions after receiving medical hashish.
Some limitations of the examine, the authors acknowledge, embrace the absence of race and ethnicity info in addition to any information on sufferers’ comorbidities or the underlying causes of their continual ache. Nor does the examine embrace any evaluation of hashish dosages or product kind. Researchers additionally couldn’t know why sufferers selected to make use of medical marijuana or whether or not the choice was meant to lower their reliance on opioids.
What’s extra, whereas the examine examines whether or not sufferers obtained medical hashish or have been prescribed opioids, there’s no technique to know whether or not sufferers truly used any or the entire quantities supplied—or whether or not sufferers supplemented these quantities with medicine from different sources.
Medical marijuana “is often not lined by insurance coverage and was thus unaffordable.”
However, authors say, the examine is the primary with a big pattern dimension “that evaluated the affiliation between the size of receiving [medical cannabis] and discount in every day opioid doses.” Most earlier analysis have relied on self-reported survey information or have been restricted to small teams of sufferers.
“These findings contribute strong proof for clinicians relating to the potential advantages of [medical cannabis] in decreasing the opioid burden for sufferers,” the examine says, noting that as of 2019, 1 in 5 adults had continual ache, and greater than 22 p.c of these mentioned they’d just lately used prescription opioids for aid.
With opioid-related deaths at disaster ranges, extra restrictive pointers for prescribing the medicine have resulted in “discontinuation and lowered initiation of opioid prescriptions,” authors be aware. That dangers slicing off sufferers abruptly, placing individuals who’ve come to depend on opioids to handle their continual ache in a tough spot. Some flip to the unregulated market, the place risks resembling fentanyl poisoning are far higher.
“With out humane tapering of opioids and efficient options for sufferers receiving long-term opioid remedy,” the examine says, “a lot of them are at excessive danger of overdose (by way of turning to the illicit market) and of suicide.”
Researchers be aware that medical remedy additionally varies significantly by earnings, citing information exhibiting that folks insured by Medicaid obtain opioids at greater charges than these with personal insurance coverage and usually tend to obtain long-term opioid remedy. “Few sufferers within the examine inhabitants have been insured by Medicaid,” they write, “and of these, many who initiated [medical cannabis] didn’t proceed. It’s because [medical cannabis] is often not lined by insurance coverage and was thus unaffordable.”
Research co-author Nicole Quackenbush, of New York’s Workplace of Hashish Administration, acknowledged sufferers who’ve lengthy reported that hashish helps successfully handle ache.
“Because the inception of the Medical Hashish Program in New York State, we’ve heard anecdotal proof from sufferers, caregivers and well being care suppliers suggesting that medical hashish can cut back the quantity of opioids sufferers take to handle ache,” she mentioned, “and now we have now the examine demonstrating a statistically and clinically important discount for these sufferers who have been on medical hashish for an extended period.”
Legalization advocates greeted publication of the brand new examine as extra proof that hashish may help handle ache, in lots of instances higher and extra safely than prescribed drugs. In a blog post, NORML referred to as the examine’s findings “in step with quite a few different research documenting that sufferers steadily use hashish for ache mitigation, and that many sufferers both cut back or remove their consumption of opioids and different drugs following hashish remedy.”
“The connection between hashish and opioid use is amongst of the best-documented elements of marijuana coverage,” mentioned NORML Deputy Director Paul Armentano. “In brief, the science demonstrates that marijuana is a comparatively protected and efficient ache reliever — and that sufferers with authorized entry to it persistently cut back their use of prescription opioid drugs.”
There’s no deficit of anecdotal reviews, data-based research and observational analyses which have signaled that some individuals use hashish as an alternative choice to conventional pharmaceutical medicine like opioid-based painkillers and sleep drugs. However the brand new analysis contributes to a rising physique of printed analysis inspecting hashish as a viable remedy for continual ache, and significantly as a alternative for opioids.
Final month an analogous report discovered that adult-use hashish legalization on the state degree was related to “reductions in opioid demand.” Leveraging information from Drug Enforcement Administration (DEA) monitoring of prescription opioid shipments, that examine discovered a “26 p.c discount in retail pharmacy-based codeine distribution” in authorized states.
One other examine just lately printed by the American Medical Affiliation (AMA) discovered that roughly one in three continual ache sufferers report utilizing marijuana as a remedy possibility, and most of that group has used hashish as an alternative choice to different ache drugs, together with opioids.
A separate AMA examine discovered an affiliation between state-level medical marijuana legalization and important decreases in opioid prescriptions and use amongst sure most cancers sufferers.
A examine launched in September discovered that giving individuals authorized entry to medical hashish may help sufferers cut back or cease use of opioid painkillers with out compromising their high quality of life.
The identical month, one other examine discovered that the pharmaceutical trade takes a critical financial hit after states legalize marijuana—with a median market lack of practically $10 billion for drugmakers per every legalization occasion.
Final yr, a analysis paper that analyzed Medicaid information on prescribed drugs discovered that legalizing marijuana for grownup use is related to “important reductions” in using prescribed drugs for the remedy of a number of situations.
Photograph courtesy of Philip Steffan.