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In 2019, an estimated 10.1 million people aged 12 or older misused opioids, [1] and opioid addiction remains at an all-time high. The use of medical cannabis has been proposed as an alternative therapy to opioids, but further studies are needed to evaluate efficacy and dosing, as well as determine whether medical cannabis use can reduce dependence on opioids for pain management.

“In the setting of the current opioid crisis, we must identify alternatives that may mitigate the reliance on opioids for controlling pain,” said Asif M. Ilyas, MD, MBA, program director of the hand & upper extremity surgery fellowship at The Rothman Orthopaedic Institute and professor of orthopaedic surgery at Thomas Jefferson University Hospital in Philadelphia.

“At this point, we are not advocating for the routine use of medical cannabis or saying it is a better option, but our studies show potential.”

Opioid Prescriptions Before and After Medical Cannabis Use

Dr. Ilyas was the lead investigator of 2 recent studies on medical cannabis use in patients with chronic orthopaedic pain. The studies were presented at the 2022 Annual Meeting of the American Academy of Orthopaedic Surgeons.

For the 2 studies, Dr. Ilyas and colleagues reviewed data on filled opioid prescriptions for patients with chronic back pain or OA who were certified for medical cannabis access between February 2018 and July 2019. They compared the average morphine milligram equivalents (MME) per day for opioid prescriptions filled 6 months before access to medical cannabis versus 6 months after access.

They found that providing access to medical cannabis in these patient populations can reduce – or even eliminate – the use of opioids for pain management. Pain and quality of life scores improved in the 2 studies after patients were certified for medical cannabis use.

Deeper Dive: Chronic Back Pain Data

Analysis of data on chronic musculoskeletal, non-cancer back pain showed:

• A significant decrease in the overall average MMEs per day after medical cannabis access, from 15.1 to 11.0 (n=186)
• A reduction of MMEs per day to 0 for 38.7% of patients
• A significant decrease in MMEs, from 3.5 to 2.1 (n=134), for patients who started at less than 15 MMEs per day; reduction to 0 MMEs per day for 48.5% of patients in this group
• A significant decrease in MMEs, 44.9 to 33.9 (n=52), for patients who started at greater than 15 MMEs per day; reduction to 0 MMEs per day for 13.5% of patients in this group
• Improved intensity, frequency, and daily function at 3, 6, and 9months after access to medical cannabis compared with baseline
• A significant decrease in MMEs per day, from 13.2 to 9.5 (n=76), for patients who used 2 or more routes of administration for medical cannabis

Deeper Dive: Osteoarthritis Data

Patient outcome measures were assessed at 3, 6, and 9 months following medical cannabis use among patients who had been taking opioids to treat the pain of OA. Analysis of data after access to medical cannabis showed:

• A significant decrease in the average MMEs per day of prescriptions filled by patients, from 18.2 to 9.8 (n=40); 46.3% average drop in MMEs per day
• Reduction of MMEs per day to 0 for 37.5% of patients.
• A significant decrease in patients’ pain scores, from 6.6 (n=36) to 5.0 (n=26) at 3 months and to 5.4 (n=16) at 6 months
• A significant increase in the Global Physical Health quality of life score, from 37.5 to 41.4 at 3 months.

“Our studies show that medical cannabis can be an effective treatment for chronic back pain and osteoarthritis, potentially helping reduce the reliance on opioids,” said Dr. Ilyas. “However, additional research is needed to better understand the best routes and frequencies, potential adverse events, and long-term outcomes of medical cannabis use.

“In the interim, prescribers should use shared decision making with their patients when considering medical cannabis for chronic musculoskeletal pain conditions.”

Sources

Greis A, Renslo B, Vaccaro A, Plusch K, Ilyas AM. Medical Cannabis Use Reduces Opioid Prescriptions in Patients with Chronic Back Pain (Abstract 080). Presented at the American Academy of Orthopaedic Surgeons’ 2022 Annual Meeting, March 22-26, 2022, Chicago, Illinois.

Renslo B, Greis A, Plusch K, Ilyas AM. Medical Cannabis Use Reduces Opioid Prescriptions in Patients with Osteoarthritis (Abstract 085). Presented at the American Academy of Orthopaedic Surgeons’ 2022 Annual Meeting, March 22-26, 2022, Chicago, Illinois.

Reference

1. US Department of Health and Human Services. Opioid Crisis Statistics. Accessed on March 23, 2022.