Highlights
- •Medical cannabis users reported substituting cannabis for pain medications.
- •User rationale for substitution was fewer side effects and better pain management.
- •Most users reported improved pain and health since using cannabis.
- •Intentions behind and duration of cannabis use affected substitution behavior.
- •Unlike previous studies, >50% of participants were women and adults >50 years old.
Abstract
Chronic pain is common, costly, and challenging to treat. Many individuals with chronic
pain have turned to cannabis as an alternative form of pain management. We report
results from an ongoing, online survey of medical cannabis users with chronic pain
nationwide about how cannabis affects pain management, health, and pain medication
use. We also examined whether and how these parameters were affected by concomitant
recreational use, and duration of use (novice: <1 year vs experienced: ≥1 year). There
were 1,321 participants (59% female, 54% ≥50 years old) who completed the survey.
Consistent with other observational studies, approximately 80% reported substituting
cannabis for traditional pain medications (53% for opioids, 22% for benzodiazepines),
citing fewer side effects and better symptom management as their rationale for doing
so. Medical-only users were older (52 vs 47 years old; P < .0001), less likely to drink alcohol (66% vs 79%, P < .0001), and more likely to be currently taking opioids (21% vs 11%, P < .0001) than users with a combined recreational and medical history. Compared with
novice users, experienced users were more likely to be male (64% vs 58%; P < .0001), take no concomitant pain medications (43% vs 30%), and report improved
health (74% vs 67%; P = .004) with use. Given that chronic pain is the most common reason for obtaining
a medical cannabis license, these results highlight clinically important differences
among the changing population of medical cannabis users. More research is needed to
better understand effective pain management regimens for medical cannabis users.
Perspective: This article presents results that confirm previous clinical studies
suggesting that cannabis may be an effective analgesic and potential opioid substitute.
Participants reported improved pain, health, and fewer side effects as rationale for
substituting. This article highlights how use duration and intentions for use affect
reported treatment and substitution effects.
Key words
To read this article in full you will need to make a payment
Subscribe to The Journal of Pain
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly.Eur J Intern Med. 2018; 49: 44-50
- Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.JAMA Intern Med. 2014; 174: 1668-1673
- Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer.Eur J Intern Med. 2018; 49: 37-43
- Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.J Headache Pain. 2018; 19: 37
- Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain.J Pain. 2016; 17: 739-744
- Medical marijuana laws reduce prescription medication use in Medicare Part D.Health Aff (Millwood). 2016; 35: 1230-1236
- Medical marijuana laws may be associated with a decline in the number of prescriptions for Medicaid enrollees.Health Aff (Millwood). 2017; 36: 945-951
- Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population.JAMA Intern Med. 2018; 178: 667-672
- Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: Findings from a 4-year prospective cohort study.Lancet Public Health. 2018; 3: E341-E350
- Pain management: Fibromyalgia drugs are 'as good as it gets' in chronic pain.Nat Rev Rheumatol. 2010; 6: 439-440
- Fibromyalgia: A clinical review.JAMA. 2014; 311: 1547-1555
- Marijuana use and use disorders in adults in the USA, 2002-14: Analysis of annual cross-sectional surveys.Lancet Psychiatr. 2016; 3: 954-964
- Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability.Neuropsychopharmacology. 2018; 43: 2046-2055
- Cannabis as a substitute for prescription drugs - a cross-sectional study.J Pain Res. 2017; 10: 989-998
- CDC guideline for prescribing opioids for chronic pain–United States, 2016.JAMA. 2016; 315: 1624-1645
- Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.Pain. 2001; 94: 149-158
- Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.Lancet Neurol. 2015; 14: 162-173
- The effect of medicinal cannabis on pain and quality-of-life outcomes in chronic pain: A prospective open-label study.Clin J Pain. 2016; 32: 1036-1043
- Drug overdose deaths in the United States, 1999-2016.NCHS Data Brief. 2017; : 1-8
- Early phase in the development of cannabidiol as a treatment for addiction: Opioid relapse takes initial center stage.Neurotherapeutics. 2015; 12: 807-815
- Characteristics of adults seeking medical marijuana certification.Drug Alcohol Depend. 2013; 132: 654-659
Institute of Medicine. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press, 2011
- Risks and benefits of marijuana use: A national survey of U.S. adults.Ann Intern Med. 2018; 169: 282-290
- Comparing adults who use cannabis medically with those who use recreationally: Results from a national sample.Addict Behav. 2016; 61: 99-103
- Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients.Int J Drug Policy. 2017; 42: 30-35
- Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors.Drug Alcohol Rev. 2016; 35: 326-333
- Practical considerations in medical cannabis administration and dosing.Eur J Intern Med. 2018; 49: 12-19
Malani P, Singer D, Solway E, Kirch M, Clark S: Older adults’ perspectives on medical marijuana. University of Michigan National Poll on Healthy Aging. April 2018. Available at: http://hdl.handle.net/2027.42/143211
- Opioid-sparing effect of cannabinoids: A systematic review and meta-analysis.Neuropsychopharmacology. 2017; 42: 1752-1765
- The effects of cannabis among adults with chronic pain and an overview of general harms: A systematic review.Ann Intern Med. 2017; 167: 319-331
- Benefits and harms of plant-based cannabis for posttraumatic stress disorder.Ann Intern Med. 2017; 167: 332-340
- Cannabis use and risk of prescription opioid use disorder in the United States.Am J Psychiatry. 2018; 175: 47-53
- Chronic pain patients' perspectives of medical cannabis.Pain. 2017; 158: 1373-1379
- Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep.J Psychopharmacol. 2017; 31: 569-575
- Do medical marijuana laws reduce addictions and deaths related to pain killers.J Health Econ. 2015; 58: 29-42
Available at: Procon.org. 31 legal medical marijuana states and DC. 2018. Accessed October 22, 2018
Available at: Procon.org. Number of legal medical marijuana patients. 2018. Accessed October 22, 2018
- Cannabis as a substitute for opioid-based pain medication: Patient self-report.Cannabis Cannabinoid Res. 2017; 2: 160-166
- A cross-sectional survey of medical cannabis users: Patterns of use and perceived efficacy.Cannabis Cannabinoid Res. 2016; 1: 131-138
- The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, (DC): National Academies Press.2017
- Medical cannabis in Arizona: Patient characteristics, perceptions, and impressions of medical cannabis legalization.J Psychoactive Drugs. 2015; 47: 259-266
- Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study.PLoS One. 2017; 12 (e0187795-e0187795)
- Adverse health effects of marijuana use.N Engl J Med. 2014; 370: 2219-2227
- Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: A review.JAMA Psychiatry. 2016; 73: 292-297
- Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees.JAMA Intern Med. 2018; 178: 673-679
- Cannabinoids for medical use: A systematic review and meta-analysis.JAMA. 2015; 313: 2456-2473
Article Info
Publication History
Published online: January 25, 2019
Accepted:
January 23,
2019
Received in revised form:
January 22,
2019
Received:
October 18,
2018
Footnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Drs. Boehnke, Scott, and Williams declare no conflicts of interest. Dr. Clauw has consulted for Pfizer, Inc, Eli Lilly and Company, Tonix Pharmaceuticals, Aptinyx, Regeneron, IMC, and Intec. Dr. Litinas is Chief Medical Officer at and co-owner of Om of Medicine, a medical cannabis provisioning center in Ann Arbor, Michigan. Dr. Sisley has received funding from the Multidisciplinary Association for Psychedelic Studies and is a member of the Steering Committee/Entrepreneurship and Social Initiative Impact Advisor Board for the Lambert Center for the Study of Medicinal Cannabis and Hemp.
Identification
Copyright
© 2019 by the American Pain Society
