Malcolm Henry
Medical marijuana could be a viable alternative to opioid painkillers for people dealing with arthritis or chronic back pain, two new studies show.
Many patients prescribed opioids for their chronic pain wound up taking fewer painkillers — or stopping them altogether — after doctors certified them for medical cannabis, said lead researcher Dr. Asif Ilyas, an orthopedic surgeon at Rothman Orthopaedic Institute in Philadelphia.
“We found broadly a significant reduction in opioid use when they started using medical cannabis,” Ilyas said. “We saw a decrease in approximately 40% of opioid use after starting medical cannabis, with 37% to 38% of patients completely discontinuing opioid use altogether.”
If validated, these results indicate that medical marijuana could be a potential means of combating America’s opioid epidemic, which has been driven in part by prescription painkillers, said Dr. Stuart Fischer, an orthopedic surgeon with Summit Orthopaedics and Sports Medicine in Summit, N.J.
“We have a huge number of people who are on opioids who are being treated for chronic back pain,” said Fischer, who wasn’t part of the studies. “If we could move that population to something that’s safer but just as effective, we would do very well.”
For the studies, Ilyas and his colleagues recruited 186 patients with chronic back pain and 40 patients with chronic arthritis pain.
Between February 2018 and July 2019, doctors certified the patients to purchase medical marijuana in the state of Pennsylvania. The patients were allowed to use pot as they chose — some vaped or smoked, while others used edibles.
Doctors then tracked the patients’ opioid painkiller use for six months using a state-run prescription drug monitoring database, and using an opioid measurement called morphine milligram equivalents (MME):
- Average daily opioid prescriptions for arthritis patients declined during the study period, falling from 18.2 to 9.8 MME.
- Back pain patients also experience a reduction in their average daily opioid prescriptions, from 15.1 to 11 MME.
- About 37% of arthritis patients and 38% of back pain patients quit opioid painkillers altogether.
Patients in both groups experienced a reduction in their pain symptoms and an improvement in their physical health.
Medical cannabis also doesn’t appear to carry the same risk of addiction as opioid painkillers, Ilyas added.
“One of the biggest central problems with opioids is both addiction and the need for higher dosages to achieve the same results,” Ilyas said. “Based on our current understanding of medical cannabis, you do not need increasing doses to achieve the same results and we’re not yet seeing any addictive qualities to it.”
These results provide fresh evidence for the potential to treat pain with medical pot, Fischer said.
“Obviously these studies are early. Medical marijuana has not been in public use for all that long, so we need more data and we need more studies. We need more information,” Fischer continued. “Nonetheless, these two studies are a very, very good start.”
More research is needed, in part, to convince insurance companies to cover the cost of medical pot as they do prescription opioids, the experts said.
“One of the biggest barriers to usage is cost,” Ilyas explained. “It’s quite expensive, and there’s no insurance coverage for it at this time, even with private carriers.”
Ilyas said his future research will focus on how benefits differ, depending on the type of medical cannabis product, and different delivery methods.
“We want to emphasize this looks very promising, but we’re very early in our understanding of this. More investigation is needed,” Ilyas said.
Ilyas presented results from the two studies at the annual meeting of the American Academy of Orthopedic Surgeons, taking place this week in Chicago. Information presented at meetings should be considered preliminary until published in a peer-reviewed journal.
More information
The Mayo Clinic has more about medical cannabis.
SOURCES: Asif Ilyas, MD, orthopedic surgeon, Rothman Orthopaedic Institute, Philadelphia; Stuart Fischer, MD, orthopedic surgeon, Summit Orthopaedics and Sports Medicine, Summit, N.J.; March 22-26, 2022 presentations, American Academy of Orthopedic Surgeons, annual meeting, Chicago
