Could marijuana be an effective pain alternative to prescription medications?
July 1, 2019
Science Daily/Taylor & Francis Group
A new study has shown how cannabis could be an effective treatment option for both pain relief and insomnia, for those looking to avoid prescription and over the counter pain and sleep medications -- including opioids.
The study, published in the Journal of Psychoactive Drugs, which looked at 1,000 people taking legalized marijuana in an American state found that among the 65% of people taking cannabis for pain, 80% found it was very or extremely helpful.
This led to 82% of these people being able to reduce, or stop taking over the counter pain medications, and 88% being able to stop taking opioid painkillers.
74% of the 1,000 interviewees bought it to help them sleep -- 84% of whom said the marijuana had helped them, and over 83% said that they had since reduced or stopped taking over-the-counter or prescription sleep aids.
The study suggests that cannabis could lower opioid use. However, the researchers caution that more needs to be done to understand the potential therapeutic benefits of cannabis.
"Approximately 20% of American adults suffer from chronic pain, and one in three adults do not get enough sleep," says Dr Gwen Wurm, Assistant Professor of Clinical Pediatrics at the University of Miami Miller School of Medicine.
Traditional over the counter medications and painkillers can help, however they may have serious side effects. Opioids depress the respiratory system, meaning that overdoses may be fatal.
"People develop tolerance to opioids, which means that they require higher doses to achieve the same effect," says Dr. Julia Arnsten, Professor of Medicine at Albert Einstein College of Medicine. "This means that chronic pain patients often increase their dose of opioid medications over time, which in turn increases their risk of overdose."
Although less common, sleeping pills can lead to dependence, and can also cause grogginess the next day, interfering with people's work and social lives.
As a consequence, some people are looking to marijuana to help with their symptoms.
To find out more about these users, Wurm and her colleagues used survey data from people who purchased cannabis from two retail stores in Colorado, US, where it is legal for both medical and recreational use -- meaning any adult over 21 with a valid government ID may purchase product.
"In states where adult use of cannabis is legal, our research suggests that many individuals bypass the medical cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary," says Wurm.
Although the survey was conducted among customers willing to participate -- meaning the results may not reflect the overall population of dispensary customers -- other national survey data, and data from medical patients at medical cannabis dispensaries, also demonstrate that people who use cannabis to treat symptoms both decrease and stop their use of prescription medications.
The study adds weight to the theory that widening access to medical cannabis could lower the use of prescription painkillers, allowing more people to manage and treat their pain without relying on opioid prescription drugs that have dangerous side effects.
This is backed up with other research that shows that states with medical cannabis laws have a 6.38% lower rate of opioid prescribing, and that Colorado's adult-use cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010.
Wurm adds: "Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetemol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the U.S."
However, the researchers caution that more research is needed to understand the health benefits and side effects of cannabis.
"The challenge is that health providers are far behind in knowing which cannabis products work and which do not. Until there is more research into which cannabis products work for which symptoms, patients will do their own "trial and error," experiments, getting advice from friends, social media and dispensary employees," says Wurm.
https://www.sciencedaily.com/releases/2019/07/190701224523.htm
Mixed findings regarding quality of evidence supporting benefit of medical marijuana
June 23, 2015
Science Daily/JAMA - Journal of the American Medical Association
In an analysis of the findings of nearly 80 randomized trials that included about 6,500 participants, there was moderate-quality evidence to support the use of cannabinoids (chemical compounds that are the active principles in cannabis or marijuana) for the treatment of chronic pain and lower-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, sleep disorders, and Tourette syndrome, according to a study in the June 23/30 issue of JAMA.
Medical cannabis refers to the use of cannabis or cannabinoids as medical therapy to treat disease or alleviate symptoms. In the United States, 23 states and Washington, D.C., have introduced laws to permit the medical use of cannabis; many other countries have similar laws. Despite the wide us of cannabis and cannabinoid drugs for medical purposes, their efficacy for specific indications is not clear, according to background information in the article.
Penny F. Whiting, Ph.D., of the University of Bristol, Bristol, United Kingdom, and colleagues evaluated the evidence for the benefits and adverse events (AEs) of medical cannabinoids by searching various databases for randomized clinical trials of cannabinoids for a variety of indications. The researchers identified 79 trials (6,462 participants) that met criteria for inclusion in the review and meta-analysis.
The researchers found that most studies suggested that cannabinoids were associated with improvements in symptoms, but these associations did not reach statistical significance in all studies. There was moderate-quality evidence to suggest that cannabinoids may be beneficial for the treatment of chronic neuropathic or cancer pain and spasticity due to multiple sclerosis (sustained muscle contractions or sudden involuntary movements). There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette syndrome; and very low-quality evidence for an improvement in anxiety. There was low-quality evidence for no effect on psychosis and very low-level evidence for no effect on depression.
There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. There was no clear evidence for a difference in association (either beneficial or harmful) based on type of cannabinoids or mode of administration. Only 2 studies evaluated cannabis. There was no evidence that the effects of cannabis differed from other cannabinoids.
"Further large, robust, randomized clinical trials are needed to confirm the effects of cannabinoids, particularly on weight gain in patients with HIV/AIDS, depression, sleep disorders, anxiety disorders, psychosis, glaucoma, and Tourette syndrome are required. Further studies evaluating cannabis itself are also required because there is very little evidence on the effects and AEs of cannabis," the authors write.
Editorial: Medical Marijuana
"If the states' initiative to legalize medical marijuana is merely a veiled step toward allowing access to recreational marijuana, then the medical community should be left out of the process, and instead marijuana should be decriminalized," write Deepak Cyril D'Souza, M.B.B.S., M.D., and Mohini Ranganathan, M.D., of the Yale University School of Medicine, New Haven, Conn., in an accompanying editorial.
"Conversely, if the goal is to make marijuana available for medical purposes, then it is unclear why the approval process should be different from that used for other medications. Evidence justifying marijuana use for various medical conditions will require the conduct of adequately powered, double-blind, randomized, placebo/active controlled clinical trials to test its short- and long-term efficacy and safety. The federal government and states should support medical marijuana research. Since medical marijuana is not a life-saving intervention, it may be prudent to wait before widely adopting its use until high-quality evidence is available to guide the development of a rational approval process."
https://www.sciencedaily.com/releases/2015/06/150623113152.htm
What drives patients to use medical marijuana: Mostly chronic pain
New study seeks to understand whether people are using cannabis for evidence-based reasons
February 4, 2019
Science Daily/Michigan Medicine - University of Michigan
A new study seeks to understand whether people are using medical cannabis for evidence-based reasons.
Slowly but surely, the stigma surrounding marijuana use is losing its grip in the U.S. Since the 1990s, advocates have pushed for a re-evaluation of cannabis (the plant species name often used interchangeably with marijuana) as a viable treatment for a host of ailments. As of 2018, 33 states and the District of Columbia have approved the medical use of cannabis, while 10 states have legalized marijuana for recreational use. Despite this fact, at the federal level, marijuana remains a Schedule 1 drug under the Controlled Substances Act, defined as a drug with no currently accepted medical use and a high potential for abuse.
New research from the University of Michigan, published in the February issue of Health Affairs, takes a deeper dive into state medical marijuana registry data to provide more insight into its use.
"We did this study because we wanted to understand the reasons why people are using cannabis medically, and whether those reasons for use are evidence based," says lead author Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center.
He and his U-M colleagues Daniel J. Clauw, M.D., a professor of anesthesiology, medicine, and psychiatry and Rebecca L. Haffajee, Ph.D., assistant professor of health management and policy, as well as U-M alum Saurav Gangopadhyay, M.P.H., a consultant at Deloitte, sought out data from states with legalized medical use of marijuana.
To examine patterns of use, the researchers grouped patient-reported qualifying conditions (i.e. the illnesses/medical conditions that allowed a patient to obtain a license) into evidence categories pulled from a recent National Academies of Sciences, Engineering and Medicine report on cannabis and cannabinoids. The report, published in 2017, is a comprehensive review of 10,000 scientific abstracts on the health effects of medical and recreational cannabis use. According to the report, there was conclusive or substantial evidence that chronic pain, nausea and vomiting due to chemotherapy, and multiple sclerosis (MS) spasticity symptoms were improved as a result of cannabis treatment.
Evidence-based relief
One major finding of the Health Affairs paper was the variability of available data. Less than half of the states had data on patient-reported qualifying conditions and only 20 reported data on the number of registered patients. The authors also noted that the number of licensed medical users, with 641,176 registered medical cannabis patients in 2016 and 813,917 in 2017, was likely far lower than the actual number of users.
However, with the available data, they found that the number of medical cannabis patients rose dramatically over time and that the vast majority -- 85.5 percent -- of medical cannabis license holders indicated that they were seeking treatment for an evidence-based condition, with chronic pain accounting for 62.2 percent of all patient-reported qualifying conditions.
"This finding is consistent with the prevalence of chronic pain, which affects an estimated 100 million Americans," the authors state.
This research provides support for legitimate evidence-based use of cannabis that is at direct odds with its current drug schedule status, notes Boehnke. This is especially important as more people look for safer pain management alternatives in light of the current opioid epidemic.
Notes Boehnke, "Since the majority of states in the U.S. have legalized medical cannabis, we should consider how best to adequately regulate cannabis and safely incorporate cannabis into medical practice."
https://www.sciencedaily.com/releases/2019/02/190204172220.htm
Worrisome statistics around medical cannabis users operating vehicles
More public education and guidelines are needed to increase marijuana users' understanding of cannabis-related driving impairment
January 9, 2019
Science Daily/Michigan Medicine - University of Michigan
More than half of people who take medical cannabis for chronic pain say they've driven under the influence of cannabis within two hours of using it, at least once in the last six months, according to a new survey. One in five of them said they'd driven while 'very high' in the past six months.
One in five of them said they'd driven while 'very high' in the past six months, researchers from the University of Michigan Addiction Center report in the journal Drug & Alcohol Dependence .
Lead author Erin E. Bonar, Ph.D., assistant professor of psychiatry and a practicing clinical psychologist at the U-M Addiction Treatment Services finds the results of a survey of 790 Michigan medical cannabis users troubling.
Hundreds of thousands of Americans have state approval to use medical marijuana, including nearly 270,000 in the state of Michigan, according to Statista, as of May 2018. Michigan is second only to California for the highest number of medical marijuana patients in a state.
Risky driving
Bonar says that when people drive under the influence of marijuana their reaction time and coordination may be slowed down and they could have a harder time reacting to the unexpected. If they are in a risky situation, they could be more likely to be involved in motor vehicle crash, because they would not be able to respond as quickly.
For the study, the team surveyed adults in Michigan who were seeking medical cannabis recertification or a new certification for chronic pain in 2014 and 2015. The researchers asked about respondents' driving habits for the past six months.
Fifty-six percent of participants reported driving within two hours of using cannabis, 51 percent reported they drove while a "little high," and 21 percent reported driving while "very high."
"There is a low perceived risk about driving after using marijuana, but we want people to know that they should ideally wait several hours to operate a vehicle after using cannabis, regardless of whether it is for medical use or not," Bonar said. "The safest strategy is to not drive at all on the day you used marijuana."
There is uncertainty about how marijuana could affect driving for chronic daily users, who might have even longer-lasting effects that linger in their system, Bonar added.
Uncharted territory
To add complexity to the issue, in November Michigan voters approved the use of recreational marijuana in the state. In early December, it became legal under state law for any Michigan resident over the age of 21 to use marijuana inside a private residence, and to grow up to 12 plants for personal use. Retail sales are only allowed for those with medical marijuana cards issued by the state. Marijuana use and possession remains illegal under federal law.
In light of this policy change, Bonar says, all cannabis users need a clear understanding of the side effects of this drug.
"When it comes to driving, we haven't yet figured out the best way to know how impaired marijuana users are at any given time," she says. "With alcohol, you can do some quick math based on the amount you drank, and take an educated guess at your blood alcohol level. For marijuana, an estimate like this would be complicated. It's hard to quantify because there is a lot of variation in marijuana dosing, THC potency, and route of administration. We also don't have specific guidelines yet about when exactly it would be safe to operate a vehicle."
Bonar says the goal of her team's study -- conducted before the passage of the ballot question that resulted in the change in state law -- is to help medical marijuana users to be safer on the roads.
"We believe more research is needed to inform a larger public education effort that will help individuals understand the risks for themselves, and others, of driving while under the influence of cannabis," she says. "It is especially needed during this time of rapid policy change as many states are determining how to manage marijuana legalization. We also need clearer guidelines about marijuana dosing and side effects with an understanding of how individual differences in things like sex and body weight interact as well."
This study was funded by the National Institute on Drug Abuse. The lead project investigator was Mark Ilgen, Ph.D., director of UMATS. Additional study authors include James Cranford, Ph.D., Brooke Arterberry, Ph.D., Maureen Walton, M.P.H., Ph.D., and Kipling M. Bohnert, Ph.D.
https://www.sciencedaily.com/releases/2019/01/190109170635.htm