Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study
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BACKGROUND: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives. PURPOSE: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use. METHODS: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected. RESULTS: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001). CONCLUSIONS: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.
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Opioid sparing, or the reduction of opioid use, resulting from the use of CBM for pain management was the primary outcome in one study and a secondary outcome in six studies.
“Opioid sparing, or the reduction of opioid use, resulting from the use of CBM for pain management was the primary outcome in one study86 and a secondary outcome in six studies.69,73,81,84,87,91”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [86]
Three studies found positive associations between medical cannabis use and opioid sparing.
“Three studies found positive associations between medical cannabis use and opioid sparing.69,73,102”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [102]
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- Authors
- Vigil, J. M., Stith, S. S., Adams, I. M., & Reeve, A. P.
- Affiliations
- University of New Mexico (US)
- Corresponding author
- Vigil, Jacob M.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-11-16
- Volume
- 12
- Issue
- 11
- Pages
- e0187795
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5690609
- OpenAlex
- W2767379958
- Cited by
- 143
- References
- 35
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 9 · 2023: 10 · 2022: 26 · 2021: 21 · 2020: 26 · 2019: 25 · 2018: 8
- FWCI
- 15.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- medical cannabis, prescription opioid use, chronic pain, chronic back pain, opioid cessation, opioid dose reduction, harm reduction, prescription drug monitoring programs, intravenous morphine, cannabis side effects, quality of life, opioid epidemic, New Mexico, Colorado, Washington State, Oregon, Washington, D.C., California
- MeSH terms
- Analgesics, Opioid, Female, Humans, Male, Middle Aged, Quality of Life, Cohort Studies, Chronic Pain, Medical Marijuana
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