Insights on marijuana and opioid use in people with cancer
April 22, 2019
Science Daily/Wiley
A new study reveals that many people with cancer use marijuana, and rates of use in the U.S. have increased over time. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study also found that patients with cancer are more likely to use prescription opioids than adults without cancer.
Pain is a common symptom of cancer, and many affected patients do not receive adequate pain relief. In light of rapidly evolving marijuana legislation and a growing opioid epidemic, a team led by Jona Hattangadi-Gluth, MD, and Kathryn Ries Tringale, MD, MAS, of the University of California, San Diego, examined trends in the self-disclosed use of marijuana and opioids among patients with cancer.
After analyzing data from the U.S. National Health and Nutrition Examination Survey between 2005 and 2014, the investigators matched 826 people with cancer to 1,652 controls without cancer. Among survey respondents who had cancer, 40.3 percent used marijuana within the past year, compared with 38.0 percent of respondents without cancer. Also, people with cancer were more likely to use prescription opioids than their demographically equivalent counterparts without cancer (13.9 percent versus 6.4 percent).
"Prospective clinical trials are needed to quantify the efficacy of marijuana in cancer-specific pain as well as the risk of opioid misuse in this patient population," said Dr. Tringale.
When looking at rates of marijuana and opioid use in more than 19,000 survey respondents with and without cancer over 10 years, the researchers found significantly increased use of marijuana over time -- likely reflecting increased availability due to legislative changes -- but they found stable rates of opioid use. A diagnosis of cancer did not significantly affect the odds of substance use over time from 2005 to 2014.
"Medical marijuana legalization has previously been associated with a reduction in hospitalizations related to opioid dependence or abuse, suggesting that if patients are in fact substituting marijuana for opioids, this may introduce an opportunity for reducing opioid-related morbidity and mortality," said Dr. Hattangadi-Gluth. "Of course, it will also be important to identify risks and adverse effects of marijuana, which has not previously been studied on large randomized clinical trials, given its scheduling as a class 1 controlled substance."
https://www.sciencedaily.com/releases/2019/04/190422100947.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
Medical marijuana could reduce opioid use in older adults
Study shows up to 65 percent of older adults who use medical marijuana significantly reduced their chronic pain and dependence on opioid painkillers
May 1, 2018
Science Daily/Northwell Health
A study shows up to 65 percent of older adults who use medical marijuana significantly reduced their chronic pain and dependence on opioid painkillers.
A questionnaire of older men and women suffering from chronic pain who were given medical marijuana found that the drug significantly reduced pain and their need for opioid painkillers, Northwell Health researchers report.
The results of the study, "Older Adults' Use of Medical Marijuana for Chronic Pain: A Multisite Community-Based Survey," are scheduled to be presented May 3, 2018 at the annual meeting of the American Geriatrics Society in Orlando, FL.
To gauge how effective medical marijuana was at managing chronic pain and reducing opioid use, researchers surveyed 138 medical marijuana users with an anonymous 20-question survey focusing on how often they used the marijuana, in what form they took it, how much it reduced pain and whether or not they were able to cut back their use of other painkillers.
When patients were asked if they were able to curb their use of other painkillers after starting medical marijuana, 18 percent reported decreasing their use "moderately," 20 percent "extremely" and 27 percent "completely." An overwhelming number of subjects (91 percent) would recommend medical marijuana to others.
Comments from patients tell the tale:
"My quality of life has increased considerably since starting medical marijuana," one patient said. "I was on opiates for 15 years, and 6 months on marijuana, and off both completely."
Another patient said: "It [medical marijuana] is extremely effective and has allowed me to function in my work and life again. It has not completely taken away the pain, but allows me to manage it."
"I was on Percocet and replaced it with medical marijuana. Thank you, thank you, thank you," said another.
These patients had been living with chronic pain from osteoarthritis, spinal stenosis, hips and knees that could not be replaced, and pain not relieved by steroid injections, said Diana Martins-Welch, MD, a co-author of the study and physician in the Division of Geriatric and Palliative Medicine, Department of Medicine at Northwell Health.
Based on these results, she believes that medical marijuana could be effective in curbing the opioid epidemic now ravaging the United States. "What I'm seeing in my practice, and what I'm hearing from other providers who are participating in medical marijuana programs, is that their patients are using less opioids," said Martins-Welch. "I've even gotten some patients completely off opioids."
As effective as medical marijuana can be, it's not widely available or prescribed, Martins-Welch said. Plus, people have to jump through many hoops just to get certified to receive it, she said.
Martins-Welch believes medical marijuana should be more widely available and easier to get. Medical marijuana is legal in only 30 states, she said. In addition, because marijuana is federally illegal, it's expensive and not covered by insurance, putting it beyond the reach of many patients who could benefit from it, she said.
Medical marijuana can cost on average $300 for a one-month supply, Martins-Welch said. "And it's a cash-only business."
"Even the process you have to go through to get certified is expensive," she said.
Martins-Welch and colleagues surveyed men and women between the ages 61 to 70 about their use of medical marijuana. Patients responded to 20 questions about their marijuana use. The researchers found that most patients, 45 percent, used vaporized oil, while 28 percent used pills and 17 percent used marijuana-laced oil. Twenty-one percent used marijuana once a day, 23 percent used it twice daily, and 39 percent used marijuana more than twice a day.
Using marijuana in these forms dramatically reduces its mind-altering effect, Martins-Welch said.
In most cases, a doctor recommended medical marijuana (46 percent) followed by a family member or friend (24 percent) or another health care provider (6 percent), while others did not specify who recommended it (24 percent).
When asked how pain levels changed before and one month after starting marijuana, most patients reported that average pain scores dropped from 9.0 on a scale of 0-10 to a more moderate pain threshold of 5.6.
However, older patients reported a reduction in the use of other painkillers less often than younger patients (64 percent versus 93 percent), the researchers found. Older patients also recommended medical marijuana less often than younger ones (86 percent versus 100 percent respectively).
When patients were quizzed about whether side effects of medications impacted their daily activities, the average score went from 6.9 before starting medical marijuana to 3.5 a month after using the drug.
https://www.sciencedaily.com/releases/2018/05/180501085137.htm