Legalized medical cannabis lowers opioid use

April 2, 2018

Science Daily/University of Georgia, School of Public and International Affairs

States that have approved medical cannabis laws saw a dramatic reduction in opioid use, according to a new study by researchers at the University of Georgia.

In a paper published today in the Journal of the American Medical Association, Internal Medicine, researchers examined the number of all opioid prescriptions filled between 2010 and 2015 under Medicare Part D, the prescription drug benefit plan available to Medicare enrollees.

In states with medical cannabis dispensaries, the researchers observed a 14.4 percent reduction in use of prescription opioids and nearly a 7 percent reduction in opiate prescriptions filled in states with home-cultivation-only medical cannabis laws.

"Some of the states we analyzed had medical cannabis laws throughout the five-year study period, some never had medical cannabis, and some enacted medical cannabis laws during those five years," said W. David Bradford, study co-author and Busbee Chair in Public Policy in the UGA School of Public and International Affairs. "So, what we were able to do is ask what happens to physician behavior in terms of their opiate prescribing if and when medical cannabis becomes available."

Since California approved the first medical cannabis law in 1996, 29 states and the District of Colombia have approved some form of medical cannabis law.

"Physicians cannot prescribe cannabis; it is still a Schedule I drug," Bradford said. "We're not observing that prescriptions for cannabis go up and prescriptions for opioids go down. We're just observing what changes when medical cannabis laws are enacted, and we see big reductions in opiate use."

The researchers examined all common prescriptions opiates, including hydrocodone, oxycodone, morphine, methadone and fentanyl. Because heroin is not a legal drug, it was not included as part of the study.

Last year, the U.S. Department of Health and Human Services declared a public health emergency related to the abuse of opiates. Opioid overdoses accounted for more than 42,000 deaths in 2016, more than any previous year on record, and more than 40 percent of opioid overdose deaths involved a prescription opioid, according to HHS.

Opioid prescription rates increased from about 148 million prescriptions in 2005 to 206 million prescriptions by 2011, Bradford said. This coincided with an increase in the number of opioid-related deaths.

"There is a growing body of literature that suggests cannabis may be used to manage pain in some patients, and this could be a major component of the reductions we see in the use of opiates," he said.

The researchers did not, however, see any significant reductions in the number of non-opioid drugs prescribed during the study period.

"In other studies, we examined prescription rates for non-opioid drugs such as blood thinners, flu medications and phosphorus stimulants, and we saw no change," said Ashley Bradford, lead author of the study and graduate student in UGA's department of public administration and policy. "Medical cannabis wouldn't be an effective treatment for flu or for anemia, so we feel pretty confident that the changes we see in opioids are because of cannabis because there is a legitimate medical use."

The researches concede that if medical cannabis is to become an effective treatment, there is still much work to be done. Scientists are only just beginning to understand the effects of the compounds contained in cannabis, and an effective "dose" of cannabis would need to be defined clearly so that each patient receives a consistent dose.

"Regardless, our findings suggest quite clearly that medical cannabis could be one useful tool in the policy arsenal that can be used to diminish the harm of prescription opioids, and that's worthy of serious consideration," David Bradford said.

Coauthors on the paper Amanda Abraham, assistant professor of public administration and policy at UGA and Grace Bagwell Adams, assistant professor of health policy and management in UGA's College of Public Health.

https://www.sciencedaily.com/releases/2018/04/180402202236.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

Millennials prefer healthy habits, less likely to choose opioids to manage pain

Survey finds millennials regret opioid use, lack knowledge on proper disposal

August 30, 2017

Science Daily/American Society of Anesthesiologists

Often spending their days hunched over phones, tablets or computers and their free time at spin class or playing sports, millennials are the next generation poised to experience chronic pain. Even at their young age, millennials say acute and chronic pain are already interfering with their quality of life.

Their preferred method to manage pain? Lifestyle changes such as exercising, eating right, quitting smoking and losing weight, according to a nationwide survey commissioned by the American Society of Anesthesiologists (ASA) in conjunction with September's Pain Awareness Month.

The survey also found millennials were half as likely as baby boomers to have turned to opioids to manage pain, and 1 in 5 millennials regret that they used the highly addictive painkillers.

But while the results reflect a positive trend, they also reveal a knowledge gap. The survey found many millennials were:

• ·      More likely to obtain opioids inappropriately. One in 10 millennials obtained opioids through another household member's prescription, compared to 3 percent of Gen Xers, 1 percent of baby boomers and none of the silent generation.
• ·      More likely to think it's OK to take an opioid without a prescription. Nearly 30 percent of millennials thought it was OK to take an opioid without a prescription, compared to 20 percent of Gen Xers, 12 percent of baby boomers and 3 percent of the silent generation.
• ·      AND less likely to dispose of leftover opioids safely. In fact, 1 in 5 millennials said they "did not know" the best way to safely dispose of opioids, and only 37 percent were aware that a collection center at a local police station, hospital pharmacy or drug store was the best method of disposal.

"It's encouraging that millennials see the value of opting for safer and often more effective methods of managing pain," said ASA President Jeffrey Plagenhoef, M.D. "But clearly they are in need of further education when it comes to opioids and chronic pain because using the drugs initially to treat pain can turn into a lifelong struggle with addiction."

Learning how to manage pain safely and effectively is vital: 75 percent of millennials say they have had acute pain (which comes on suddenly and lasts less than three months) and nearly 60 percent have experienced chronic pain (which lasts longer than three months). The source of that pain is reflective of millennials' lifestyle, including technology use (leading to eye strain, neck aches, hand or finger pain, wrist or arm pain), migraines and sports injuries.

According to the survey, millennials (ages 18-36) and members of Generation X (ages 37-52) are most likely to report pain interfered with their work responsibilities, parenting abilities and participation in family activities.

It's important to address pain before it interferes with quality of life by seeing the right specialist for pain management. Whatever the age, people in severe pain who don't find relief through lifestyle changes should see a physician who specializes in pain management, such as a physician anesthesiologist. These specialists have received four years of medical school and additional training in a medical specialty, followed by an additional year of training to become an expert in treating pain. They have the expertise to best help you manage your pain.

But engaging in lifestyle changes before chronic pain can gain a further foothold is preferable. When possible, prevention is best. "Chronic pain does not have to be an automatic response to aging," said Dr. Plagenhoef. "Healthy lifestyle changes such as exercising, proper nutrition and maintaining a healthy weight can keep millennials from dealing with some of the chronic pain their parents and grandparents are experiencing."

To help all generations effectively manage their pain, ASA offers the following tips:

• ·      Take a break from devices and gaming: Aches from smartphone, tablet, gaming and other digital device overuse is common. To avoid it, use devices at eye level instead of looking down for long periods of time, which puts strain on your neck and back. Use the talk to text feature to limit finger and wrist strain. Sit up straight while gaming and get off the couch and stretch occasionally. To avoid digital eye strain, look away from the screen every 20 seconds and position yourself so there is an appropriate distance between your eyes and the screen.
• ·      Don't be a weekend warrior. Whether you plan to hit the basketball court after many years away or do CrossFit weekly, ease into it. Warm up your muscles and stretch to avoid pain and injury. If you think you've been injured after exercise or playing sports see a pain management specialist right away to evaluate the pain.
• ·      Remember to move. Whether you're in the library studying or at a desk job, get up and move at least once an hour, if not more. Sitting and being sedentary can lead to aches and pains, especially lower back pain. Stretch your legs and back by standing and walking on a regular basis rather than sitting for long periods of time.
• ·      Get healthy. Take charge of your health now and engage in healthy lifestyle changes before chronic pain sets in. Participate in low-impact aerobic and strength training exercises regularly. Maintain a healthy weight and eat a balanced diet. Don't smoke, or if you do, talk to a physician about programs available to help you quit.
• ·      Take and dispose of opioids the right way. If a physician prescribes opioids, ask many questions about taking them appropriately. Don't continue taking opioids when your pain subsides. If you have leftover opioids, dispose of them at a collection center at a local police station, hospital pharmacy, or drugstore. This will ensure others who have not been prescribed the opioids do not have access to them.

The 10-question ORC International CARAVAN® Omnibus Survey was conducted online August 7-9, 2017 among 1,011 U.S. adults 18 years or older: 34 percent were millennials, 25 percent were Gen Xers, 35 percent were baby boomers (ages 53-71) and 6 percent were from the silent generation (ages 72-92). The demographically representative sample included 504 men and 507 women.

https://www.sciencedaily.com/releases/2017/08/170830124926.htm

Mind-body therapies immediately reduce unmanageable pain in hospital patients

July 25, 2017

Science Daily/University of Utah

After participating in a single, 15-minute session of certain mind-body therapies, patients reported an immediate decrease in pain levels similar to what one might expect from an opioid painkiller. This study is the first to compare the effects of mindfulness and hypnosis on acute pain in the hospital setting.

Mindfulness training and hypnotic suggestion significantly reduced acute pain experienced by hospital patients, according to a new study published in the Journal of General Internal Medicine.

After participating in a single, 15-minute session of one of these mind-body therapies, patients reported an immediate decrease in pain levels similar to what one might expect from an opioid painkiller. This study is the first to compare the effects of mindfulness and hypnosis on acute pain in the hospital setting.

The yearlong study's 244 participants were patients at the University of Utah Hospital in Salt Lake City who reported experiencing unmanageable pain as the result of illness, disease or surgical procedures. Willing patients were randomly assigned to receive a brief, scripted session in one of three interventions: mindfulness, hypnotic suggestion or pain coping education. Hospital social workers who completed basic training in each scripted method provided the interventions to patients.

While all three types of intervention reduced patients' anxiety and increased their feelings of relaxation, patients who participated in the hypnotic suggestion intervention experienced a 29 percent reduction in pain, and patients who participated in the mindfulness intervention experienced a 23 percent reduction in pain. By comparison, those who participated in the pain coping intervention experienced a 9 percent reduction. Patients receiving the two mind-body therapies also reported a significant decrease in their perceived need for opioid medication.

"About a third of the study participants receiving one of the two mind-body therapies achieved close to a 30 percent reduction in pain intensity," said Eric Garland, lead author of the study and director of the U's Center on Mindfulness and Integrative Health Intervention Development. "This clinically significant level of pain relief is roughly equivalent to the pain relief produced by 5 milligrams of oxycodone."

Garland's previous research has indicated that multi-week mindfulness training programs can be an effective way to reduce chronic pain symptoms and decrease prescription opioid misuse. This new study added a novel dimension to Garland's work by revealing the promise of brief mind-body therapies for people suffering from acute pain.

"It was really exciting and quite amazing to see such dramatic results from a single mind-body session," said Garland. "Given our nation's current opioid epidemic, the implications of this study are potentially huge. These brief mind-body therapies could be cost-effectively and feasibly integrated into standard medical care as useful adjuncts to pain management."

Garland and his interdisciplinary research team aim to continue studying mind-body therapies as non-opioid means of alleviating pain by conducting a national replication study in a sample of thousands of patients in multiple hospitals around the country.

https://www.sciencedaily.com/releases/2017/07/170725122228.htm