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

New app could make cannabis use safer

'Am I Stoned' app designed to help users understand their impairment

https://www.sciencedaily.com/images/2018/04/180424160233_1_540x360.jpg

April 24, 2018

Science Daily/Experimental Biology 2018

Researchers have developed a prototype app called 'Am I Stoned' that could help cannabis users understand how the drug is affecting them through a series of phone-based tasks.

Although cannabis, also known as marijuana, has been shown to impair memory, reaction time and attention, it is difficult to assess this impairment in a natural setting. Researchers have developed a prototype app called 'Am I Stoned' that could help cannabis users understand how the drug is affecting them through a series of phone-based tasks.

Elisa Pabon, a doctoral student at the University of Chicago, will present results from initial testing of the app at the American Society for Pharmacology and Experimental Therapeutics annual meeting during the 2018 Experimental Biology meeting to be held April 21-25 in San Diego.

"One of our long-term goals is for the app to improve the safety of cannabis use by making individual users more aware of their impairment," said research team leader Harriet de Wit, professor in the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago. "By gathering data from users in the field, the app will also contribute to the overall scientific knowledge in terms of how cannabis affects users."

As a step towards developing a mobile phone app that could be used in a natural environment, the researchers examined the usefulness of various tasks in assessing impairment in a controlled laboratory environment. They asked 24 healthy non-daily cannabis users to consume a capsule containing a placebo or 7.5 or 15 milligrams of tetrahydrocannabinol (THC), the ingredient in cannabis that makes people high. The study participants then completed standardized computer-based tasks known to detect impairment as well as app-based tasks on an iPhone, which could be used for briefer assessments outside of the laboratory. Neither the participants nor the researchers knew who received the placebo and who received THC.

The researchers successfully detected impairments from THC using three of the four computer tasks and one of the iPhone tasks. The study also showed that users were generally aware of their impairment.

"The effects of THC on performance may be subtle, so we need highly sensitive tasks to detect impairments," said Pabon. "It is likely that the computer tasks, which took 15 to 20 minutes to complete, were more sensitive to THC impairment because they provided more opportunity to detect a drug effect."

Although the app is not intended to predict a person's ability to drive or engage in activities that may cause harm, the researchers do plan to use what they are learning to develop an app that people can use to assess their own performance. This would require a person to complete the tasks when sober to provide personalized baseline information that could be used in the future to assess their level of impairment after using cannabis.

The researchers plan to use the findings from this study to improve the sensitivity of the app-based tasks to detect THC-induced impairment so that they can eventually deploy the app in a more naturalistic setting.

https://www.sciencedaily.com/releases/2018/04/180424160233.htm

Hemp shows potential for treating ovarian cancer

Researchers demonstrate hemp's ability to slow cancer growth and uncover mechanism for its cancer-fighting ability

https://www.sciencedaily.com/images/2018/04/180423155046_1_540x360.jpg

April 23, 2018

Science Daily/Experimental Biology 2018

Results from some of the first studies to examine hemp's ability to fight cancer show that it might one day be useful as plant-based treatment for ovarian cancer. Hemp is part of the same cannabis family as marijuana but doesn't have any psychoactive properties or cause addiction.

Sara Biela and Chase Turner, graduate students in the lab of Wasana Sumanasekera at Sullivan University College of Pharmacy in Kentucky, will present new findings tied to hemp's anti-cancer properties at the American Society for Biochemistry and Molecular Biology annual meeting during the 2018 Experimental Biology meeting to be held April 21-25 in San Diego.

"Hemp, like marijuana, contains therapeutically valuable components such as cannabidiol, cannabinol, and tetrahydrocannabinol," explained Biela. "However, unlike marijuana, hemp's therapeutic ability has not been studied in detail."

Two new studies examined the therapeutic potential of an extract known as KY-hemp, which is produced from hemp grown in Kentucky. The plant strain, growing conditions and processing techniques were all optimized to produce an extract containing substances with potential therapeutic benefit and to eliminate any residue that could contaminate the product.

In one study, the researchers found that adding various doses of KY-hemp extract to cultured ovarian cells led to significant dose-dependent slowing of cell migration. This finding indicated that the extract might be useful for stopping or slowing down metastasis -- the spreading of cancer to other parts of the body.

In a second study, the researchers explored the biology of KY-hemp's protective effects against ovarian cancer, which they had observed in previous studies. Experiments with cultured ovarian cancer cells showed that KY-hemp slowed the secretion of the interleukin IL-1 beta. Interleukins produce inflammation that can be damaging and has been linked to cancer progression. The hemp-induced slowing of IL-1 β secretion represents a possible biological mechanism responsible for KY-hemp's anti-cancer effects.

"Our findings from this research as well as prior research show that KY hemp slows ovarian cancer comparable to or even better than the current ovarian cancer drug Cisplatin," said Turner. "Since Cisplatin exhibits high toxicity, we anticipate that hemp would carry less side effects. However, that needed to be tested in the future."

The researchers plan to test the extract in mice after they complete additional studies in cultured cancer cells to learn more about how it leads to cancer cell death.

https://www.sciencedaily.com/releases/2018/04/180423155046.htm

Prenatal cannabis use associated with low birth weights

The study, led by Colorado School of Public Health, shows a 50 percent increase in low birth weights among women who use cannabis during pregnancy

April 23, 2018

Science Daily/University of Colorado Anschutz Medical Campus

With marijuana use during pregnancy on the rise, a new study led by the Colorado School of Public Health shows that prenatal cannabis use was associated with a 50 percent increased likelihood of low birth weight, setting the stage for serious future health problems including infection and time spent in Neonatal Intensive Care Units.

"Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy," said the study's lead author Tessa Crume, PhD, MSPH, assistant professor of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

The study was published last month in The Journal of Pediatrics.

Crume and her colleagues utilized survey data from 3,207 women who participated in the Colorado Pregnancy Risk Assessment Monitoring System in 2014 and 15. They found the prevalence of marijuana use in the state of Colorado was 5.7 percent during pregnancy and 5 percent among women who were breastfeeding.

They also discovered that prenatal marijuana use was associated with a 50 percent increased chance of low birth weight regardless of tobacco use during pregnancy. Prenatal marijuana use was three to four times higher among women who were younger, less educated, received Medicaid or WIC, were white, unmarried and lived in poverty.

Crume said the numbers are surprising but also reflect changing attitudes toward marijuana, especially in a state like Colorado where it is legal.

"There is increased availability, increased potency and a vocal pro-cannabis advocacy movement that may be creating a perception that marijuana is safe to use during pregnancy," Crume said.

The National Survey on Drug Use and Health suggests that cannabis use among pregnant women has increased as much as 62 percent between 2002 and 2014. At the same time, the potency of the drug has increased six or seven fold since the 1970s along with the ways it is consumed -- eating, vaping, lotions etc.

"Growing evidence suggests prenatal cannabis exposure has a detrimental impact on offspring brain function starting in the toddler years, specifically issues related to attention deficit disorder," Crume said. "But much of the research on the effects of prenatal cannabis on neonatal outcomes was based on marijuana exposures in the 1980s and 1990s which may not reflect the potency of today's cannabis or the many ways it is used."

The study found that 88.6 percent of women who used cannabis during pregnancy also breastfed. The risk of cannabis to the infant through breastmilk remains unknown. Various studies have found that cannabinoids are passed to the baby in this way. One of the study's co-authors, Dr. Erica Wymore, MD, MPH, from Children's Hospital Colorado and the CU School of Medicine, is currently conducting a study to evaluate this issue.

The researchers recommend that health care providers ask pregnant women about their cannabis use and advise them to stop during pregnancy and lactation.

"Obstetric providers should refrain from prescribing or recommending cannabis for medical purposes during preconception, pregnancy and lactation," Crume said. "Guidance and messaging about this should be incorporated into prenatal care. And screening of pregnant women at risk for cannabis dependency should be linked to treatment options."

https://www.sciencedaily.com/releases/2018/04/180423125052.htm

How can medical marijuana benefit older adults?

April 19, 2018

Science Daily/Wiley

Managing symptoms such as pain, nausea, and psychiatric illness can be challenging as people age. A new Journal of the American Geriatrics Society review highlights what's currently known about the indications and risks of medical marijuana use for older adults.

The review notes that medical marijuana appears useful for the treatment of pain (particularly neuropathic pain) and chemotherapy-induced nausea and vomiting. It has neuropsychiatric side effects but even when smoked, it does not appear to increase the risk for lung cancer.

Importantly, however, medical marijuana's positive and negative effects have not been thoroughly studied specifically in older adults.

"There is a dearth of evidence supporting the use of cannabinoids for medical indications in older adults. Common sense practices are applicable here though, including performing a thorough assessment for side effects and expecting that lower doses will have a greater impact," said lead author Dr. Joshua Briscoe, of the Duke University Medical Center. "As younger generations age, it is also important to expect that they have experience using marijuana in recreational contexts, which will affect their approach to its use in a medical setting."

https://www.sciencedaily.com/releases/2018/04/180419131034.htm

Scientific guidelines for using cannabis to treat stress, anxiety and depression

April 19, 2018

Science Daily/Washington State University

In a first-of-a-kind study, Washington State University scientists examined how peoples' self-reported levels of stress, anxiety and depression were affected by smoking different strains and quantities of cannabis at home.

Their work, published this month in the Journal of Affective Disorders, suggests smoking cannabis can significantly reduce short-term levels of depression, anxiety, and stress but may contribute to worse overall feelings of depression over time.

It marks one of the first attempts by U.S. scientists to assess how cannabis with varying concentrations of the chemical compounds tetrahydrocannabinol (THC) and cannabidiol (CBD) affect medicinal cannabis users' feelings of wellbeing when smoked outside of a laboratory.

"Existing research on the effects of cannabis on depression, anxiety and stress are very rare and have almost exclusively been done with orally administered THC pills in a laboratory," said Carrie Cuttler, clinical assistant professor of psychology at WSU and lead author of the study. "What is unique about our study is that we looked at actual inhaled cannabis by medical marijuana patients who were using it in the comfort of their own homes as opposed to a laboratory."

For example, the WSU research team found that one puff of cannabis high in CBD and low in THC was optimal for reducing symptoms of depression, two puffs of any type of cannabis was sufficient to reduce symptoms of anxiety, while 10 or more puffs of cannabis high in CBD and high in THC produced the largest reductions in stress.

"A lot of consumers seem to be under the false assumption that more THC is always better," Cuttler said. "Our study shows that CBD is also a very important ingredient in cannabis and may augment some of the positive effects of THC."

The researchers also found that while both sexes reported decreases in all three symptoms after using cannabis, women reported a significantly greater reduction in anxiety following cannabis use.

Data for the study were taken from the trademarked app Strainprint, which provides medical cannabis users a means of tracking how different doses and types of cannabis affect a wide variety of symptoms of wellbeing.

Strainprint users rate the symptoms they are experiencing before using cannabis on a scale of 1-10 and then input information about the type of cannabis they are using. Twenty minutes after smoking, they are prompted to report how many puffs they took and to rerate the severity of their symptoms.

Cuttler and WSU colleagues Alexander Spradlin and Ryan McLaughlin used a form of statistical analysis called multilevel modeling to analyze around 12,000 anonymous Strainprint entries for depression, anxiety and stress. The researchers did not receive any of the Strainprint users personally identifying information for their work.

"This is to my knowledge one of the first scientific studies to provide guidance on the strains and quantities of cannabis people should be seeking out for reducing stress, anxiety and depression," Cuttler said. "Currently, medical and recreational cannabis users rely on the advice of bud tenders whose recommendations are based off of anecdotal not scientific evidence."

The study is among several cannabis-related research projects currently underway at WSU, all of which are consistent with federal law and many of which are funded with Washington state cannabis taxes and liquor license fees.

https://www.sciencedaily.com/releases/2018/04/180419100110.htm

People who use medical marijuana more likely to use and misuse other prescription drugs

New study raises questions about cannabis to reduce opioid use

April 17, 2018

Science Daily/Wolters Kluwer Health

Can medical marijuana help to fight the opioid epidemic? Many believe that it can. But a new study finds that people who use medical marijuana actually have higher rates of medical and non-medical prescription drug use -- including pain relievers. The study appears in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM), published by Wolters Kluwer.

Rather than being at lower risk, people who use medical marijuana may be at higher risk for non-medical prescription drug use, suggests the study by Theodore L. Caputi, BS of University College Cork's School of Public Health and Keith Humphreys, PhD, of Stanford University. However, an accompanying commentary questions whether medical cannabis is the cause of higher prescription drug use, or whether other factors explain the association.

Does Use of Medical Marijuana Increase or Decrease Prescription Drug Use?

The researchers analyzed more than 57,000 responses to the 2015 National Survey on Drug Use and Health. Participants were asked about medical and non-medical ("inconsistent with doctor's instructions") use of prescription drugs. The survey also asked about marijuana use, including whether it was recommended by a healthcare professional. The survey identified 776 people who used medical marijuana -- about 1.4 percent of all responders.

People who used medical marijuana were more likely to say they had used prescription drugs in the past year. They were about 60 percent more likely to report any prescription drug use, relative to those who did not use medical marijuana.

People who used medical marijuana were also more than twice as likely to report non-medical use of prescription drugs, including pain relievers, stimulants, and tranquilizers. "Non-medical use of pain relievers is of particular interest because of pain relievers' role in the opioid overdose epidemic," Mr. Caputi and Dr. Humphreys observe.

Higher levels of non-medical prescription drug use by people who used medical marijuana persisted in an analysis limited to people who used prescription drugs. The researchers write, "This suggests that the elevated risk for prescription drug non-medical use among people who use medical marijuana cannot be ascribed simply to their having a medical concern or greater access to prescription drugs."

Previous studies have reported that states where medical marijuana is legal have lower rates of medical and non-medical prescription drug use and related harms -- including opioid overdose. "These reports have led many to believe that use of medical marijuana is a protective factor against non-medical prescription drug use," Mr. Caputi comments. "However, individual-level inferences cannot be made using the ecological studies cited frequently in the debate over medical marijuana."

Mr. Caputi notes the lack of large-scale follow-up data on whether patients are using cannabis together with or in place of prescription drugs. However, he adds, "Physicians and practitioners should know that, from cross-sectional data, medical marijuana use is positively associated with non-medical prescription drug use.

"Our findings don't prove a causal connection between marijuana and opioid use, but they do suggest physicians can use medical marijuana as a marker for high risk of non-medical prescription drug use."

In the accompanying commentary, Marcus A. Bachhuber, MD, MSPH, and colleagues at Montefiore Medical Center/Albert Einstein College of Medicine point out that the findings do not show that medical cannabis causes increased use of prescription drugs. Dr. Bachhuber is author of an ecological study finding a protective effect of medical marijuana regulation on opioid overdose mortality,

"Given that people who take medical cannabis and those who do not are likely to have different underlying medical conditions, it is possible that medical cannabis use reduces prescription drug use yet prescription drug use remains relatively high in that group," Dr. Bachhuber comments, He notes that chronic pain is the most common reason for medical marijuana use.

In other studies, people who take medical marijuana consistently report substituting cannabis for other prescription and illicit drugs. Dr. Bachhuber and coauthors conclude: "To fully understand the effect of medical cannabis on the use of other drugs, prospective longitudinal studies randomizing patients to cannabis versus other treatments are urgently needed."

https://www.sciencedaily.com/releases/2018/04/180417181122.htm

Cannabis-based medicine may cut seizures in half for those with tough-to-treat epilepsy

April 18, 2017

Science Daily/American Academy of Neurology

Taking cannabidiol may cut seizures in half for some children and adults with Lennox-Gastaut syndrome (LGS), a severe form of epilepsy, according to new information released today from a large scale controlled clinical study that will be presented at the American Academy of Neurology's 69th Annual Meeting in Boston, April 22 to 28, 2017. Cannabidiol is a molecule from the cannabis plant that does not have the psychoactive properties that create a "high."

Nearly 40 percent of people with LGS, which starts in childhood, had at least a 50 percent reduction in drop seizures when taking a liquid form of cannabidiol compared to 15 percent taking a placebo.

When someone has a drop seizure, their muscle tone changes, causing them to collapse. Children and adults with LGS have multiple kinds of seizures, including drop seizures and tonic-clonic seizures, which involve loss of consciousness and full-body convulsions. The seizures are hard to control and usually do not respond well to medications. Intellectual development is usually impaired in people with LGS.

Although the drop seizures of LGS are often very brief, they frequently lead to injury and trips to the hospital emergency room, so any reduction in drop seizure frequency is a benefit.

"Our study found that cannabidiol shows great promise in that it may reduce seizures that are otherwise difficult to control," said study author Anup Patel, MD, of Nationwide Children's Hospital and The Ohio State University College of Medicine in Columbus and a member of the American Academy of Neurology.

For the randomized, double-blind, placebo-controlled study, researchers followed 225 people with an average age of 16 for 14 weeks. The participants had an average of 85 drop seizures per month, had already tried an average of six epilepsy drugs that did not work for them and were taking an average of three epilepsy drugs during the study.

Participants were given either a higher dose of 20 mg/kg daily cannabidiol, a lower dose of 10 mg/kg daily cannabidiol or placebo as an add-on to their current medications for 14 weeks.

Those taking the higher dose had a 42 percent reduction in drop seizures overall, and for 40 percent, their seizures were reduced by half or more.

Those taking the lower dose had a 37 percent reduction in drop seizures overall, and for 36 percent, seizures were reduced by half or more.

Those taking the placebo had a 17 percent reduction in drop seizures, and for 15 percent, seizures were reduced by half or more.

There were side effects for 94 percent of those taking the higher dose, 84 percent of those taking the lower dose and 72 percent of those taking placebo, but most side effects were reported as mild to moderate. The two most common were decreased appetite and sleepiness.

Those receiving cannabidiol were up to 2.6 times more likely to say their overall condition had improved than those receiving the placebo, with up to 66 percent reporting improvement compared to 44 percent of those receiving the placebo.

"Our results suggest that cannabidiol may be effective for those with Lennox-Gastaut syndrome in treating drop seizures," said Patel. "This is important because this kind of epilepsy is incredibly difficult to treat. While there were more side effects for those taking cannabidiol, they were mostly well-tolerated. I believe that it may become an important new treatment option for these patients."

There is currently a plan to submit a New Drug Application to the FDA later this year.

https://www.sciencedaily.com/releases/2017/04/170418161907.htm

Position statement: Avoid using medical marijuana to treat sleep apnea

Sleep apnea should be excluded from state medical cannabis programs

April 16, 2018

Science Daily/American Academy of Sleep Medicine

Medical cannabis and synthetic marijuana extracts should not be used for the treatment of obstructive sleep apnea, according to a position statement from the American Academy of Sleep Medicine (AASM).

In November 2017 the Minnesota Department of Health announced the decision to add obstructive sleep apnea as a new qualifying condition for the state's medical cannabis program. However, the AASM has concluded that sleep apnea should be excluded from the list of chronic medical conditions for state medical cannabis programs due to unreliable delivery methods and insufficient evidence of treatment effectiveness, tolerability and safety.

"Until we have further evidence on the efficacy of medical cannabis for the treatment of sleep apnea, and until its safety profile is established, patients should discuss proven treatment options with a licensed medical provider at an accredited sleep facility," said lead author Dr. Kannan Ramar, professor of medicine in the division of pulmonary and critical care medicine at Mayo Clinic in Rochester, Minnesota.

The position statement is published in the April 15 issue of the Journal of Clinical Sleep Medicine.

Nearly 30 million adults in the U.S. have obstructive sleep apnea, a chronic disease that involves the repeated collapse of the upper airway during sleep. Common warning signs include snoring and excessive daytime sleepiness. After early animal studies demonstrated that the synthetic cannabis extract dronabinol improved respiratory stability, recent studies in humans have explored the potential use of dronabinol as an alternative treatment for sleep apnea.

However, dronabinol has not been approved by the U.S. Food and Drug Administration for the treatment of sleep apnea, and its long-term tolerability and safety are still unknown. Furthermore, there have been no studies of the safety and efficacy of other delivery methods such as vaping or liquid formulation. Treatment with the use of medical cannabis also has shown adverse effects such as daytime sleepiness, which may lead to unintended consequences such as motor vehicle accidents.

"Until there is sufficient scientific evidence of safety and efficacy, neither marijuana nor synthetic medical cannabis should be used for the treatment of sleep apnea," said AASM President Dr. Ilene Rosen. "Effective and safe treatments for sleep apnea are available from licensed medical providers at accredited sleep facilities."

There are more than 2,500 AASM-accredited sleep facilities across the U.S. Treatment options for sleep apnea include CPAP therapy, which uses mild levels of air pressure, provided through a mask, to keep the throat open while you sleep.

https://www.sciencedaily.com/releases/2018/04/180416085927.htm

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

Relationship between legal cannabis and opioid prescribing examined

April 2, 2018

Science Daily/University of Kentucky

Alternative methods of pain management have been a topic of discussion as the United States grapples with the opioid and heroin epidemic. The legalization of cannabis has often been suggested as a possible alternative but little scientific research existed examining the relationship between cannabis laws and rates of opioid prescribing.

In an article published in the Journal of the American Medical Association, HeFei Wen, an assistant professor in the University of Kentucky College of Public Health, asks and answers the question, "Are medical and adult-use marijuana laws associated with lower rates of opioid prescribing for Medicaid enrollees?"

Wen found that medical and adult-use cannabis laws were associated with lower opioid prescribing rates. The overprescribing of opioids is considered to be a major contributor to the opioid epidemic.

"Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose," Wen said. Yet no study to date has focused on the effect of medical and adult-use marijuana laws on opioid prescribing in particular.

"Our study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws was associated with lower opioid prescribing rates and spending among Medicaid enrollees."

https://www.sciencedaily.com/releases/2018/04/180402201647.htm