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.

Medical marijuana may bring relief to older people who have symptoms like pain, sleep disorders or anxiety due to chronic conditions including amyotrophic lateral sclerosis, Parkinson’s disease, neuropathy, spinal cord damage and multiple sclerosis, according to a preliminary study released today that will be presented at the American Academy of Neurology’s 71st Annual Meeting in Philadelphia, May 4 to 10, 2019. The study not only found medical marijuana may be safe and effective, it also found that one-third of participants reduced their use of opioids. However, the study was retrospective and relied on participants reporting whether they experienced symptom relief, so it is possible that the placebo effect may have played a role. Additional randomized, placebo-controlled studies are needed.

According to the Centers for Disease Control and Prevention, approximately 80 percent of older adults have at least one chronic health condition.

“With legalization in many states, medical marijuana has become a popular treatment option among people with chronic diseases and disorders, yet there is limited research, especially in older people,” said study author Laszlo Mechtler, MD, of Dent Neurologic Institute in Buffalo, N.Y.,

 

and a Fellow of the American Academy of Neurology. “Our findings are promising and can help fuel further research into medical marijuana as an additional option for this group of people who often have chronic conditions.”

The study involved 204 people with an average age of 81 who were enrolled in New York State’s Medical Marijuana Program. Participants took various ratios of tetrahydrocannabinol (THC) to cannabidiol (CBD), the main active chemicals in medical marijuana, for an average of four months and had regular checkups. The medical marijuana was taken by mouth as a liquid extract tincture, capsule or in an electronic vaporizer.

Initially, 34 percent of participants had side effects from the medical marijuana. After an adjustment in dosage, only 21 percent reported side effects. The most common side effects were sleepiness in 13 percent of patients, balance problems in 7 percent and gastrointestinal disturbances in 7 percent. Three percent of the participants stopped taking the medical marijuana due to the side effects. Researchers said a ratio of one-to-one THC to CBD was the most common ratio among people who reported no side effects.

Researchers found that 69 percent of participants experienced some symptom relief. Of those, the most common conditions that improved were pain with 49 percent experiencing relief, sleep symptoms with 18 percent experiencing relief, neuropathy improving in 15 percent and anxiety improving in 10 percent.

Opioid pain medication was reduced in 32 percent of participants.

“Our findings show that medical marijuana is well-tolerated in people age 75 and older and may improve symptoms like chronic pain and anxiety,” said Mechtler. “Future research should focus on symptoms like sleepiness and balance problems, as well as efficacy and optimal dosing.”

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.”