Adults With Chronic Pain Replace Opioids With Medical Cannabis for Pain Relief

Approximately one-third of adults with nonchronic cancer pain report using medical cannabis for pain relief.

Among adults with chronic pain who live in US states with medical cannabis programs, 3 in 10 report using medical cannabis for pain management. More than half of these adults report a decreased use of other pain medications including prescription opioids. These are the findings of a study published in JAMA Network Open.

Given the recent opioid crisis caused by increasing rates of death due to opioid overdose, questions have arisen regarding use of medical cannabis as an effective alternative for managing chronic pain unrelated to cancer.

To answer this question, researchers conducted a cross-sectional study from March 3, 2022 to April 11, 2022 surveying 1724 adults with chronic pain in 36 states in the US and Washington, DC with medical cannabis programs. Of these 1724 adults, 1661 (96.3%), predominantly women (57.1%), fully completed the survey. The mean age of respondents was 52.3 years.

Among these survey respondents, 31% (95% CI, 28.2%-34.1%) reported ever using cannabis for pain. Meanwhile, 25.9% (95% CI, 23.2%-28.8%) of respondents reported use of cannabis for chronic pain management in the past year. This percentage remained largely unchanged with 23.2% (95% CI, 20.6%-26%) reporting cannabis use within the past 30 days.

The high degree of substitution of cannabis with both opioid and nonopioid treatment emphasizes the importance of research to clarify the effectiveness and potential adverse consequences of cannabis for chronic pain.

Approximately 94.7% of those who used cannabis for chronic pain management also used at least 1 other pharmaceutical, while 70.6% used at least 1 nonpharmacologic pain treatment.

Over half of respondents claimed that cannabis use enabled them to reduce their use of prescription opioids, prescription nonopioids, and over-the-counter pain medications. Less than 1% of respondents reported an increase in these pain-relieving medications.

Less than half of respondents claimed that cannabis use altered their use of nonpharmacologic pain management treatments, including physical therapy, meditation, and cognitive behavioral therapy.

Pain management using cannabis decreased use of physical therapy in 38.7% of these adults, meditation in 19.1%, and cognitive behavioral therapy in 26%. In contrast, cannabis use increased use of physical therapy in only 5.9% of respondents, meditation in 23.7%, and cognitive behavioral therapy in 17.1%.

“The high degree of substitution of cannabis with both opioid and nonopioid treatment emphasizes the importance of research to clarify the effectiveness and potential adverse consequences of cannabis for chronic pain,” the researchers noted. “Our results suggest that state cannabis laws have enabled access to cannabis as an analgesic treatment despite knowledge gaps in use as a medical treatment for pain.”

Study limitations included potential self-reporting bias and sampling bias as well as pain treatment changes due to other factors such as forced opioid tapering.

References:

Bicket MC, Stone EM, McGinty EE. Use of cannabis and other pain treatments among adults with chronic pain in US states with medical cannabis programs. JAMA Netw Open. Published online January 6, 2023. doi:10.1001/jamanetworkopen.2022.49797