A woman smokes cannabis.
VISUALSPECTRUM/Stocksy
  • New research finds that people using cannabis for pain relief may reduce their use of prescription drugs, including opioids.
  • Researchers found that over 50% people who used cannabis to manage their chronic pain reported that it led them to decrease their use of opioid medications or other over-the-counter drugs.
  • Medical cannabis products are in 35 U.S. states.

Cannabis has been used for years by people with chronic pain to manage their symptoms, with medical cannabis products available to these people in 37 U.S. states along with Washington D.C as of 2022.

A new survey suggests that many people turning to cannabis for pain relief are also reducing their use of prescription and non-prescription medications, including opioids.

“Most people [surveyed] who used cannabis to manage their chronic pain said that cannabis use resulted in lower use of prescription opioids,” study author Dr. Mark Bicket, assistant professor in the Department of Anesthesiology at the University of Michigan in Ann Arbor, Mich., told Healthline.

“That was also the case for prescription non-opioid medications, as well as for over-the-counter pain medications,” he said.

Cannabis users report a decrease in opioid use

In a research letter published Jan. 6 in JAMA Network Open, researchers surveyed over 1,600 people with chronic pain who lived in one of the 36 states — and Washington, D.C. — with active medical cannabis programs in early 2022.

The average age of respondents was 52 years and more than half were female.

Around three in 10 people reported ever using cannabis to manage their chronic pain, with around one in four doing so over the past year.

The majority of people who used cannabis also reported using at least one prescription or non-prescription medication. 

In addition, over 66% of cannabis users used a non-medication treatment such as physical therapy, meditation or cognitive behavioral therapy.

Researchers found that more than half of people who used cannabis to manage their chronic pain reported that cannabis led them to decrease their use of prescription opioids, prescription non-opioid medications, or over-the-counter pain medications.

In contrast, less than 1% of people reported that their use of cannabis led to an increase in their use of prescription or non-prescription medication.

Some people also reported that their cannabis use led to a decrease in their use of physical therapy, meditation or cognitive behavioral therapy. However, others reported increased use of these non-medication treatments.

Study fits with other research on cannabis

Dr. Sherry Yafai, an emergency medicine physician at Saint John’s Physician Partners Urgent Care in Santa Monica, said these results fit with other research showing that in states with a medical cannabis law, Medicare Part D prescriptions for opioids decreased after the medical cannabis program began.

In addition, some research shows that “in states that have cannabis rules, we’re seeing a decrease in opiate overdoses,” said Yafai.

Although the new study showed that some people with chronic pain are using cannabis, the study wasn’t designed to show whether cannabis actually reduces their pain symptoms.

“Ideally, we’d want to know how patients are doing over time — what is the pain level before starting cannabis and what happens after starting it,” Dr. Roger Chou, professor of medical informatics and clinical epidemiology at Oregon Health & Science University in Portland, Ore., told Healthline.

In addition, the study didn’t compare people who used cannabis to those who didn’t, so we don’t know how people would have fared without cannabis.

“Perhaps patients would have done similarly well if they used another medication or non-pharmacological therapy,” said Chou.

He pointed to other limitations of the new study such as a lack of information about other factors that might have impacted people’s pain and which types of cannabis products people used. 

“So, while this study certainly suggests that patients feel that cannabis helps their chronic pain,” said Chou, “similarly designed studies have suggested the same thing for a number of other therapies that ended up being ineffective.”

Other research supports cannabis for pain relief

Yafai said one of the challenges of a study like this is that people have different ideas of what “medical cannabis” is, so people surveyed may be using a wide range of cannabis products.

This could include cannabidiol (CBD) derived from hemp, which is legal at the federal level due to the 2018 Agriculture Improvement Act, making it available to people in most states.

“So are we really talking about all these individuals having access to CBD? Or were they going to a dispensary and smoking good old-fashioned THC flower?” said Yafai.

Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis, but it is not the only cannabinoid found in the cannabis plant.

Looking at other research — including studies designed to address the issues identified by Chou — there is evidence that cannabis may reduce people’s pain symptoms.

Chou was a co-author on a review published last year in the Annals of Internal Medicine looking at previous studies on the use of cannabis for chronic pain.

He and his colleagues found that certain cannabis products may offer short-term improvements in chronic pain, although there was an increased risk of dizziness and sedation.

In spite of those positive findings, a study published last November in JAMA Network Open suggests that the pain-relieving effect of cannabis may stem, at least partially, from people believing that it will work — the so-called placebo effect.

Bicket acknowledges that because many people with chronic pain are already using cannabis to manage their symptoms, it “highlights the need for further research on the benefits and risks of using cannabis for chronic pain.”

Chou agrees: “[The study] underscores the importance of well-conducted research to clarify the effectiveness, as well as the potential harms, of cannabis,” he said.

Caution using cannabis with other medications

In the real-world, people’s experience with cannabis varies, in part because they may be using different cannabis products.

Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., said the majority of his patients who have tried cannabis for pain have been helped by it.

“But what I’ve found in my clinical experience is that [cannabis] is not effective by itself unless a patient’s pain is mild or is not something they deal with on a daily basis,” he said.

Instead, cannabis may work well alongside other treatments such as an anti-inflammatory or arthritis medications, said Mikhael.

However, he cautions against people using cannabis alongside prescription opioid medications, due to a lack of safety studies.

“There’s no clear safety data on how combining those drugs will affect people’s ability to drive, operate heavy machinery or do tasks that require focus,” he said.

“So I highly recommend that patients come off the opioids while they’re trying cannabis,” he said, “because we don’t know how their body is going to handle both of those drugs together.”

Safety tips for using cannabis for chronic pain

Mikhael and others suggest that people with chronic pain talk to their doctor before trying cannabis.

“It’s important for people to have a conversation with their doctor to come up with what would be an ideal treatment,” said Bicket.

“People should also understand that there are a lot of unknowns when it comes to the use of cannabis [for chronic pain],” he said. “They should be aware of those when trying to make a decision about what’s the right treatment for them.”

Yafai offered the following tips for people who are interested in using cannabis for pain relief:

  • Know your state’s cannabis laws. “Know what’s legal in your state and what’s not legal in your state,” she said, “because we don’t want anyone to get into trouble.”
  • Start low and go slow. Start at the lowest possible dose and increase it slowly. “Don’t just start at the largest dose that your friend is using,” said Yafai, “because if they’ve been using cannabis for a long time, they’ve adjusted to that dose.”
  • Be cautious with edibles. Dosages can vary widely with edibles, from 1 milligram THC to 100 milligrams THC. “Depending on the individual, those higher dosages can be very dangerous,” she said. Also, keep edibles out of reach of children, who can become very sick if they eat them.

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