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20th December 2022
Widespread state medical marijuana legalisation in the US is associated with a lower rate of opioid dispensing and pain-related hospital events among some adults receiving treatment for newly diagnosed cancer according to an analysis by US researchers.
Pain is an extremely common cancer symptom with a 2022 meta-analysis of 12 studies (10 with breast cancer and 2 lung cancer) patients, finding a pooled pain prevalence rate of 40%. Although paracetamol and non-steroidal anti-inflammatory drugs are universally accepted as part of the treatment of cancer pain at any stage of the WHO analgesic ladder, strong opioids are the mainstay of analgesic therapy in treating moderate to severe cancer-related pain. Nevertheless, with tightened regulations leading to a decrease in opioid prescribing across the United States, evidence points to a decline in opioid use among end-of-life care in those with cancer although there has been a rise in pain-related emergency department visits, suggesting that end of life cancer pain management may be worsening. Although medical marijuana has been studied and found to be efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids, a 2016 review suggested that while marijuana may have the potential for refractory cancer pain, much of the data are based on animal data, small trials, or are outdated.
With the potential to help patients with cancer pain, in the current study, US researchers set out to assess the associations between medical marijuana legalisation and opioid-related and pain-related outcomes for adult patients receiving cancer treatment. The team used data from national commercial claims between 2012 to 2017. The researchers assessed several measures including the proportion of patients having 1 or more days of opioids and 1 or more pain-related emergency department visits or hospital events, during the 6 months after a new cancer diagnosis.
Medical marijuana and opiate use
A total of 38,189 patients with newly diagnosed breast cancer, 12,816 with colorectal cancer (55.4% male) and 7,190 (51.1% female) with lung cancer were included in the analysis.
Medical marijuana legalisation was associated with a reduction in the rate of 1 or more opioid days from 90.1% to 84.4% (difference = 5.6, 95% CI 2.2 – 9.0, p = 0.01) among breast cancer patients. For colorectal cancer patients, there was also a reduction, this time from 89.4% to 84.4% (difference = 4.9, 95% CI 0.5 – 9.4, p = 0.03). Finally, opioid use reduced from 31.5% to 22.1% (difference = 9.4, 95% CI 0.8 – 17.9, p = 0.03) among patients with lung cancer with recent opioids.
Medical marijuana legalisation was also associated with a reduction in the rate of 1 or more pain-related hospital events from 19.3% to 13.0% (difference = 6.3, 95% CI 0.70 – 12.0, p = 0.03) among patients with lung cancer with recent opioids. However, the difference for the other two forms of cancer was not significant.
The authors concluded that medical marijuana legalisation was associated with a lower rate of opioid dispensing and pain-related hospital events among some adults receiving treatment for newly diagnosed cancer.
Bao Y et al. Medical Marijuana Legalization and Opioid- and Pain-Related Outcomes Among Patients Newly Diagnosed With Cancer Receiving Anticancer Treatment. JAMA Oncol 2022
17th October 2022
Medicinal cannabis use appears to be associated with a reduction in patient’s use of opiate-based analgesics and improvements in self-reported physical functioning according to a study by US researchers.
In the US there has been an opiate crisis of epidemic proportions. Data from the CDC indicate that in the year ending in June 2020, 48,006 deaths were attributable to overdosing on synthetic opioids other than methadone. Fortunately, it appears that the level of opiate-related deaths in the US is beginning to fall with a slight decrease in 2019 compared to 2017. Although there may be any number of reasons as to why deaths are falling, one potential explanation for this reduction is greater use of medicinal cannabis (MC) use compared to opiates. In fact, a 2017 study identified how patients reported less use of opiates, antidepressants, alcohol, anti-anxiety, migraine and sleep medications after using MC. Despite this possible rise in use, an overview of the efficacy, tolerability and safety of cannabis-based medicines for chronic pain management concluded that there were inconsistent findings of the efficacy of cannabinoids in neuropathic pain, painful spasms in multiple sclerosis and for any chronic pain. However, many US states have taken steps to legalise and decriminalise the use of MC. As a result, for the present study, the US team sought to characterise the demographics and use patterns of those who had physician-approved medical cannabis access and to examine patient’s perceptions of changes in health functioning and use of opiate-based pain medicines (OBPM) after access to MC. The team developed a 66-item questionnaire that was distributed online, assessing a wide range of factors including demographics, medical conditions, health functioning and changes in pain medication use before and after use of MC.
Medicinal cannabis and changes to opiate-based medicine use
A total of 2,183 responses were included of whom 54.4% were female and nearly two thirds (64.9%) were aged 30 to 59. A third (33%) of respondents reported that they had 6 or more ailments and nearly half (47.9%) reported having pain and mental health issues, whereas pain alone was reported by only 9.1%.
The majority (54.9%) reported using medicinal cannabis regularly throughout the day and 7.8% had been using medicinal cannabis for more than 10 years.
In terms of physical functioning, bodily pain (e.g., the level of pain or interference of pain in normal work) was reportedly improved by 89.6% of respondents after use of MC, as was social functioning (84.3%).
Prior to MC usage, 60.9% of respondents were using OBPM with 36.8% using hydrocodone-acetaminophen (paracetamol) or oxycodone-acetaminophen (26.8%). However, after using MC, 41.7% reported that they had stopped using pain medicines and 37.5% had reduced their pain medicines. Interestingly, 11.5% reported improved functioning after using MC and reducing their OBPM.
The authors concluded that medicinal cannabis may play an important role at both the individual and community level as a viable alternative to opioids for pain management and without negatively affecting health functioning.
Prtichett CE et al. Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use Subst Use Misuse 2022