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Daily Cannabis Users May Use Opioids Less Often

January 18, 2020
Study participants reported their therapeutic reasons for - and responses to - daily marijuana use compared to illicit opioids.

A PPM Brief

More patients are turning to cannabis as a possible substitution for opioids to treat their pain. Definitive research into cannabis as a pain-relieving remedy is still ongoing, including its comparative risk of abuse, misuse, and potential overdose of opioids. Some research has suggested that increased access to cannabis may facilitate reduction in opioid use and harms. In a new analysis,1 researchers investigated the longitudinal association between the frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) and who experience chronic pain.

With research pinning cannabis access to lower opioid usage, researchers aimed to see how daily cannabis use affects daily opioid use. (Image: iStockPhoto)

Using data in two prospective cohorts, researchers interviewed PWUD participants at least once in Vancouver, British Columbia, Canada, who reported major or persistent pain from June 2014 to December 2017 (n = 1,152; 424 [36.8%] women; median age at baseline 49.3 years [IQR 42.3-54.9]). The researchers used statistical modeling to estimate the odds of daily opioid use for daily and occasional users of cannabis relative to non-users of cannabis, holding other factors (sex, race, age, use of other drugs, pain severity) equal. For those who reported cannabis use, the researchers looked at the reasons behind the use. A few highlights:

  • Approximately 455 (40%) patients reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period
  • The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%)
  • After adjusting for demographics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34-0.74, P < 0.001).

Overall, those who reported using cannabis every day had about 50% lower odds of using illicit opioids every day compared to cannabis non-users; however, those who reported occasional use of cannabis were not more or less likely than non-users to use illicit opioids on a daily basis. Daily cannabis users were more likely than occasional cannabis users to report a number of therapeutic uses for the cannabis, including pain, nausea, and sleep.

The study’s self-reported measures of substance use and chronic pain, and lack of data for cannabis preparations, dosages, and modes of administration contributed as limitations to the findings. Certainly, the focus on illicit rather than prescription opioids factors into the findings as well, in terms of any practical application.

“Although more experimental research (eg, randomized controlled trial of cannabis coupled with low-dose opioids to treat chronic pain among PWUD) is needed, these findings suggest that some PWUD with pain might be using cannabis as a strategy to alleviate pain and/or reduce opioid use,” the researchers concluded in their paper.

Last updated on: January 16, 2020
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