Medical Cannabis can Reduce the use of Opioids in Patients with Chronic Back Pain and Osteoarthritis, but Further Study Needed

 

A study from the American Academy of Orthopaedic Surgeons (AAOS) has demonstrated that pain and quality of life scores improved after patients took a course of medical cannabis. Results showed that enabling access to medical cannabis for patients suffering from chronic back pain and osteoarthritis (OA) can reduce (perhaps even completely eradicate) the use of opioids in the management of pain.

It is estimated that 50 million Americans suffer from non-cancer-related chronic back pain which has traditionally been treated with opioids. The two studies from AAOS have shown there are alternative methods of treating pain and conditions such as osteoarthritis which cause it. This is music to the ears of healthcare professionals as in 2019 it was estimated 10.1 million people aged 12 or older misused opioids 2019 meaning opioid addiction remains at an all-time high. Whilst the use of medical cannabis has been widely researched as an alternative therapy to opioids, the AAOS believe further studies are required to enable reviews in the efficacy and dosing of the drug. 

The program director of the hand & upper extremity surgery fellowship at Rothman Orthopaedic Institute, Dr Ilyas, said, “In the setting of the current opioid crisis, we must identify alternatives that may mitigate the reliance on opioids for controlling pain.”

Dr Ilyas who is also a Professor of orthopaedic surgery at Thomas Jefferson University Hospital in Philadelphia went on to clarify, “At this point, we are not advocating for the routine use of medical cannabis or saying it is a better option, but our studies show potential.”

 

The two studies produced by the AAOS reviewed data of filled opioid prescriptions filled for patients with chronic back pain and OA, who were prescribed medical cannabis, between February 2018 and July 2019. The average morphine milligram equivalents (MME) per day of opioid prescriptions filled six months before access to medical cannabis was compared to the six months after patients gained access.

Chronic musculoskeletal Non-Cancer Back Pain Results:

  • Post a medical cannabis prescription there was a significant decrease in the overall average MME per day, from 15.1 to 11.0 (n=186).
  • 38.7% of patients reduced down to zero MME per day.
  • The percentages of patients who dropped to zero MME per day in these groups were 48.5% and 13.5%, respectively. Patients who started at less than 15 MME per day and greater than 15 MME per day had significant decreases, from 3.5 to 2.1 (n=134) and 44.9 to 33.9 (n=52). 
  • Patients reported improved intensity, frequency, and daily function after medical cannabis use, compared to baseline (three, six, and nine months).
  • Patients who used two or more routes of administration for medical cannabis showed a significant decrease in MME per day, from 13.2 to 9.5 (n=76).

After access to medical cannabis, the study demonstrated (three, six, and nine months):

  • There was a significant decrease in the average MME per day of prescriptions filled by patients, from 18.2 to 9.8 (n=40). The average drop in MME per day was 46.3%.
  • 37.5% of patients dropped down to zero MME per day was 37.5%.
  • Recorded measures on patients' pain scores dramatically reduced, from 6.6 (n=36) to 5.0 (n=26) and 5.4 (n=16)
  • Quality of life score (The Global Physical Health) increased significantly, from 37.5 to 41.4, at the three-month stage.

Dr Ilyas elaborated, “Our studies show that medical cannabis can be an effective treatment for chronic back pain and osteoarthritis, potentially helping reduce the reliance on opioids. However, additional research is needed to better understand the best routes and frequencies, potential adverse events, and long-term outcomes of medical cannabis use. In the interim, prescribers should use shared decision making with their patients when considering medical cannabis for chronic musculoskeletal pain conditions.”

 

 

Article title: Annual Meeting - American Academy of Orthopaedic Surgeons
Website title: Aaos.org
URL: https://www.aaos.org/annual/
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