Access to medical cannabis may reduce opioid use for patients with chronic low back pain, with a higher chance of opioid cessation found among patients with lower baseline opioid use, according to results presented here.
“The extent of patients who went from taking opioids to manage chronic pain to no longer requiring opioids at all surprised us,” Asif M. Ilyas, MD, MBA, FAAOS, president of the Rothman Opioid Foundation and professor of orthopedic surgery at Rothman Orthopaedic Institute and Thomas Jefferson University, told Healio. “We anticipated seeing some decrease in usage, but we were surprised by both the extent of the decrease in usage and the number of patients who altogether voluntarily discontinued using their opioids when they received medical cannabis.”
Using a prescription drug monitoring program system for patients with chronic musculoskeletal non-cancer back pain, Ilyas and colleagues compared average morphine milligram equivalents per day of opioid prescriptions filled within 6 months prior to access to medical cannabis and opioid prescriptions filled after obtaining access to medical cannabis. Researchers collected patient demographic information, as well as VAS back pain score, numeric back pain intensity, numeric back pain frequency, VAS right leg pain score, VAS left leg pain score, numeric leg pain frequency, numeric leg pain intensity and Oswestry Disability Index scores.
Decrease in opioid use
Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed patients experienced a significant decrease in overall average morphine milligram equivalents per day from 15.1 to 11 after receiving a medical cannabis prescription. Researchers found 38.7% of patients dropped to 0 morphine milligram equivalents per day.
Morphine milligram equivalents per day significantly decreased from 3.5 to 2.1 in patients who started with less than 15 morphine milligram equivalents per day and from 44.9 to 33.9 in patients who started with greater than 15 morphine milligram equivalents per day prior to receiving a medical cannabis prescription, according to results. Researchers noted 48.5% and 13.5% of patients who received less than 15 and greater than 15 morphine milligram equivalents per day dropped to 0 morphine milligram equivalents per day, respectively.
Improvements in pain, function
Results showed improvements in patient pain intensity, frequency and daily function at 3, 6 and 9 months post-medical cannabis certification compared with baseline. Although patients who used a single medical cannabis administration route had an insignificant decrease in morphine milligram equivalents per day from 20 to 15.1, researchers found a significant decrease in morphine milligram equivalents per day from 13.2 to 9.5 among patients who used two or more medical cannabis administration routes.
“We’re early on in our understanding of [medical cannabis], but it could become an important tool in the management of chronic pain conditions in orthopedics going forward to improve patient outcomes, to decrease pain and also decrease our broader societal reliance on opioids,” Ilyas said.