The author concluded, “[The] use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence.”
Summary of key findings:
Six out of six general chronic pain studies demonstrated significant improvement in symptoms.
Five out of five neuropathic pain studies found a significant improvement in symptoms. (Three out of five studies investigated “smoked” cannabis, while two examined an oral spray preparation).
Canadian researchers came to similar conclusions in their 2011 Review Study of 18 trials, identifying 15 trials that demonstrated efficacy in treating chronic non-cancer pain. Of the 18 studies, 15 investigated neuropathic pain, while five (overlapping studies) examined other types of pain (one in fibromyalgia; one in rheumatoid arthritis; and, one as an adjunct to opioids in patients with mixed chronic pain; and, two in mixed chronic pain).
They noted several trials reported significant improvements in sleep, with no serious side effects. Further, the studies found just a few adverse effects which were mild to moderate and well tolerated.
Can Cannabis Help Patients Eliminate (Or Reduce) Opioids?
In recent years, North America has been ravaged by an ever-growing epidemic: opioid abuse. Since Purdue Pharma brought OxyContin to the market in the mid 1990s, prescriptions have increased four-fold. Following the increase in prescriptions, rates of heroin addiction and the number of opioid-related overdoses have skyrocketed.
“Cannabis can play an important role in pain relief — with or without opiates — and, given the epidemic level of opioid overdoses, clearly more physicians should seriously consider cannabis as part of their patients’ therapeutic protocol. Not to, would be irresponsible, if not unethical.”
— Dr. Michael Hart
While the government has (belatedly) tried to solve the epidemic by clamping down on “pill mills,” and revising recommended opioid prescription protocols, the actions have elicited unintended consequences. Many individuals who developed a dependency on prescription narcotics found access to OxyContin more difficult, and turned to heroin for a cheaper, more easily accessible, and more potent “high.” There is incontrovertible evidence that proves opioids are often a gateway to heroin, with four out of five heroin addicts reporting have become opioid addicted starting with prescription narcotics, like Vicodin and OxyContin.
Data from the Centers for Disease Control (CDC) illustrate how dire the situation is:
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How could medical marijuana help? By providing an efficacious substitute to opioids, or helping patients reduce their opioid intake. The (CDC) argues that the opioid prescribing is fueling the epidemic, so it would be a sensible strategy to encourage physicians to consider cannabis as an alternative (or, adjunct) to opioid-based treatment programs.
According to Dr. Abrams, “In my clinical practice I have seen many patients decrease their dose of narcotics or wean off them altogether with the addition of cannabis to their regimen. Pain relief, with or without opiates, is another area where cannabis may be quite useful.”
Evidence suggests opioids are only effective for acute pain, and many patients find they must progressively increase their dosage to achieve the same effect; within a short period of time, their pain isn’t responsive to opioid treatment. On the other hand, there is evidence that cannabis (or, more specifically, cannabinoids) may act synergistically with opioids, allowing patients to lower dosage of opioids while achieving comparable pain relief.
According to Dr. Abrams, evidence from studies on animal models, suggest, "Cannabinoids appear to be synergistic with opioids in producing analgesia.” Based on preclinical research, Dr. Abrams conducted a small study to investigate cannabis as an opioid potentiator. His team found that vaporized cannabis didn’t affect morphine or oxycodone blood levels, but they observed synergistic pain relief. After the addition of vaporized cannabis, patients realized a 27% decrease in pain. Abrams and his team concluded vaporized cannabis “augments the analgesic effects of opioids without significantly altering plasma opioid levels.”
“We have studied the effectiveness of cannabis in painful nerve damage (neuropathy) as well as in combination with opiates. From my own oncology practice I am impressed that cancer patients are able to decrease their use of narcotic analgesics when adding in cannabis medicines.” — Dr. Donald Abrams, Chief of Hematology & Oncology - San Francisco General Hospital
Other studies support the role of cannabis as part of a strategy to reduce opioid use. A University of Michigan March 2016 Study provided evidence that cannabis may be superior to opioids and provide a valuable harm reduction strategy. Noting that while opioids are commonly used to treat patients with chronic pain, “there is little evidence that they are effective for long term [chronic pain] treatment.
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