MCP patients showed significantly higher odds of opioid discontinuation (OR 17,27) and dose reduction (OR 5,12) with a 47-percentage-point reduction in daily opioid dosing as well as improvements in pain reduction and quality of life.
Summary
Historical cohort study on Medical Cannabis Program (MCP) enrollment in New Mexico, n=37 chronic pain patients with habitual opioid use (MCP group) vs. n=29 non-enrolled (control), observation over 21 months. MCP enrollment associated with 17,27-fold higher adjusted odds of opioid prescription cessation (95% CI 1,89–157,36, p=0,012), 5,12-fold higher odds of dose reduction (95% CI 1,56–16,88, p=0,007) and 47 percentage points lower daily opioid dose vs. +10,4 percentage points increase in control (95% CI -90,68 to -3,59, p=0,034). Monthly trend in MCP group: -0,64mg IV morphine equivalent (95% CI -1,10 to -0,18, p=0,008), control: +0,18mg (95% CI -0,02 to +0,39, p=0,081). Patient-reported outcomes after 1 year: improvements in pain reduction, quality of life, social activity, concentration (all p<0,001); few side effects.
P
PopulationChronic pain patients with habitual opioid use, n=66 (37 MCP enrollment, 29 controls); mean age 54 vs. 60 years; predominantly chronic back pain
I
InterventionEnrollment in the New Mexico Medical Cannabis Program (MCP); cannabis use ad libitum
C
ControlChronic pain patients not enrolled in the MCP (n=29)
O
OutcomeMCP enrollment associated with 17,27-fold higher age-/sex-adjusted odds of opioid discontinuation (CI 1,89–157,36; p=0,012), 5,12-fold higher odds of dose reduction (CI 1,56–16,88; p=0,007) and 47 percentage point reduction in daily opioid dose vs. +10,4 percentage points in the comparison group (p=0,034)
Confidence in the evidence
Very lowLowModerateHigh
Very low
The lowest GRADE level, the effect estimate remains uncertain.
Background: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
Purpose: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
Methods: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.
Results: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).
Conclusions: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.