Opioids versus medical marijuana: Pain management

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The nation is in the middle of a health crisis.1 The CDC reports that there were more than 700,000 deaths related to drug overdoses from 1999 to 2017, with 400,000 of those related to opioids, both prescription and illicit.2 There are more than 650,000 opioid prescriptions dispensed daily in the United States, with the majority being for pain management.3 According to the National Institute on Drug Abuse, dentists and oral surgeons are two of the biggest prescribers of opioids.4,5

An increased tolerance for opioid use has driven the need for alternative methods of pain management.5 In 2016, federal guidelines required providers to reduce the number of opioids prescribed for pain. In addition, many individuals are unable or unwilling to take certain medications.5 The limitations require alternative options for managing pain. Medical marijuana is being considered as an alternative to opioids.6

Medical marijuana has been used for thousands of years for pain management.7 The oldest pharmacopeia has cannabis in it, and was used for over 100 ailments, including gout, arthritis, and malaria. It was also used to treat tremors, as an anti-inflammatory, and to manage pain.7 Today, there are new cannabis-based medications that have been approved by the FDA for certain types of pain, such as neuropathic pain and pain associated with chemotherapy.7 Patients reported that use of the medications achieved the results of reduced pain levels.6 Many cannot afford the hefty cost of prescription drugs and turn to cannabis for pain management.

Even when taken appropriately as prescribed, opioids have a serious risk of addiction, abuse, and overdose.6 That risk increases for senior citizens, who are turning to medical marijuana instead of opioids to manage their ailments.6 Alarmingly, 50% of all opioid prescriptions are for seniors, yet seniors account for only 13% of the population. A study by The National Survey on Drug Use and Health discovered that cannabis use increased for this demographic by 250%, and 93% of users felt relief from their symptoms.6

New research points to cannabis as a possible option for relieving pain associated with chemotherapy.8 A study conducted by Israeli researchers found that marijuana provided considerable pain relief for more than half of the 1,200 cancer patients over a six-month period.8

German researchers published 16 studies regarding chronic nerve pain and marijuana.8 More than 50% of the 1,700 participants reported an increased reduction in pain while using marijuana-based remedies.8

There are studies that link marijuana to a reduction of migraine pain.9 The European Academy of Neurology found that marijuana reduced migraine pain by 40% or more.9 Marijuana also decreased pain in those who experienced cluster headaches and pain associated with muscle spasticity.

Although medical marijuana is not for everyone, experts see its potential in replacing opioids.8 Researchers polled approximately 3,000 medical marijuana patients and discovered that the majority found relief equal to that of their other medications, without the side effects.1 The study reports that 97% were able to reduce their amount of opioid use, and 81% said that using medical marijuana alone was more effective than a combination of opioids and marijuana.

It is an interesting time in the history of cannabis. There are increasing debates on the qualities and advantages of medical marijuana. Mindful of the gaps in research and the lack of support by health-care providers, it is difficult to have the conversations necessary to support the needs of patients. Unanswered questions and inconsistencies among providers may affect patients’ quality of care. Providers may miss opportunities to counsel patients regarding medical marijuana use. As the use of cannabis continues to increase, additional research is essential to answer questions that many people are asking about the benefits of medical marijuana. 

References

1. Hill KP, Palastro MD, Johnson B, Ditre JW. Cannabis and pain: A clinical review. Cannabis Cannabinoid Res. 2017;2(1):96-104. Published 2017. Accessed December 18, 2018.

2. Understanding the epidemic. CDC website. https://www.cdc.gov/drugoverdose/epidemic/index.html. Updated December 19, 2018. Accessed December 20, 2018.

3. Blessing E, Steenkamp M, Manzanares J, Marmar CR. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics. 2015;12(4):825-836.

4. NIH partners with the dental community to help curb the opioid crisis. National Institute on Drug Abuse website. https://www.drugabuse.gov/about-nida/noras blog/2018/07/nih-partners-dental-community-to-help-curb-opioid-crisis. Published July 25, 2018. Accessed December 18, 2018.

5. Meshkin B. Personalized medicine’s role in ending opioid abuse in dentistry. Perio-Implant Advisory website. https://www.perioimplantadvisory.com/articles/2017/04/personalized-medicines-role-in-ending-opioid-abuse-in-dentistry.html. Published April 10, 2017. Accessed December 18, 2018.

6. Choo EK, Ewing SWF, Lovejoy TI. Opioids out, cannabis in. J Amer Med Assoc. 2016;316(17):1763.

7. Corroon JM, Mischley LK, Sexton M. Cannabis as a substitute for prescription drugs—a cross-sectional study. Current neurology and neuroscience reports. NCBI website. https://www.ncbi.nlm.nih.gov/pubmed/28496355. Published May 2, 2017. Accessed December 19, 2018.

8. Schneiderman M. Mills D. Opioids vs. marijuana: Which is more dangerous? Healthline website. https://www.healthline.com/health-news/opioids-vs-marijuana#1. Accessed December 19, 2018.

9. Doheny K. Can marijuana be the answer for pain? WebMD website. https://www.webmd.com/a-to-z-guides/news/20180420/can-marijuana-be-the-answer-for-pain. Published April 20, 2018. Accessed December 18, 2018.

Kimberly Farley, MSHS, RDH, has more than 20 years of experience as a clinician and educational leader. Farley founded Oral Health &
Wellness Learning to bridge the gap between oral health and cannabis. Focusing on medicinal marijuana, the company’s objective is to break the stigma by promoting clean and healthy medicinal experiences through education, and to help clients understand the benefits of cannabis in a nonjudgmental environment.

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