Using Medical Marijuana With Opioid Painkillers Doesn’t Hike Substance Abuse Risk

A new study has found that patients who use both prescription painkillers and medical marijuana are no more likely to abuse other drugs. The study—which was conducted at a medical cannabis clinic—did show that users have a higher rate of substance abuse than the general population, but it also found that medical marijuana users aimed to reduce their opioid painkiller use. On one hand, the finding suggests that using both addictive substances together isn’t a particular risk for other substance abuse, but it also raises difficult questions about the positives and negatives of using medical marijuana for pain management.

The basic aim of the study was to fill a gap in our knowledge about the impacts of using both medical marijuana and opioid painkillers in terms of other drug or alcohol abuse. The researchers recruited 273 patients from a medical cannabis clinic in Michigan, asking them about their use of prescription painkillers, their levels of pain, how well they function and whether they used other drugs.

The findings showed that those who used other prescription medications as well as marijuana were older, reported more pain and functioned less well than those who just used medical marijuana. Of all the participants, 60 percent reported using both medical marijuana and prescription painkillers in the past month, but the authors found no difference between these and non-prescription drug users in other substance abuse.

The study shows that 40 percent of the sample used alcohol alongside marijuana, but there was no significant difference between the prescription painkiller users and the non-users. The researchers also found no difference in rates of the use of other drugs over the last three months, including cocaine, street opioids, amphetamines and sedatives. However, it’s worth emphasizing that the overall rate of substance abuse was higher in this sample than in the general population.

Those who used both prescription painkillers and medical marijuana for pain relief also tended to rate marijuana as more effective for managing their pain and expressed a strong desire to reduce their use of prescription medications.

Prescription Painkiller Abuse Epidemic

Lead author of the study Brian Perron commented that, “In states where medical marijuana is legal, physicians should be aware that medical marijuana is a potentially safer and more effective treatment approach than opioids.”

This comment, and the findings from the study, appear to paint marijuana for pain relief in a positive light. This is hardly ideal—after all, marijuana is addictive and does carry risks of its own—but taking a step back and looking at the damage done by prescription painkillers reveals the complexity of the issue.

According to the Centers for Disease Control and Prevention (CDC), 44 Americans die every day as a result of prescription painkiller overdose, and in 2013, overdoses on painkillers killed more 25- to 64-year-olds than motor vehicle crashes. There were almost 44,000 drug overdose deaths in 2013, and over half of these were due to prescription medications. For opioid painkillers specifically, over 16,200 people died of an overdose in 2013, and almost 2 million Americans aged 12 or older either abused or were dependent on prescription painkillers.

Can Medical Marijuana Reduce Opioid Painkiller Overdoses?

The patients in this study rated marijuana as more effective than prescription painkillers, but, of course, this is self-rated and ultimately not particularly reliable. Additionally, there is only limited scientific evidence on its effectiveness for pain relief. However, their desire to reduce their use of prescription painkillers is more promising, and if they are successful, it could make a dent in the continuing epidemic.

Some evidence suggests that this is happening. In a study looking at data from 1999 to 2010, researchers found that opioid painkiller-related deaths were 25 percent lower in states that allow the use of medical marijuana for ongoing cancer and non-cancer pain. This seems to support the idea from this study that medical marijuana users reduce their use of opioid painkillers.

It might not seem like a big decrease, but using the 2013 opioid overdose data above, a 25 percent decrease would equate to around 4,000 lives saved. However, the overdose data already include the reductions from the 13 states with medical marijuana for chronic pain (so 4,000 is a simplification and an overestimate), but if such programs were extended nationwide, it’s clear that thousands of lives could still be saved.

The only issue is the moral one: should we potentially reduce the abuse and suffering caused by one drug by simply offering another one? This doesn’t have a straightforward answer, but given the scope of the epidemic, it’s a question that needs to be seriously considered.

Beating Addiction Is the Priority, but Harm Reduction Can Still Help

The ideal situation would be to reduce the rates of prescription painkiller overdose and abuse without resorting to other substances, and things like prescription drug monitoring programs and pill disposal services are already making progress on this. Additionally, getting more people struggling with addiction into treatment should be the main priority.

However, for those genuinely experiencing chronic pain, the use of marijuana—if patients see it as effective and successfully reduce their opioid painkiller use as a result—may be a beneficial addition to treatment. It’s a harm reduction strategy: we know it’s better to use neither opioids nor marijuana, but if that’s not possible, marijuana could help reduce the death and suffering caused by painkillers. However, this study suggests that medical marijuana users are more likely to use other drugs overall—despite the lack of a difference between only marijuana and marijuana-and-opioid users—so more research is needed to answer the more challenging questions it raises about the role of pot in pain management.

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