Opioids are a class of medicines and drugs that have been increasingly prescribed for a large number of conditions – particularly those in which pain is a major symptom. However, opioids carry a huge risk of addiction, abuse, and overdose. There were an estimated 446,032 opioid-related deaths between 1999 and 2018 in the US alone. Emergency medicine physicians are on the frontline of care from resuscitating overdoses to managing acute pain while counterbalancing opioid-seeking behaviour.
Emergency medicine physicians are acutely aware that administering opioids in the emergency department and writing outpatient prescriptions for opioids directly contributes to the misuse and dependence on the medications. Therefore, many physicians would prefer to consider alternative treatments – according to the results of a recent survey. One such alternative therapy is medical cannabis.
Medical cannabis is being increasingly considered as an adjunct or alternative to opioids for reducing pain – particularly chronic pain. However, the illegality of cannabis at the federal level in the US means that there is little research into whether emergency medicine physicians would consider its use in acute settings. The aim of the current study was to “assess emergency medicine physicians’ preferences for using medical cannabis compared to opioids in an emergency medicine setting were it to become legalised.”
Design and Methods of the Study
Researchers distributed a survey questionnaire to US physicians who attended the largest national emergency medicine conference (American College of Emergency Physicians Annual Conference) in 2018. A total of 539 completed surveys were included for assessment.
To compare demographic variables, age, gender, race, practice setting, medical specialty, type of medical degree, years of, cannabis legality in state of practice, and belief that cannabis has medical value, to three cannabis versus opioids scenarios, chi-square tests and Fisher’s exact test were performed.
Results of the Study
Most respondents were practicing in states where medical cannabis is legal (54.8%) and 23.1% of respondents were practicing in states where both medical and adult-use recreational cannabis is legal. A majority (70.7%) of the practitioners who completed the survey believed that cannabis has medical value.
Participating physicians were asked whether they would prefer to use cannabis or opioids as a first-line treatment of a medical condition – provided medical cannabis was legal at the federal level, was administrable in different formats (flower, pill, sublingual, and intravenous), available for use in an emergency setting. The results revealed that most physicians would prefer to use cannabis if medical studies found that it was equally effective (52.3%), and more would prefer cannabis if it was found to be more effective (79.6%).
A belief that cannabis has medical value significantly increased the odds that physicians would choose cannabis over opioids if cannabis was found to be equally or more effective than opioids. However, a significant proportion of respondents chose “don’t know/no preference”. The researchers believe that this suggests ambivalence or lack of knowledge about medical cannabis.
The researchers of this study reported surprise at the results as they “did not expect emergency medicine physicians would be willing to use cannabis in an emergency setting at this point in time given its decades of stigma as a dangerous drug.” A comprehensive review by the National Academies of Sciences concluded that medical cannabis is useful for treating adult chronic pain. Nonetheless, cannabis – even for medical uses – remains federally illegal in the US.
The researchers conclude that these results reflect emergency medicine physicians’ desire to have an alternative treatment option to the “known potentially addictive effects of opioids, understanding the gravity of the opioid epidemic.” Based on these findings, which are consistent with a similar study published in the previous year which revealed that 68.3% of physicians believe that cannabis has medical value, further study of this potential alternative/adjunctive therapeutic is warranted.