Fewer jurisdictions in the world have embraced cannabis reforms quite as much as US states. Despite remaining prohibited at the federal level in the US, medical cannabis is now legally available for the vast majority of citizens in the country, due to state-level reform. In fact, 37 of the country’s 50 states and the District of Columbia (Washington D.C.) now allow individuals to access medical cannabis through various routes.
According to recent figures, the most common reason for medical cannabis use among US patients is pain management. A number of studies have highlighted an apparent trend among patients who have not gained sufficient benefit from traditional pain treatments or have experience intolerable adverse events accessing alternative therapies – including medical cannabis. The estimations of cannabis use or its substitution in place of conventional treatments among adults with chronic non-cancer pain however are not well characterised.
A recent study aimed to address this by assessing the use of cannabis and other pain treatments among chronic pain patients who have access to legal medical cannabis programmes in the US.
Design and Methods of the Study
The researchers employed a cross-sectional study design to assess self-reported use of medical cannabis, pharmacological treatments (including prescription opioids, prescription non-opioid analgesics, and over-the-counter analgesics), common non-pharmacological treatments (such as physical therapy, meditation, and cognitive behavioural therapy), and the substitution of medical cannabis in place of these treatments for chronic pain. ‘Self-reported use’ was separated into three categories: ‘ever’, ‘past 12 months’, and ‘past 30 days’.
In order to collect the required data, a survey was developed and distributed to a representative sample of adults via the National Opinion Research Center (NORC) AmeriSpeak Panel. This panel consists of around 54,000 members and is sourced from a sample covering 96% of US households with a recruitment rate of 34%. A screener survey identified people with chronic pain (as defined using the National Health Interview Survey (NHIS) criterion of pain unrelated to cancer on most days or every day in the past 6 months) and consequently invited them to complete the full survey.
The survey was conducted between March 3rd, 2022, and April 11th, 2022. A total of 1,724 individuals were identified as having chronic pain, of which 1,661 (96.3%) completed the full survey.
Results of the Study
Of the 1,661 individuals who completed the full survey, 948 (57.1%) were female and the mean age of the sample was 52.3 years. Almost a third (31%) of respondents reported that they had ever used cannabis for their pain. Furthermore, over a quarter (25.9%) reported using cannabis for pain management in the past 12 months, and 23.2% reported use in the past 30 days. The vast majority of respondents who reported cannabis use also reported using at least one other pharmacologic (94.7%) or non-pharmacologic pain treatment (70.6%).
While the use of both pharmacologic and non-pharmacologic conventional therapies remained prevalent in the study sample, a significant portion of those who consumed medical cannabis no longer took as many other medications they were prescribed for their pain. In fact, more than half of adults who consumed cannabis reported that they had has also reduced their use of prescription opioids, prescription non-opioids, and over-the-counter pain medications. Furthermore, less than 1% of this group reported that they had increased their use of these medications while using medical cannabis. Due to the study design the authors were unable to prove that medical cannabis was the definite cause of these changes.
On the other hand, fewer than half of respondents reported that medical cannabis use had changed their use of non-pharmacologic treatments: 38.7% reported that their use of physical therapy had decreased (5.9% reported that it had actually increased); 19.1% reported decreased use of meditation (23.7% reported an increase in meditation); and 26% reported that they had reduced their use of cognitive behavioural therapy (17.1% increased use).
These results indicate that a significant portion (3 in 10) of adults with chronic pain living in states with legal access to medical cannabis use these products. Furthermore, the majority of these patients report substituting medical cannabis for more established treatments, including opioids.
The researchers note that their data “suggest that state cannabis laws have enabled access to cannabis as an analgesic treatment despite knowledge gaps in use as a medical treatment for pain.”
While they also acknowledge the limitations of this study – for example, the possibility of self-reporting biases – the high proportion of patients opting to substitute medical cannabis for both pharmacologic and non-pharmacologic treatments highlights the importance of continued research to establish the safety and efficacy of cannabis-based medicines in this setting.