Scholarly Research and EBP Poster

December 7, 2017

Is medical cannabis a safer alternative for chronic pain than opioids?

Devin Dunn, Shelby Furubayashi, Siera Stokes
Westminster College

Abstract:
Background
Opioids are the leading cause of drug overdoses in North America. (Rudd et al., 2016) Opioids are often a
provider’s first choice medication for treating chronic pain even though other options exist.
Questions
For chronic pain, (1) Is there less risk of dependency using medical cannabis compared with opioids? (2) Is
medical cannabis effective in treating chronic pain? (3) Are there additional reasons to choose medical cannabis
over opioids?
Methods
The authors studied 37 peer reviewed articles and applied in depth analysis, critical thinking, article appraisal,
author credibility analysis, applicability analysis, ethical considerations and clinical significance assessment to
arrive at the final 4 research articles that are incorporated in the review.
Conclusion/Results
This research shows that cannabinoids are effective in treating chronic pain. Medical cannabis is a safer
alternative to opioids and has added benefits by treating frequent comorbidities of chronic pain such as
depression and anxiety. Results suggested that cannabinoids should be considered to replace opioids, as a first
choice analgesic for chronic pain, to decrease the amount of opioids used by patients.

Problem Statement:
Opioid drug abuse is rampant throughout North America; opioids are often prescribers’ first choice analgesic
for chronic pain. Other options exist, including cannabis. Cannabis may be a more effective and less habit-
forming choice for treating chronic pain. Understanding the effectiveness and safety of using cannabis would be
valuable because opioids are the cause of 33,091 overdose deaths per year in North America. (Rudd, Seth,
David, Scholl 2016). If cannabis could safely replace opioid use it could save lives.

Questions to be explored:
1. For chronic pain, is there less risk of dependency using cannabinoids compared with opioids?
2. Are cannabinoids effective at treating chronic pain?
3. Are there additional reasons to choose cannabinoids over opioids?

Methodology:
For this review, the authors searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL),
Health Source: Nursing/Academic Edition, Health Reference Center Academic, and Science Direct (Elsevier)
databases using these search terms: “medical marijuana”, “cannabinoids”, “opioids”, “opioid dependence” and
reviewed 37 articles about this topic; the selection was then narrowed to 12 articles. In depth analysis, critical
thinking, article appraisal, author credibility analysis, applicability analysis, ethical considerations and clinical
significance assessment were used to arrive at the final 4 research articles which are incorporated in the review.

Summary:

Multiple articles were reviewed in order to determine the validity of the problem and provide further
understanding of the pros and cons of cannabinoids and opioids. Four separate articles were evaluated
including: Rationale for cannabis-based interventions in the opioid overdose crisis, Associations between
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December 7, 2017
medical cannabis and prescription opioid use in chronic pain patients: a preliminary cohort study, Medical
cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of
patients with pain, and Cannabis as a substitute for prescription drugs - a cross-sectional study. These articles
provided different studies and perspectives to enhance the understanding of effectiveness of medical cannabis.
Multiple articles included or referred to quantitative data with adequate sample sizes to show the effect that
opioid drugs are having on the population and how cannabinoids could reduce opioid morbidity and mortality.

While reviewing multiple articles it was apparent that the opioid epidemic is a serious problem and drug
overdose is the leading cause in accidental death in the U.S. with 33,091 related to opioids (Lucas, 2017).
Opioids were found to be a poor treatment for long-term therapy due to the risk for dependence and multiple
side effects. Historically, cannabis has been illegal and may have been ‘scary’ due to the unknown. However,
with recent research and studies performed, many are learning that cannabis does in fact, have many helpful
uses and can benefit numerous types of patients.

The first article reviewed was Rationale for cannabis-based interventions in the opioid overdose crisis. This
article tried to determine if cannabis is more effective than opioids for chronic pain, if cannabis is a viable
option to reduce opioid use, and if cannabis can be used as an adjunct therapy to methadone or Suboxone
treatment in order to increase treatment success rates. The authors performed a Systematic Review and Meta-
analysis. Lucas (2017) came to the conclusion that the growing body of research supporting the medical use of
cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care
providers, and academic researchers to seek the immediate implementation of cannabis-based interventions in
the opioid crisis at the regional and national level, and to subsequently assess their potential impact on public
health and safety.

Secondly, the article Associations between medical cannabis and prescription opioid use in chronic pain
patients: a preliminary cohort study was reviewed. The purpose was to determine if natural cannabis could
serve as an alternative to opioid use for the treatment of chronic pain. The main question asked was, Does a
Medical Cannabis Program (MCP) have an effect on opioid prescription patterns, pain reduction, quality of life,
social life, activity levels, and concentration (Vigil, Stith, Adams, & Reeve, 2017)? This study performed a
historical, cohort research design using a convenience sample. During a 21-month study researchers
implemented the use of the New Mexico Prescription Monitoring Program to determine opioid prescription
patterns. Survey questions were also given, before and after the study, to gauge effectiveness of cannabis in pain
reduction, quality of life, social life, activity levels, and concentration. Results from the study showed, over
80% of the Medical Cannabis Program subjects reduced their daily opioid prescription dosages/fills and 40%
ceased filling opioid prescriptions completely after a year and a half of being part of the Medical Cannabis
Program (Vigil, Stith, Adams, & Reeve, 2017). Subjects who were part of the MCP reported a reduction in pain
with improved quality of life, increased social interactions, and activity levels resulting from the Medical
Cannabis Program. In conclusion, a Medical Cannabis Program (MCP) has shown to help in the reduction of
opioid use. With medical cannabis shown to provide pain reduction, increased quality of life, an improved
social life, activity levels, and concentration.

Thirdly, in the article Medical cannabis use is associated with decreased opiate medication use in a
retrospective cross-sectional survey of patients with pain the authors asked the question ‘Does the use of
medical cannabis for chronic pain change individual’s patterns of opioid use?’ (Boehnke, Litinas, & Clauw,
2016). A cross sectional study was designed using convenience sampling and data was collected through an
online questionnaire which included demographic information, changes in opioid use, quality of life, medication
classes used, and medication side effects before and after initiation of cannabis usage. Researchers found that
Opioid use decreased by 48-79% amongst participants, NSAID, disease-modifying anti-rheumatic drugs,
antidepressants, SSRI’s, SNRI’s and other drug use also decreased with the introduction of medical cannabis.
Side effects of medication on everyday functioning decreased substantially after cannabis use (Boehnke,
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December 7, 2017
Litinas, & Clauw, 2016). Authors recommend that medical cannabis should become an integral medication used
to treat chronic pain.

Lastly, in the article Cannabis as a substitute for prescription drugs - a cross-sectional study Corroon, Mischley
and Sexton (2017) asked “How many people use or have used cannabis intentionally as a substitute for
prescription narcotics/opioids, anxiolytics/benzodiazepines and antidepressants with an improvement towards
treatment?’ They realized that there isn’t adequate research on how frequently patients have substituted
cannabis for prescription drugs. A cross-sectional survey was conducted with social media users who had
received and used cannabis from the dispensaries in Washington State within the last 90 days. All data was
collected through an anonymous online survey. The authors found that 46% of the respondents stated that they
had substituted cannabis for prescription drugs within the last 90 days. Cannabis was exchanged for opioids 2.6
times more frequently than for any other prescriptions drugs. Participants also concluded that cannabis has
provided them with adequate symptom relief. (Corroon, Mischley, & Sexton, 2017). They recommended
increasing the amount of professional guidance offered for those who are substituting medical cannabis for
prescription drugs illegally since it is apparent that despite the illegality of cannabis many patients are self-
medicating.

Implications for Nursing:

This review directly impacts nurses, nursing students, educators, providers and communities. If cannabinoids
are implemented as an analgesic it would change the way nurses and providers think about treating pain. It
would change the way student nurses are educated about pain management. It would have implications on
legislation, government regulation and societal views of pain management. Most importantly it would have a
direct impact on communities and lives by altering the course of the opioid epidemic.

References

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Uncertainty. Mayo Clinic Proceedings, 91(7), 830–832. https://doi.org/10.1016/j.mayocp.2016.04.008

Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical Cannabis Use Is Associated With Decreased Opiate

Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. The Journal

of Pain, 17(6), 739–744. https://doi.org/10.1016/j.jpain.2016.03.002

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Patient Care for Chronic Pain. JAMA, 316(17), 1763–1764. https://doi.org/10.1001/jama.2016.13677

Corroon, J. M., Mischley, L. K., & Sexton, M. (2017). Cannabis as a substitute for prescription drugs – a cross-

sectional study. Journal of Pain Research, 10, 989–998. https://doi.org/10.2147/JPR.S134330

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December 7, 2017
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