Pain affects one’s mood, memory, relationships, and overall quality of life. Constant aches and discomfort can cause frustration, depression, anxiety, anger, social isolation, poor sleep, and related health risks. Pain is a problem. A big problem. And it gets worse as we age: Fifty percent of older adults who live on their own and 75-85 percent of the elderly in care facilities reportedly suffer from chronic pain.
With a growing number of people turning to marijuana for relief, this survey sought to answer several questions: How satisfied are patients with cannabis as an analgesic? How does medical marijuana compare to other pain management approaches, in particular, opiates? How do the most common pain management therapies compare in terms of their impact on quality of life?
Eight hundred people responded to the survey over a six-week period. Most were between 50 and 70 years old. Over 80 percent reported that they were suffering from chronic pain; close to half reported suffering from acute pain; about 40 percent reported suffering from both. On average, respondents had tried four different treatment methods for their pain. One in four respondents had tried six or more treatment modalities.
- Cannabis, opiates, exercise/physical therapy and NSAIDs all provided noticeable pain relief in more than half of patients.
- Cannabis was the only therapeutic approach for which there were no reports of worsening pain. In contrast, surgery, exercise, and nerve blockers benefited some but resulted in increased pain in a significant minority of survey participants.
- Cannabis and exercise/physical therapy were reported to be the most effective therapies for improving quality of life measurements. Over half of patients using these treatment approaches reported improvements in functional ability, mood, and energy.
- A striking number of patients (around half) reported that opiates had a negative impact on overall wellbeing, and resulted in worsening mood, energy, functional ability and sleep.
- Over half of respondents reported that they had used both cannabis and opiates for pain management. Of great interest was the impact of cannabis therapy on opiate usage: Ninety-one percent of this subgroup reported that they used fewer or no opiates after beginning cannabis therapy. Sixty-three percent said that they went off opiates altogether.
- Among those using marijuana, just under 90 percent said they used it one or more times per day.
- There were no significant differences in outcomes for patients using high THC versus CBD-rich products. Both types of cannabis were found to be highly effective in managing pain. Use of CBD-rich products, then, appears to be based on personal preferences with respect to psychoactivity and/or factors we did not measure. Moreover, some patients reported anecdotally that the psychoactivity of THC contributed positively to cannabis’ pain-relieving effect.
- The most common method of administration was vaporization, which is generally a safe mode of administration–barring additives and thinning agents that can be found in low quality vaping products.
Cannabis appears to be an effective pain management tool with few negative side effects. Patient-reported outcomes for cannabis therapy contrasted particularly sharply with those for opiates, which while effective for pain management, had a negative impact on quality of life measurements in a significant number of patients.
The observed decrease in opiate usage among patients on cannabis therapy was the study’s most striking finding. Again, 91 percent of survey respondents reported that they decreased the amount of opiates they were taking or eliminated them altogether. This finding is supported by preclinical (animal) research, which suggests that cannabinoids and opiates may work synergistically; a low dose of cannabinoids in combination with an opiate may increase the opiate’s effectiveness thereby slowing the development of tolerance, and decreasing the risk of addiction. Not surprisingly, the endocannabinoid system is implicated in opiate addiction and withdrawal. Increasing the concentration of endogenous cannabinoids has been shown to reduce the effects of opiate withdrawal in animals.
These observations are validated by public health statistics: The Johns Hopkins Bloomberg School of Public Health reported in 2015, “In states where it is legal to use medical marijuana to manage chronic pain and other conditions, the annual number of deaths from prescription drug overdose is 25 percent lower than in states where medical marijuana remains illegal.”
A tenet of healthcare in the United States is “First, do no harm.” Patient reports of cannabis’ efficacy together with its low side effect profile suggest that it should be considered as a first-line treatment for pain and/or as an adjunct treatment to opiates rather than as a medication of last resort.