The Risks Behind Medicinal Cannabis Treatment
Written by Heema Joshi, BMS'22
Published on December 4, 2020
We previously discussed the supporting evidence of the implementation of medicinal cannabis can offer persistent pain patients as well as those combatingOpioid Use Disorders (OUD) an alternative and beneficial option. In addition to discussing the advancements and beneficial effects of medicinal cannabis, it is essential to also focus on the risks that can arise. Due to the rising rates of marijuana use and its implementation into health care, concerns have surfaced on the indirect and long-term effects of cannabis use.
One study’s objective was to see if indirect side effects such as degradation of mental health and increased likelihood of substance disorders were proportional to medical cannabis use.This study used a nationally representative sample and collected data through a survey given at the beginning of the experiment (from 2001-2002; Wave 1) and then three years later (Wave 2). The sample consisted of 34,653 participants with an average age of 45 years. The results showed that there was an increased likelihood ofpsychiatric disorders in those individuals who used cannabis monthly. In addition,7.7% out of the 1279 participants that used cannabis at wave 1 had the presence of cannabis dependence/addiction and 28.4% with cannabis misuse/abuse at wave 2. Data also supported that cannabis use was correlated with increased prevalence and incidence of drug and alcohol use disorders. It is important to mention that the study did not find a connection between anxiety and mood disorders with increased cannabis use; rather, the most significant finding was the correlation between cannabis use and the onset of future substance use disorders, including nicotine dependence.
A more recent study, published in 2018, was conducted taking into account the amount of cannabis use, opioid use, pain severity and management. The Pain and Opioids IN Treatment (POINT) study, examined a national cohort of people with chronic non-cancer pain prescribed opioids, to determine the effectiveness of cannabis in non-cancer chronic pain patients, changes in pain severity, opioid use, and potential opioid sparing effects of cannabis. Results were collected on 1,514 participants completing four (4) annual self-administered questionnaires. All participants were older than 18 years of age, had chronic pain in the last 3 months and were currently taking opiates. Amongst the participants, the median age was 58 years and 56% were female. Participants dealt with chronic pain for a median of 10 years, and used strong opioids for a median of 4 years. By the 4-year follow up, 295 individuals had utilized cannabis for pain and their interest in cannabis use for pain increasedfrom 33% at baseline to 60%. In terms of pain, individuals who used cannabis had greater pain severity (with no sign of decrease), as well as lower self-efficacy in managing pain. In addition, there was no evidence that cannabis use reduced prescribed opioid use or led to opioid discontinuation - with 70% of the participants using cannabis stating that it had no effect on reducing opioid use.
The results these studies demonstrate that incorporating medicinal cannabis into the regimen of individuals who are already susceptible to drug dependencies may give rise to more harm by causing patients to haveless self-efficacy in pain management. In addition, participants who reported recreational and social factors as part of their motivation to use cannabis may also be likely to develop a further condition with its use. The alleviating effect and improvement of quality of life that medicinal cannabis cannot be ignored, but are these benefits worth the risks? These implications may make it difficult for patients who already face tremendous and critical health conditions to view medicinal cannabis as a being worthwhile.
Overall, physicians must take into diligent consideration of all factors, such as the increased likelihood of developing a psychiatric disorder and reduced self-efficacy, before recommending a patient use cannabis medicinally. In this and the previous blog, we have discussed both risks and benefits of medicinal cannabis treatment through supporting and contradictory evidence. In my final installment blog, I will discuss what these findings mean for the implementation of medicinal cannabis for persistent pain and for OUD through a holistic overview.