Can Medicinal Cannabis Reduce Opioid Use for Chronic Pain?

This is the question researchers at Albert Einstein College of Medicine and Montefiore Health System hope to answer as they embark on a new five-year study. The research team has been granted $3.8 million in funding from the National Institutes of Health (NIH) to conduct the first long-term study of medicinal cannabis versus opioid use among patients with, and without, HIV.

“There is a lack of information about the impact of medical marijuana on opioid use in those with chronic pain,” said principal investigator Dr. Chinazo Cunningham, associate chief of general internal medicine at Einstein and Montefiore. “We hope this study will fill in the gaps and provide doctors and patients with some much needed guidance.”

Chronic pain conditions are common in the US, and until recently, prescription opioids were the preferred drug for pain management. However the abuse potential of opioids – as evidenced by the millions of Americans who are now dependent on prescription painkillers – has prompted doctors and other healthcare providers to look for alternatives.

The decision to include HIV-positive patients in the impending study was made based on the fact that up to 90 percent of these individuals experience chronic pain. Adults with HIV are often prescribed opioid painkillers, despite the very real risk of opioid misuse and abuse.

With the legalization of medicinal cannabis use in 29 US states, along with the District of Columbia, the drug is becoming a viable treatment option for patients suffering from chronic pain. Yet, the hypothesis that medicinal cannabis could reduce opioid use among chronic pain patients has never been tested in a scientific study.

In addition, few studies have explored how active chemical compounds found in cannabis, including tetrahydrocannabinol (THC) and cannabidiol (CBD), specifically affect pain and quality of life. Studies demonstrating negative outcomes associated with illicit cannabis use could also be less applicable to patients who receive their medicine from licensed producers of the drug.

In the current study, Cunningham and his colleagues plan to enroll 250 HIV-positive and HIV-negative patients who are currently using opioid-based drugs to manage their chronic pain. Patients included in the study will also have secured physician-approval to use medicinal cannabis provided by New York State-based dispensaries.

Study participants will be asked to complete bi-monthly questionnaires to assess their pain levels and their reported use of opioids and cannabis, each from medical and illicit sources. The pain patients will also provide blood and urine samples every three months over an 18 month period.

“As state and federal governments grapple with the complex issues surrounding opioids and medical marijuana, we hope to provide evidence-based recommendations that will help shape responsible and effective healthcare practices and public policies,” said Cunningham.