Study: Inhaled Cannabis Augments Analgesic Efficacy Of Opiates

NEW YORK: The co-administration of inhaled cannabis and sub-therapeutic doses of oxycodone produces enhanced analgesic effects in human subjects, according to clinical trial data published in the journal Neuropsychopharmacology.

A team of investigators from the United States and Australia assessed the efficacy of inhaled cannabis and low doses of oxycodone on experimentally-induced pain in a double-blind, placebo-controlled model. Researchers assessed subjects’ pain tolerance after receiving both substances separately or in concert with one another.

While neither the administration of cannabis nor oxycodone alone significantly mitigated subjects’ pain, the combined administration of both drugs did so effectively. Authors determined, “Both active cannabis and a low dose of oxycodone (2.5 mg) were sub-therapeutic, failing to elicit analgesia on their own; however, when administered together, pain responses … were significantly reduced, pointing to the opioid-sparing effects of cannabis.”

They concluded, “Smoked cannabis combined with an ineffective analgesic dose of oxycodone produced analgesia comparable to an effective opioid analgesic dose without significantly increasing cannabis’s abuse liability.”

The findings are similar to those of a 2011 clinical trial determining that vaporized cannabis interacts synergistically with opioids to induce pain relief and therefore “may allow for opioid treatment at lower doses with fewer side effects.”

In jurisdictions where marijuana is legally available, patients frequently acknowledge reducing their use of conventional medications, particularly opioids and benzodiazepines, after engaging in cannabis therapy.

For more information, contact Paul Armentano, NORML Deputy Director, at: Full text of the study, “Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability,” appears in Neuropsychopharmacology.

Medical Cannabis and Reduced Prescription Use

NEW MEXICO: In a soon-to-be published article in the *Journal of the American Medical Directors Association, *University of New Mexico researchers, in

collaboration with Industrial Rehabilitation Clinics of Albuquerque, followed patients who enrolled voluntarily in the New Mexico state medical cannabis program and found that they significantly reduced their utilization of scheduled prescription medications in the months following enrollment. All prescriptions for scheduled medications must be reported to the New Mexico Prescription Monitoring Program with opiates and benzodiazepines being the two most common. Based on these prescription records, patients enrolled in the medical cannabis program reduced the monthly average number of prescriptions, types of prescriptions (drug classes), number of prescribers, and number of related pharmacy visits. 71% of medical cannabis program enrollees either ceased or reduced their use of scheduled prescriptions within 6 months of enrolling

While other studies on medical cannabis have looked at similar state-level outcomes, this study is the first to take the approach of examining individual patients throughout their enrollment in the medical cannabis program and comparing those patients to a comparison group of similar patients who did not enroll in the medical cannabis program.

The findings of this study indicate that once a patient enrolls in the medical cannabis program there is an increased likelihood that the patient will decrease their usage of scheduled medications. These medications include many drugs of abuse such as opiates, benzodiazepines, and sleeping medications. Opiates in particular are in the public discourse because of the danger of overdose, addiction and death.

Study: Medical Cannabis Associated With Improved Cognitive Performance, Reduced Opioid Use

MASSACHUSETTS: Medical cannabis administration is associated with improved cognitive performance and lower levels of prescription drug use, according to longitudinal data published online in the journal Frontiers in Pharmacology.

Investigators from Harvard Medical School, Tufts University, and McLean Hospital evaluated the use of medicinal cannabis on patients’ cognitive performance over a three-month period. Participants in the study were either naïve to cannabis or had abstained from the substance for at least ten years. Baseline evaluations of patients’ cognitive performance were taken prior to their cannabis use and then again following treatment.

Researchers reported “no significant decrements in performance” following medical marijuana treatment. Rather, they determined, “[P]atients experienced some improvement on measures of executive functioning, including the Stroop Color Word Test and Trail Making Test, mostly reflected as increased speed in completing tasks without a loss of accuracy.”

Participants in the study were less likely to experience feelings of depression during treatment, and many significantly reduced their use of prescription drugs. “[D]ata revealed a notable decrease in weekly use across all medication classes, including reductions in use of opiates (-42.88 percent), antidepressants (-17.64 percent), mood stabilizers (-33.33 percent), and benzodiazepines (-38.89 percent),” authors reported – a finding that is consistent with prior studies.

Patients in the study will continue to be assessed over the course of one-year of treatment to assess whether these preliminary trends persist long-term.

For more information, please contact Paul Armentano, NORML Deputy Director, at: Full text of the study, “Splendor in the grass? A pilot study assessing the impact of marijuana on executive function,” appears in Frontiers of Pharmacology.

Citing Themselves as a Top Factor in Prescribed Opioid Abuse, 73% of US Physicians Want More Alternative Therapies And Less Meds

MASSACHUSETTS: US physicians who prescribe opioid pain medications are owning their role in today’s opioid abuse while citing structural problems that feed the issue, and calling for more alternative therapies integrated with medication. The data are from the latest public health perception analysis created by InCrowd, a provider of real-time market intelligence to the life sciences and healthcare firms.

In a microsurvey performed October 27-28 using InCrowd’s technology platform, US physicians including pain management specialists, primary care physicians, and emergency room (ER) doctors who prescribe opioids — cited physician overprescribing for pain management as the single biggest factor in the increased misuse of opioids by patients in the past 5 years, topping the list at 30%. 24% cited patient aggressive drug-seeking behavior, and 18% cited the accessibility of pain medication that is not prescribed.

“We were told for years that (opioids) wouldn’t be addictive in the great majority of patients. This was obviously wrong,” said one ER physician.

Respondents overwhelmingly (73%) wanted alternatives therapies to be integrated into treatment plans instead of a sole focus on medicating pain. 62% said that having a plan at the outset to wean patients off pain medications would help establish expectations with patients that the medication would not be a long-term solution.

Respondent verbatim remarks cited systemic healthcare factors such as the concern that patients could rate doctors lower on CMS-mandated patient satisfaction scores when they decline patient’s request for narcotics. As one primary care physician (PCP) explained, “Doctors are caught in the middle,” between treating pain as the “fifth vital sign” as advised by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) starting in 2000, and not overprescribing. Lack of Medicaid or Affordable Care Act coverage for specialists and for non-medication alternatives leads to PCPs managing patients’ pain and prescriptions instead of a pain management specialist. One physician cited that social media teaches patients “how to use/abuse Rx meds given in compassion to those actually in pain.”

Other data show that:

  •  Few physicians were heavy opioid prescribers. Only 8% of respondents prescribed opioids for the majority — more than 50% — of their patients. 46% said 5% or less of their patient base was currently being treated with a prescription opioid, while another 46% prescribed them for between 5% and 50% of their patients.
  •  The majority wanted additional limitations on opioid pain prescribing. 60% of physician respondents wanted more frequent evaluations of patients taking a prescribed opioid, while 59% wanted smaller quantities of pain medications in each prescription refill.
  •  Marijuana ranked the lowest of all alternative treatment options that were currently prescribed by respondents, cited by just 10% of respondents. Non-habit forming pain medication topped the list, cited by 82%, followed by physical therapy, at 80%. Exercise (72%), mental health treatment (48%), and vitamin and herbal treatments (20%) were also prescribed.

“Physicians show extreme frustration with the entire healthcare system when it comes to the opioid crisis,” said Diane Hayes, president and cofounder of InCrowd. “Their vote for sweeping healthcare change as reflected by the data should be a rallying cry to make this a top national priority in 2017.”

The opioid epidemic microsurvey included responses from 225 US-based, triple-verified, board-certified physicians in primary care, pain management and emergency medicine who have prescribed opioid pain medications to their patients. Respondents have been in practice an average of 25 years and came in equal parts from major regions of the US. They responded to a 4-question microsurvey using InCrowd’s real time market insights platform on October 27-28, 2016.