The National Institutes of Health (NIH) has just awarded a grant for the first long-term study of whether medical marijuana can reduce opioid painkiller use among people with chronic pain. Studies have shown that medical marijuana laws are associated with fewer opioid prescriptions and overdose deaths; researchers at Albert Einstein College of Medicine and Montefiore Health System will use the five-year, $3.8 million grant to test marijuana as an alternative to opioids for pain management.
"There is a lack of information about the impact of medical marijuana on opioid use in those with chronic pain," Chinazo Cunningham, associate chief of general internal medicine at Einstein and Montefiore and principal investigator on the grant, said in a statement. "We hope this study will fill in the gaps and provide doctors and patients with some much needed guidance."
The study will enroll 250 people in New York state, some of them HIV-positive. Chronic pain is commonly reported among people with HIV, and it can lead to depression, substance misuse, and other issues. They're likely to receive opioids to help manage their pain, despite having a higher risk of misuse. Marijuana could provide an alternative; in fact, in the 29 states and the District of Columbia that have legalized medical marijuana, chronic pain and/or HIV/AIDS are qualifying conditions.
The 250 participants, HIV-positive and HIV-negative, will be people who've been physician-certified to use medical marijuana. Every two weeks for 18 months, they'll complete a web-based questionnaire about their pain levels and use of marijuana and opioids. (They'll be asked about both medicinal and illicit use.) Urine and blood samples will be taken every three months during in-person research visit. Finally, some subjects will be selected for in-depth interviews about how medical marijuana use affected their use of opioids.
That question—whether medicinal pot use over time directly reduces opioid use or not—has never really been studied. (The research around medical marijuana laws and opioid prescriptions is correlational; looking back in time and connecting one event to another.) In fact, medical weed is still a fairly under-researched area, with no studies about how its main chemical compounds, tetrahydrocannabinol (THC) and cannabidiol (CBD), can affect health outcomes like pain, function, and quality of life. Better understanding those effects would not only add useful information to our public debate about medical marijuana—it might just help us fight the opioid crisis, too.
It's not that experts are terribly concerned about people being prescribed painkillers and then getting addicted as that's rare, but rather that the overprescription of opioids in general has contributed to extra pills that get diverted to people who misuse them.
"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," Cunningham said.
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