A Pilot Study of a Medical Cannabis - Opioid Reduction Program

Kevin Rod

doi:10.11648/j.ajpn.20190703.14

Abstract

Many chronic pain patients are prescribed opioids at doses exceeding the current Guideline. Tapering the dose can be difficult, as patients fear a return to a state of overwhelming pain. Several factors can increase the likelihood of success: the patient’s readiness for change, psychological support, pharmacological support and careful monitoring. This pilot study addressed these four factors. Six hundred patients took part. Each was taking daily opioid doses ranging from 90-240 mg morphine equivalent dose (MED). All indicated they were prepared to reduce their opioid dose. Over a six-month period, opioid doses were tapered according to individual needs, usually 10% every 1-2 weeks. Psychological support was provided through a freely available web-based mental health and wellness tool. Medical cannabis provided pharmacological support at the rate of 0.5g/day for each 10% reduction in opioid dose, as needed. Physicians monitored patients regularly according to each patient’s needs. After 6 months, 156 patients (26%) had ceased taking opioids. An additional 329 patients (55%) had reduced their opioid use by an average of 30%. One hundred fourteen patients (19%) neither increased nor decreased their opioid use. The one patient whose opioid dose was increased had poorly controlled pain and an aggravated pain condition. The success of this medical cannabis – opioid reduction program in a large proportion of patients is grounds for further investigation.

Highlights

Opioids are regularly prescribed to help chronic pain patients manage their condition and regain control of their lives
The Research Ethics Board of IRB Services approved the protocol for this pilot study of a Medical Cannabis – Opioid Reduction Program (MCORP)
An additional 329 patients (55%) had reduced their opioid use by an average of 30%. Cannabis use among these patients ranged from 1-3g per day

Summary

Introduction

Opioids are regularly prescribed to help chronic pain patients manage their condition and regain control of their lives. The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommends a maximum daily dose (watchful dose) equivalent to 90 mg morphine (MED) [1], yet higher doses are often used. The recent steep rise in opioid-related deaths, many tied to prescribed medications [2], causes great concern. Physicians are considering tapering the opioid regimens for many of their chronic pain patients, using a patient-centered approach. Tapering requires as much care as prescribing opioids. Patients’ greatest fear when tapering opioids is returning to their previous state of overwhelming chronic pain. Communicating the expected improved function without worsening pain can be reassuring, but patients must be ready for such an important change in their lives. A positive relationship and strong therapeutic alliance of patient and physician is paramount

Methods

Results

Conclusion