Medical Marijuana and the Opioid Epidemic: Response to Theriault and Schlesinger.

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Back to table of contents Previous article Next article Letters to the EditorFull AccessMedical Marijuana and the Opioid Epidemic: Response to Theriault and SchlesingerMark Olfson, M.D., M.P.H., Melanie M. Wall, Ph.D., Carlos Blanco, M.D., Ph.D.Mark OlfsonSearch for more papers by this author, M.D., M.P.H., Melanie M. WallSearch for more papers by this author, Ph.D., Carlos BlancoSearch for more papers by this author, M.D., Ph.D.Published Online:1 Mar 2018https://doi.org/10.1176/appi.ajp.2017.17101149rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We appreciate the opportunity to respond to the concerns raised by Theriault and Schlesinger because they reflect common public perceptions concerning medical marijuana and its potential to combat the opioid epidemic. The authors are correct that our recent longitudinal epidemiological analysis concerned associations between the use of recreational rather than medical marijuana and the development of opioid use disorder. However, users of medical and recreational marijuana are not as distinct as the authors assume. According to the 2013–2014 National Survey on Drug Use and Health (N=96,100), more than a third of medical marijuana users used recreational marijuana in the past year (1). In a study from Washington state, medical (N=131) and recreational (N=525) marijuana users had similar mean drug use scores on the Addiction Severity Index (medical=0.14 [SD=0.09], compared with recreational=0.13 [SD=0.11]), and similar percentages of users reported depression (64% compared with 62%), violent behavior (14% compared with 15%), and hallucinations (8% compared with 9%), although recent medical problems were more common in the medical marijuana group than in the recreational marijuana group (76% compared with 51%) (2). In a second study, adults with a history of medical marijuana use were similar to nonmedical marijuana users except that medical marijuana users were more likely to have used cocaine (3).The extent to which medical cannabinoids can effectively reduce chronic pain deserves further study. At present, empirical support remains modest. In a meta-analysis of eight placebo-controlled studies of cannabinoids for pain, five studies failed to separate from placebo, and the overall effect on pain improvement across the eight studies fell just below statistical significance (odds ratio=1.41, 95% CI=0.99–2.00) (4). By contrast, there is stronger evidence supporting the effectiveness of several nonpharmacological therapies, such as exercise, multidisciplinary rehabilitation, and acupuncture, for low back pain (5), the leading source of worldwide disability. We further urge caution against overinterpreting results from ecological studies, which temporally tie medical marijuana legislation to declining opioid mortality, because they do not include information on whether individuals who use marijuana alter their risk of developing opioid use disorder.Much remains to be learned about the complex relationships between cannabis and opioid use and how these interactions vary by patient characteristics and cannabinoid formulation. In the absence of prospective clinical evidence demonstrating protective effects, however, there is currently little medical justification for authorizing medical cannabis to lower nonmedical opioid use.From the Department of Psychiatry, Columbia University Medical Center, New York; and the Division of Epidemiology, Services and Prevention Research, NIDA, Bethesda, Md.Address correspondence to Dr. Olfson ([email protected]).The views and opinions expressed here are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or the U.S. government.The authors’ disclosures accompany the original article.References1 Compton WM, Han B, Hughes A, et al.: Use of marijuana for medical purposes among adults in the United States. JAMA 2017; 317:209–211Crossref, Medline, Google Scholar2 Roy-Byrne P, Maynard C, Bumgardner K, et al.: Are medical marijuana users different from recreational users? The view from primary care. Am J Addict 2015; 24:599–606Crossref, Medline, Google Scholar3 Ogborne AC, Smart RG, Adlaf EM: Self-reported medical use of marijuana: a survey of the general population. CMAJ 2000; 162:1685–1686Medline, Google Scholar4 Whiting PF, Wolff RF, Deshpande S, et al.: Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015; 313:2456–2473Crossref, Medline, Google Scholar5 Chou R, Deyo R, Friedly J, et al.: Nonpharmacologic therapies for low back pain: a systematic review of an American College of Physicians Clinical practice guideline. Ann Intern Med 2017;166:493–505Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byAssociation of cannabis and/or opioid with quality of life and healthcare utilization in patients with chronic pain24 November 2022 | Frontiers in Pain Research, Vol. 3Drug and Alcohol Dependence, Vol. 202 Volume 175Issue 3 March 01, 2018Pages 284-285 Metrics KeywordsDrug InteractionsPainDrug AbuseEpidemiologyPDF download History Accepted 1 December 2017 Published online 1 March 2018 Published in print 1 March 2018