Trends in Opioid Milligram Equivalents and Medical Cannabis Authorization in Chronic Pain

Overview

This retrospective study analyzed electronic health record data from a university-based pain clinic to assess associations between medical cannabis authorization (MCA) and opioid milligram equivalents (OME) in chronic non-cancer pain patients. The study found no statistically significant decrease in OME over time associated with MCA, although patients with long-term opioid use had significantly higher OME at study end.

Background

Chronic non-cancer pain patients often receive long-term opioid therapy, which carries risks including tolerance, opioid use disorder, and increased mortality. Medical cannabis has been proposed as an opioid-sparing alternative due to shared neuropharmacological pathways between the opioid and endocannabinoid systems. While preclinical studies suggest opioid-sparing effects of cannabis, human evidence remains mixed and of low certainty. This study aimed to evaluate whether medical cannabis authorization correlates with reductions in opioid dosage over time.

Data Highlights

Key Findings

• Average overall opioid milligram equivalents (OME) at study end was 33.4 mg/day with a nonsignificant increase over time.
• Patients with medical cannabis authorization (MCA) had a higher average OME (38.51 mg/day) than those without MCA (32.60 mg/day), but this difference was not statistically significant.
• MCA predicted a nonsignificant decrease of 14.25 mg/day in OME.
• Long-term opioid use was a significant predictor of higher OME, with an average of 85.34 mg/day at the final quarter, significantly greater than other patients (P < 0.0001).
• The study did not find evidence supporting opioid-sparing effects of medical cannabis authorization in this cohort.
• Future prospective research is needed to clarify potential opioid-sparing benefits of cannabis in humans.

Clinical Implications

Clinicians should be aware that medical cannabis authorization alone may not lead to significant reductions in opioid dosages among chronic pain patients. Patients with long-term opioid use represent a subgroup with substantially higher opioid requirements, highlighting the need for targeted interventions. Careful monitoring and further research are warranted to explore effective opioid tapering strategies, including the potential role of medical cannabis.

Conclusion

This longitudinal retrospective study found no statistically significant association between medical cannabis authorization and reductions in opioid milligram equivalents over time in chronic non-cancer pain patients. However, long-term opioid users exhibited significantly higher opioid dosages, underscoring the complexity of opioid management in this population.

References

1. Study Source 2024 -- Trends in Opioid Milligram Equivalents and Medical Cannabis Authorization in Chronic Pain Patients: A Retrospective Study