Medical cannabis authorization and opioid milligram equivalents over time in patients with chronic pain: a retrospective analysis - Scorecard - MDSpire
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Medical cannabis authorization and opioid milligram equivalents over time in patients with chronic pain: a retrospective analysis
University-based pain clinic with electronic health record integration
Key Highlights
Medical cannabis authorization (MCA) was not associated with a statistically significant decrease in opioid milligram equivalents (OME) over time.
Long-term opioid use was significantly associated with higher OME at study endpoint.
Preclinical and some observational data suggest opioid-sparing effects of cannabis, but human evidence remains low-certainty and mixed.
Guideline-Based Recommendations
Diagnosis
Use diagnostic coding to identify long-term opioid use in chronic pain patients.
Document medical cannabis authorization in electronic health records when applicable.
Management
Follow CDC guidelines for opioid prescribing in chronic pain.
Consider medical cannabis consultation as an educational tool on administration and dosing.
Monitor opioid dosages carefully, especially in patients with long-term opioid use.
Monitoring & Follow-up
Track opioid milligram equivalents longitudinally to assess trends in opioid use.
Monitor for potential opioid-related adverse effects including tolerance, hyperalgesia, and opioid use disorder.
Evaluate patient-reported pain and function regularly.
Risks
Long-term opioid use is associated with increased risk of anxiety, depression, opioid use disorder, and mortality.
Evidence for opioid-sparing effects of cannabis in humans is currently low-certainty and inconclusive.
Potential risks of cannabis use include unknown long-term effects and variability in dosing.
Patient & Prescribing Data
Adults with chronic non-cancer pain receiving opioid therapy at a university pain clinic
Patients with medical cannabis authorization did not show statistically significant reductions in opioid dosages; those with long-term opioid use had significantly higher opioid dosages at study end.
Clinical Best Practices
Integrate medical cannabis authorization documentation into electronic health records for comprehensive patient management.
Use longitudinal data to monitor opioid dosage trends and adjust treatment plans accordingly.
Educate patients on potential benefits and limitations of medical cannabis as adjunct therapy.
Prioritize opioid tapering strategies in patients with long-term opioid use while monitoring pain and function.
Support further prospective research to clarify opioid-sparing effects of cannabis in clinical populations.
by Michelle Sexton, Nicholas C Glodosky, Michael Cleveland, Carrie Cuttler, Euyhyun Lee, Gregory R Polston, Timothy Furnish, Imanuel Lerman, Nathaniel M Schuster, Mark S Wallace
Real-world patient-reported outcomes show high responder rates, favorable tolerability, and consistent satisfaction with hyoscine butylbromide plus for menstrual pain self-treatment.
