Medicinal Cannabis May Not Have Opioid-Sparing Effects in Chronic Noncancer Pain

The following article is part of conference coverage from the IASP 2018 conference in Boston, Massachusetts. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from IASP 2018.

Medicinal cannabis may not effectively reduce opioid use or pain interference in individuals with chronic noncancer pain, according to a study to be presented at the 2018 World Congress on Pain, held September 12-16 in Boston, Massachusetts.¹

For this prospective study, Pain and Opioids IN Treatment, or POINT, 1514 individuals who were prescribed opioid medications for chronic noncancer pain were recruited between 2012 and 2014.² Study participants were interviewed at baseline and once a year for 4 years to determine lifetime occurrence and duration of chronic pain, cannabis use (lifetime, last 12 months, and last month), presence of mental health comorbidities (ie, generalized anxiety disorder and depression), and opioid dose (in oral morphine equivalent).

Of 1514 participants, 295 patients (24%) were found to also use cannabis to manage their pain at the 4-year follow-up. The percentage of participants expressing an interest in using cannabis for their condition increased from 33% (364 participants) at baseline to 60% (723 participants) at the 4-year follow-up. At this point, patients who had resorted to less frequent or daily/near-daily cannabis use vs those who had not reported greater pain intensity (risk ratio [RR], 1.14 [95% CI, 1.01-1.29]; and RR, 1.17 [95% CI, 1.03-1.32], respectively), higher pain interference scores (RR, 1.21 [95% CI, 1.09-1.35]; and RR, 1.14 [95% CI, 1.03-1.26], respectively), lower pain self-efficacy scores (RR, 0.97 [95% CI, 0.96-1.00]; and RR, 0.98 [95% CI, 0.96-1.00], respectively), and higher generalized anxiety disorder severity scores (RR, 1.07 [95% CI, 1.03-1.12]; and RR, 1.10 [95% CI, 1.06-1.15], respectively).

Logistic regression analysis did not indicate the presence of a temporal association between pain intensity of interference and cannabis use. Cannabis use was not found to be associated with reduced rates of opioid medication use or to have opioid-sparing effects.

“As cannabis use for medicinal purposes increases globally, it is important that large, well designed clinical trials, which include people with complex comorbidities, are conducted to determine the efficacy of cannabis for chronic non-cancer pain,” concluded the study investigators.

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References

1. Campbell G, Hall W, Nielsen S, Lintzeris N, Bruno R, Peacock A, et al. Cannabis use, pain and prescription opioid use in people living with chronic non-cancer pain: findings from four years of follow-up of the POINT cohort. Presented at the World Congress on Pain 2018; September 12-16, 2018; Boston, MA. Poster 63812.
2. Campbell G, Hall WD, Peacock A, et al. Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study. Lancet Public Health. 2018;3(7):e341-e350.

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