RESEARCH ARTICLE
Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study Jacob M. Vigil1*, Sarah S. Stith2, Ian M. Adams3, Anthony P. Reeve3 1 University of New Mexico, Department of Psychology, Albuquerque, New Mexico, United States of America, 2 University of New Mexico, Department of Economics, Albuquerque, New Mexico, United States of America, 3 Industrial Rehabilitation Clinics, Albuquerque, New Mexico, United States of America *
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Abstract Background Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
OPEN ACCESS Citation: Vigil JM, Stith SS, Adams IM, Reeve AP (2017) Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study. PLoS ONE 12(11): e0187795. https://doi.org/10.1371/journal. pone.0187795 Editor: Kent E. Vrana, Pennsylvania State University College of Medicine, UNITED STATES Received: May 16, 2017 Accepted: October 26, 2017 Published: November 16, 2017 Copyright: © 2017 Vigil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data is available from https://figshare.com/s/e218026fc0ac0327d550 (DOI: 10.6084/m9.figshare.5571721). Funding: This research was funded in part by the University of New Mexico Medical Cannabis Research Fund. Competing interests: The authors have declared that no competing interests exist.
Purpose A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
Methods Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patientreported benefits and side effects of using cannabis one year after enrollment were also collected.
Results By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different
PLOS ONE | https://doi.org/10.1371/journal.pone.0187795 November 16, 2017
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Medical cannabis and opioid prescriptions
from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps
