Many people across the country suffer from chronic non-cancer pain. Stemming from a number of causes, chronic pain can diminish overall quality of life and function as well as cognitive function. Medical professionals have struggled for years to adequately treat chronic pain patients, often overprescribing opioids, with disastrous public health consequences. However, even with use of opioids, physicians are unable to help many patients satisfactorily control chronic pain. Patients who use opioids over a long timeframe to treat chronic pain often have to increase dosage to maintain effectiveness. This results for many patients in disabling or intolerable side effects, including risk of overdose, fractures, addiction, intestinal blockages and sedation. Many chronic pain patients have thus turned to cannabis as a self-management strategy for treating chronic pain, either as an alternative to opioids or to help them reduce or discontinue opioid treatment. With this in mind, medical researchers in the COMPASS Study Team undertook a one-year prospective cohort study to systematically evaluate the safety of long-term cannabis use to treat chronic non-cancer pain. They found use of herbal medical cannabis over one year to have a reasonable safety profile and to improve pain, function, quality of life and cognitive function.
Through their research, the COMPASS Study Team was able to confirm that use of herbal cannabis to treat chronic pain over a one-year period was both safe and effective. The study recruited adult, chronic non-cancer pain patients with pain that had lasted for at least six months and was refractory to conventional treatment. Participants in the study were split into two groups, a group that would use cannabis as part of its treatment plan and a control group. Participants ranged in age from 19 to 83 and had all been experiencing chronic pain for an average of 7 or 8 years.
The cannabis group was prescribed an average dose of 2.5 g herbal medical cannabis (12.5% THC) per day, to be consumed in whichever form they prefered, for one year. Throughout this year, participants had clinical visits and phone interviews to track their progress. This study was the first of its kind to track effects of herbal cannabis (as opposed to prescription oral cannabis medications) for one full year. Previous studies had shown positive outcomes for 3-4 week increments, but a long term study was needed to understand the safety and effectiveness profile for longer use.
The primary result of the study was to demonstrate that “medical cannabis used for chronic pain over one year appears to have a reasonable safety profile.” Secondary results demonstrated that participants in the cannabis group experienced pain relief and measured improvements in pain, function, quality of life and cognitive function. Not only did long term consumption of medical marijuana ease participants’ pain, it also helped to change their lives for the better. Study results were published in 2015 in the Journal of Pain.
These results are not surprising, given that there are multiple, reasonable quality trials indicating that smoked cannabis, vaporized cannabis and extracted cannabis medicines may be effective, alone or as adjuvant medications, in ameliorating or reducing the intensity of chronic, non-cancer neuropathic pain, and may also improve sleep in those with chronic neuropathic pain. In fact, a 2017 review of all available evidence, undertaken by the National Academies of Sciences, Engineering and Medicine, found “substantial evidence that cannabis is an effective treatment for chronic pain in adults.”
Moreover, patient surveys show that a high percentage of patients using medical marijuana in fact do so to treat chronic pain, and a recent University of Georgia study found a large drop in Medicare Part D painkiller prescriptions in states that legalized medical marijuana. Surveys of medical cannabis users in areas such as Hawaii, Rhode Island, San Francisco and Michigan have found that many or the majority of medical cannabis users: (1) utilize cannabis for management of chronic pain, sometimes as adjuvant therapy to prescription pain medication; (2) rate cannabis’ effectiveness, either alone or adjuvant to opioids, as higher than prescription pain medication alone; (3) may use cannabis to reduce use of prescription pain medication; and (4) see cannabis as less harmful/addictive than other pain medications.[iii]
Both published and anecdotal surveys further find that medical cannabis often assists chronic pain patients in reducing or eliminating opioid usage, while simultaneously improving pain control. This is especially important in that unlike opioids, cannabis poses no risk of overdose death. Surveys and case studies of medical cannabis patients in Michigan, Israel, Maine and Canada have found that medical cannabis use was associated with a significant decrease in opioid consumption, with the reported reduction ranging from 44% in Israel to 64% in Michigan. Thirty-nine percent of surveyed Maine patients reported reducing opioid consumption and 39% reported complete cessation of opioid usage. Michigan patients also reported decreased numbers and side effects of medications. Patients in all surveys reported improved pain control and improvement in overall QOL or aspects of QOL.[iv]
Chronic pain affects nearly 50 million American adults, as reported in 2015 by the American Pain Society. Overuse of opioids to treat chronic pain has resulted in an opioid overdose and addiction crisis. If you suffer from chronic non-cancer pain, you may be among the many chronic pain patients who are not adequately served by current medical options or who are uncomfortable with the amount of opioids they are using or with opioid side effects. Cannabis offers a relatively safe and effective option to treat chronic pain in adults. It may be especially helpful if you are seeking to reduce or eliminate current use of opioids to treat chronic pain.