In light of the current “opioid epidemic” in the United States, a dire need exists for alternatives to opioid medications for treating chronic pain. “Evidence suggests that many patients are seeking natural alternatives and either requesting cannabis or  initiating cannabis use on their own, even in states with no legislative initiative for medical use of cannabis,” says Michelle Sexton, ND. However, information is lacking on whether or not these patients are intentionally substituting cannabis for prescription drugs.


Intentional Substitution?

For a study published in the Journal of Pain Research, Dr. Sexton, James Corroon Jr., ND, MPH, and Laurie Mischley, ND, PhD, MPH, sought to better understand the prevalence of patients who eliminate prescription or over-the-counter medications by substituting them with cannabis. The study team also assessed the classes of pain medications being substituted by this population, the frequency of such substitutions, and the socio-demographic characteristics of these patients.

A total of 2,774 patients from a self-selected convenience sample who reported having used cannabis at least once in the previous 90 days were anonymously surveyed on cannabis substitution effects. Participants were recruited in Washington state through medical cannabis dispensaries and at large using a Facebook page.


Key Findings

Nearly one-half (46%) of respondents reported using cannabis as a substitute for prescription drugs. Among them, the most common classes of substituted drugs were narcotics/opioids (35.8%), anxiolytics/benzodiazepines (13.6%), and antidepressants (12.7%, Figure). This subgroup reported a total of 2,473 drug substitutions, or approximately two substitutions per patient, on average.

“Cannabis has been suggested to be a potential solution to the opioid epidemic. In a previous analysis of a dataset from this same survey, patients reported that cannabis is effective for pain with a mean effectiveness rating of 3.5 on a sliding scale, with -5 being worsening of pain and 5 being improvement in pain. These data indicate that patients are actively eliminating prescriptions in three important categories,” says Dr. Sexton. “Depression and anxiety are common comorbidities in pain patients. There is the potential that cannabis may be a substitute for several classes of drugs for the same patient.”

The odds of reporting drug substituting were 4.59 times greater among medical cannabis users than among non-medical users, and 1.66 times greater among those reporting use for managing the comorbidities of pain, anxiety, and depression. While a slightly higher percentage of those who reported drug substituting lived in states where medical cannabis use was legal at the time of the survey, the difference was not statistically significant.

In the study, substituting cannabis for prescription drugs increased in frequency with age up to age 65, and was more common in females. Older patients tend to take more drugs than younger patients and may be more sensitive to the side effects of those drugs. In regard to the higher prevalence of substituting among women, Dr. Sexton references data indicating that women are more likely to use integrative or alternative medicine. She also suggests that women may be more likely to be on anti-anxiety or antidepressant medications, as well as experiencing monthly menstrual cyclic pain or pre-menstrual symptoms such as depression or anxiety.


Important Implications

“Our findings stress the importance of physician education for quality interactions with patients on this topic,” says Dr. Sexton. “In some cases, there may be a need for monitoring of patients for adverse effects from withdrawal of some medications, and clearly, drug interactions need to be on the doctor’s radar. The findings are also an example of patients taking control of their own healthcare and are representative of the emerging field of patient-centered medicine. We are seeing deviations from the ‘top-down’ approach to healthcare, particularly when pain, anxiety, and depression are the symptoms or diagnosis.”