Opioids and Cannabis Combo for Pain May Increase Anxiety, Depression

Patients with chronic pain using opioids and cannabis may be more likely to have symptoms of anxiety and depression compared to patients using opioids alone, according to a study.

“Opioid misuse constitutes a significant public health problem and is associated with a host of negative outcomes. Despite efforts to curb this increasing epidemic, opioids remain the most widely prescribed class of medications,” the study authors wrote, reporting in the July/August issue of the Journal of Addiction Medicine. They added, “Cannabis is another substance that has recently garnered attention in the chronic pain literature, as increasing numbers of individuals use cannabis to manage chronic pain.”

Study author Andrew Rogers, MA, a doctoral student of clinical psychology working in the University of Houston Anxiety and Health Research Laboratory and its Substance Use Treatment Clinic, said in a press release, “Given the fact that cannabis potentially has analgesic properties, some people are turning to it to potentially manage their pain.” Rogers added, “There’s been a lot of buzz that maybe cannabis is the new or safer alternative to opioid, so that’s something we wanted to investigate.”

The study included 450 adults in the U.S. with moderate to severe pain for longer than three months. The adults reported on their use of opioids and cannabis as well as anxiety and depression symptoms and their tobacco, alcohol, cocaine, and sedative use. Results were compared between patients taking opioids alone versus those who added cannabis.

Although some outcomes were different between the two cohorts, pain was not one of them, according to the study’s abstract: “Results suggest that, compared to opioid use alone, opioid and cannabis co-use was associated with elevated anxiety and depression symptoms, as well as tobacco, alcohol, cocaine, and sedative use problems, but not pain experience.”

Rogers reportedly undertook the study after a conversation with advisor Michael Zvolensky, Hugh Roy and Lillie Cranz Cullen Distinguished University Professor of psychology and director of the lab and clinic, who oversaw the experiment.

“The findings highlight a vulnerable population of polysubstance users with chronic pain and indicates the need for more comprehensive assessment and treatment of chronic pain,” he said.

The study concluded, “These findings highlight a vulnerable population of polysubstance users with chronic pain, and indicates the need for more comprehensive assessment and treatment of chronic pain.”

Patients Seek Alternative Therapies for Pain

Research recently presented at the Annual European Congress of Rheumatology (EULAR 2019) meeting in Madrid, Spain, found that more than half of patients with arthritis have tried marijuana and/or cannabidiol (CBD) as a medical treatment. A survey was completed by 1,059 patients (mean age, 57.1 years; 88.1% were female). The mean time since diagnosis was 14.4 years.

The majority of patients said that MMU and/or CBD use improved their symptoms and/or disease: “Most patients who had ever used MMU and/or CBD reported that the use improved their symptoms (97.1% for MMU; 93.7% for CBD) and condition (96.1% for MMU; 93.1% for CBD),” according to the poster presented at EULAR 2019. Most patients turned to MMU and CBD to relieve pain (96.1% and 95.4%, respectively) or sleep disturbance (75.7% and 54.4%, respectively). Despite the lack of evidence, most patients reported using MMU instead of prescribed (53%) or over-the-counter (62.8%) medications.

Of the 64.6% of patients who reported their MMU use to their healthcare provider, more than half (58%) said that their provider did not take this into consideration when making changes to their treatment regimen or provide any recommendations about administration mode or dosage.

Benjamin Nowell, PhD, director of Patient-Centered Research at CreakyJoints® and an ArthritisPower® co-principal investigator and poster author, said in a previous interview with DocWire News, “In the absence of quality evidence to guide the use of such substances, patients’ actual use needs to be documented in the medical record to inform treatment decision making.”

Although current data are limited on the MMU and CBD use, Dr. Nowell strongly recommends that patients report using these treatments to their provider.

“We are hopeful that research regarding the potential benefits and risks of using these products will become a priority,” said Dr. Nowell.