In 2016, over 64,000 people in the United States died from opioid overdoses — either from painkillers, heroin, or fentanyl (a synthetic opioid). To put that number in perspective, that’s more Americans killed by opioids in 365 days than were killed during the entirety of the Vietnam War. Opioids in America are more than a crisis — they’re a national emergency.
While doctors may have helped fuel this epidemic through the over-prescription of opioids, the underlying issue that they were often trying to treat, chronic pain, remains an enormous issue. Americans, pain pills or not, are hurting. In a recent National Institutes of Health study, 25.3 million adults reported experiencing chronic pain every single day in the three months prior to the study, a number that makes up 11.2 percent of the population. An even larger number, 126 million people, reported experiencing pain of some sort in the three months prior.
Doctors have long voiced concerns that prescription opioid painkillers — on top of a high potential for addiction — aren’t actually solving the problem of chronic pain. This week, science confirmed it.
A study published in the Journal of the American Medical Association compared opioids (Vicodin, oxycodone, and fentanyl) to non-opioids (Tylenol, ibuprofen, and nerve blockers) to see if they were better at treating chronic back, hip, or knee pain. The answer was clear: They were not. “Treatment with opioids was not superior to treatment with non-opioids for improving pain-related function over 12 months,” the study reads. “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”
The news is a major blow for pharmaceutical companies like Purdue Pharma, who have made billions through prescription painkillers, but it’s even worse news for those suffering the effects of chronic pain. The question it leaves behind: If opioids aren’t the answer to chronic pain, what is?
For a growing number of doctors, the answer comes in the form of another less dangerous drug: cannabis. This past November, three doctors in Illinois started a campaign called Physicians Against Injurious Narcotics, or PAIN, which aims to expand the state’s medical marijuana program to allow anyone that qualifies for opioids to also qualify for marijuana.
Last month, promising research results from Israel added scientific evidence to back their fight. Published in the European Journal of Internal Medicine, the study followed 2,970 cancer patients between 2015 and 2017 as they embarked on a medical marijuana treatment program for chronic pain. Each patient was able to choose a plan that specifically catered to their lifestyle, and to pick from 16 different strains of the drug. Pain scales were ranked before taking the medicine and then measured again after the treatment was underway.
The results were overwhelmingly positive. Of the 1,211 cancer patients who were ultimately surveyed (902 patients from the original group died and 680 stopped treatment), 95.9 percent reported an improvement in their condition, and the vast majority of them experienced a dramatic reduction in pain. While at the outset, 52.9 percent of patients had rated their pain between 8 and 10 (on a scale of 10), after six months of treatment, the number reporting that level of pain had dropped to just 4.6 percent.
On top of managing pain, the study showed cannabis capable of addressing other issues the patients were experiencing too. Of those surveyed, 91 percent reported improvements in nausea and vomiting, 87.5 percent reported an improvement in sleep disorders, and 84 percent noticed improvement in anxiety and depression. The study’s authors fully endorse the drug as a treatment option.
“In an age where a physician often prescribes a different medication for each [cancer] symptom, cannabis, as a comprehensive treatment that affects several symptoms, becomes a desirable therapeutic option,” the authors conclude. “Cannabis as a palliative treatment for cancer patients seems to be well tolerated, effective and safe.”
Cannabis’s success in treating chronic pain is echoed in a 2018 review of more than 10,000 abstracts on the topic. Also published in the European Journal of Internal Medicine, the large-scale review offers individual conclusions about marijuana’s ability to treat a variety of conditions. Under chronic pain, the authors write, “There were five fair-to-good quality systematic reviews that contributed to the conclusion that there is substantial evidence that Cannabis is an effective treatment for chronic pain in adults.”
Despite these reports, not everyone agrees that medical marijuana is the answer to chronic pain. Kevin Sabet, founder of Smart Approaches to Marijuana (SAM), thinks that the studies miss the point. “We do know that components of marijuana like THC have shown results for modest pain relief, but that’s a very different conclusion than saying marijuana, which has hundred of components, is good for that,” Sabet tells Yahoo Lifestyle. “I think we need to really distinguish between THC and raw marijuana — especially the kind that the subject would be getting in Israel for the study.”
Sheila P. Vakharia, the policy manager of the Office of Academic Engagement for the Drug Policy Alliance — a nonprofit fighting to end the war on drugs — sees it differently. “The general pain levels reported by study participants went down dramatically,” Vakharia tells Yahoo Lifestyle. “And to see folks reporting that change is really promising.” Vakharia notes that on top of being effective in treating pain, cannabis comes with fewer risks. Namely, it’s less addictive and rarely fatal.
Although some medical professionals remain reluctant to prescribe medical marijuana, Vakharia says patients are beginning to seek out the benefits of marijuana themselves — and are safer as a result. A look at data in the states where marijuana is legal suggests she’s right. According to a 2014 study published in JAMA Internal Medicine, the rate of deaths from prescription drug overdoses is 25 percent lower in states where medical marijuana is legal.
While Sabet thinks that more research needs to be done before individuals start using marijuana as a substitute for opioids, Vakharia hopes that the shift already underway will gain momentum. “I think the evidence will continue to build — and will start to persuade people who are otherwise reluctant to consider it as a treatment for themselves, or to recommend it as a medical professional,” Vakharia tells Yahoo Lifestyle. “But only time will tell.”
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