Replacing opioids with medical marijuana in older adults with chronic pain
Thursday, July 05, 2018
While often effective and appropriate, opioid painkillers have contributed to the worst drug epidemic in history. Health experts have worked diligently to determine when dependency on these powerful prescription drugs starts, as well as how to prevent addiction.
It is estimated that 1 in 20 people who spend just two days on opioids will still be taking them a year later, a number that skyrockets to 1 in 8 people by day six, and 1 in 5 people by day 16.
Until about 20 years ago, treating chronic pain conditions with opioids was practically unheard of, because using them long-term seemed to guarantee addiction issues. Nearly 10 million Americans, or 4.1 percent of the adult population, used opioid medications in 2012-2013.
Although young adults may be the first to be tagged as prescription drug abusers, seniors may have unwittingly become involved in using opioid pain relievers. In a study of Medicare recipients from 2011, about 15 percent were prescribed an opioid when they were discharged from the hospital; three months later, 42 percent were still taking the pain medicine.
The treatment of pain in the older adult population can present significant challenges. For example, older adults may have several chronic conditions.
Now, physicians are considering treating older men and women who have chronic pain with medical marijuana to reduce their opioid use.
In a recent study, Older Adults' Use of Medical Marijuana for Chronic Pain: A Multisite Community-Based Survey, presented at the 2018 annual meeting of the American Geriatrics Society, researchers at Northwell Health surveyed 138 medical marijuana users (men and women between the ages 61 and 70 years of age) who had been living with chronic pain from osteoarthritis, spinal stenosis, hips and knees that could not be replaced, and pain not relieved by steroid injections,
Patients responded to 20 questions that focused on their marijuana use, such as how often they used marijuana, in what form, how much they used, how much their pain was reduced, and whether using marijuana helped them reduce their other pain medications. The researchers found that most patients, 45 percent, used vaporized oil; 28 percent used pills; and 17 percent used marijuana-laced oil. As far as the frequency of marijuana use, 21 percent used marijuana once a day, 23 percent used marijuana twice daily, and 39 percent used marijuana more than twice a day.
About 18 percent of patients reported that marijuana decreased their use of pain medications “moderately;” 20 percent “extremely,” and 27 percent “completely.” Patients felt that their quality of life had improved, allowing them to function at work and that although marijuana had not completely cured their pain, at least they could once again manage their lives.
When asked how pain levels changed before and one month after starting marijuana, most patients reported that average pain scores dropped from 9.0 on a scale of 0-10 to a more moderate pain threshold of 5.6.
According to Martins-Welch, a co-author of the study and physician in the Division of Geriatric and Palliative Medicine in the Department of Medicine at Northwell Health, medical marijuana needs to be more widely available, now legal in only 30 states. Also, because marijuana is federally illegal, it is expensive — $300 for a one-month supply — and not covered by insurance.
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