Medical Cannabis May Be Effective Substitute for Opioids Interview with:

Philippe Lucas VP, Patient Research & Access, Tilray Graduate Researcher, Centre for Addictions Research of BC

Philippe Lucas

Philippe Lucas
VP, Patient Research & Access, Tilray
Graduate Researcher, Centre for Addictions Research of BC What is the background for this study?

Response: In 2001 Canada become one of the first nations to develop a federally regulated program to allow access to cannabis for medical purposes with the launch of the Marihuana Medical Access Regulations (MMAR). The program has undergone numerous convolutions, culminating in the establishment by Health Canada of the Marihuana for Medical Purposes Regulations (MMPR) in 2014, which was replaced by the Access to Cannabis for Medical Purposes (ACMPR) in 2016.

One of the primary changes in the new program(s) has been to move from a single Licensed Producer (LP) of cannabis to multiple large-scale Licensed Producers. This is the first comprehensive survey of patients enrolled in the MMPR/ACMPR, and with 271 complete responses, it’s the largest survey of federally-authorized medical cannabis patients to date. What are the main findings?

Response: Overall, 71% (n = 186) of participants substituted cannabis for either prescription drugs, alcohol, tobacco/nicotine or illicit substances, with 63% reporting substitution for prescription medication (n = 166), 25% for alcohol (n = 66), 12% for tobacco/nicotine (n = 31), and 3% for illicit substances (n = 9). In regards to prescription drugs, the most common form of substitution was for opioids (32%, n=80), followed by benzodiazepines (16%, n=40), and antidepressants (12%, n = 31). It is notable that patients using cannabis to treat pain-related conditions have a higher rate of substitution for opioids, and that patients self-reporting mental health issues have a higher rate of substitution for benzodiazepines and antidepressants.

The finding that medical cannabis is used primarily to treat chronic pain is consistent with past research (Ware et al., 2010; Ware, Wang, Shapiro, & Collet, 2015). However, the extensive self- reported use to treat mental health conditions and associated symptoms represents a novel and interesting trend, and suggests that the conceptualization of cannabis as deleterious to mental health may not generalize across conditions or populations. Studies currently underway to investigate cannabis for the treatment of PTSD, anxiety, and other psychiatric conditions may soon provide more information on these potentially promising treatment options.

Cannabis is rather unique as a therapeutic treatment in that many patients report some permeability between recreational and medical use (Walsh et al., 2013). For people who use cannabis for medical purposes, although it can relieve them of the pain that they are experiencing amongst many ailments, it can become quite pricey. This is why sites like SaveOnCannabis supply discounts that you can use on at dispensaries. Looking after your health should be your main priority. Plus, who doesn’t want to save money? We all do, no matter the circumstance. Unfortunately, pateients who actually use medical marijuana to relieve aches and pains, not having a dispensary near them does hinder the process of using this product as a way to allow them to live comfortably and help make life that little bit easier. Saying this though, if you do a little research, you’ll find that there are dispensaries in illinois and various other cities around the states, where you can visit if you are in need of this product. There is always a way around this solution.

However, unlike opioids where medical use via prescription often precedes recreational use and dependence (Fischer et al., 2008), the pathways between the medical and recreational use of cannabis are reversed, with previous recreational use often a precursor to prescription medical use, while the reverse is rarely the case. Although most respondents in this study had experience with recreational cannabis use prior to initiation of medical use (81%, n=220), transition from medical use to recreational use was only reported by 7 participants (<3%), which is suggestive of a low risk of abuse associated with medical cannabis. Additionally, to our knowledge, this is the first patient survey to report vaporization as the primary method of ingestion, and non-smoked forms of ingestion as primary and preferred methods of ingestion. This suggests a health conscious shift in medical cannabis use by patients under the MMPR. What should readers take away from your report?

Response: Medical cannabis is primarily used to treat chronic pain and mental health conditions. The high rate of substitution for prescription drugs among patients with these conditions suggests that medical cannabis may be an effective adjunct or substitute treatment to opioids, benzodiazepines and other prescription drugs used to treat these conditions.

In light of the growing rate of morbidity and mortality associated with prescription opioids (Bachhuber et al., 2014; Fischer, Rehm, Goldman, & Popova, 2008), this study adds to a growing body of literature suggesting that cannabis could reduce the personal and public health burden of problematic prescription drug use, and potentially play a part in stemming the opioid overdose crisis currently impacting North America. What recommendations do you have for future research as a result of this study?

Response: In light of these findings, further research into the comparative efficacy of cannabis relative to front-line treatments for pain-related and mental health conditions is warranted, and longitudinal research would help elucidate the context of cannabis substitution effect, and the potential impact of cannabis substitution on the quality of life of patients.

Some of this research is already underway, as primary author Philippe Lucas is currently conducting a longitudinal study of the impact of medical cannabis use on quality of life and prescription drugs over a 12 month period. The study, known as the Tilray Observational Patient Survey (TOPS), is currently underway at 15 medical clinics throughout Canada and has enrolled nearly 500 of 1000 total participants to date.

Those wanting more information on this study or any of the other research projects cited in this interview can contact Philippe Lucas at [email protected]/[email protected]. Is there anything else you would like to add?

Response: This study was funded by Tilray, a federally authorised medical cannabis production and research company. Philippe Lucas is currently employed as Vice-President, Patient Research and Access for Tilray; however, his compensation is not tied in any way to the outcomes of this study.

Co-investigator Zach Walsh is currently the Primary Investigator in a Tilray-sponsored randomized clinical trial of medical cannabis and PTSD, but he receives no financial compensation for that study nor for assisting with the analysis and writing of this paper. Thank you for your contribution to the community.


Philippe Lucas, Zach Walsh.Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. International Journal of Drug Policy, 2017; 42: 30 DOI: 1016/j.drugpo.2017.01.011

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 1, 2017 by Marie Benz MD FAAD