Opioid reduction in patients with chronic non-cancer pain undergoing treatment with medicinal cannabis

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“Introduction: Opioid sparing by co-prescription of cannabinoids may enable patients to reduce their opioid consumption prescribed for chronic benign pain.

Methods: One cohort attending a small private pain clinic (N = 102), already taking opioids, was co-prescribed cannabinoids and another cohort (N = 53) attending a separate pain clinic nearby received only opioids. The two groups were studied prospectively for a year before their drug consumption was assessed.

Results: At baseline, median opioid consumption was 40 mg/day in both cohorts. Medicinal cannabis was administered daily in an oil formulation usually starting at 2.5 mg/day and was titrated to maximize benefits. At 12 months, the median dose contained 15 mg delta-9-tetrahydrocannabinol and 15 mg cannabidiol. At one-year follow-up, 46 of 102 cases had dropped out compared with only one of 53 controls. Opioid consumption had decreased significantly at one-year follow-up, the final median dose being lower in cases (2.7 mg/day) than controls (42.3 mg/day) (p < 0.05 in an intention-to-treat analysis). Disability and insomnia had also decreased in cases.

Conclusion: The introduction of cannabinoids can produce useful reductions in opioid consumption in real-world settings, with additional benefits for disability and insomnia. However, this treatment is tolerated by only a subgroup of patients.”

https://pubmed.ncbi.nlm.nih.gov/40788193/

“Plain language summary

Morphine-like drugs (opioids) decrease pain but can cause severe breathing problems and death if these drugs are consumed in excessive amounts. Stopping these drugs suddenly (going “cold turkey”) can cause severe adverse effects and, as time goes on, increasing amounts may be required to reduce pain. It might be possible to reduce opioid consumption by also taking medicinal cannabis; otherwise, reduction can be difficult to achieve. Cannabis treatment is safe when the hallucinatory component of cannabis is kept to low levels, causing minimal euphoric effects (a “stoned” sensation).In this study, two groups of patients with chronic pain were studied. Both were taking opioid drugs, but one group also took medicinal cannabis. About half of the medicinal cannabis group were not able to keep taking it due to unpleasant side effects. In the remainder, opioid consumption decreased significantly after both 6 and 12 months. Physical activity and sleep also improved. These findings indicate that medicinal cannabis can help patients to reduce their opioid consumption and improve their physical activity and sleep.”

“These findings indicate that medicinal cannabis can help patients to reduce their opioid consumption and improve their physical activity and sleep.”

https://www.tandfonline.com/doi/full/10.1080/17581869.2025.2544511

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