Should Physicians Recommend Replacing Opioids With Cannabis?, Keith Humphreys, Richard Saitz, 2019

Should Physicians Recommend Replacing Opioids With Cannabis?

Keith Humphreys PhD, Richard Saitz, MD, MPH
JAMA, 2019, 321, 7, 639-640.
doi : 10.1001/jama.2019.0077

Recent state regulations (eg, in New York, Illinois) allow medical cannabis as a substitute for opioids for chronic pain and for addiction. Yet the evidence regarding safety, efficacy, and comparative effectiveness is at best equivocal for the former recommendation and strongly suggests the latter—substituting cannabis for opioid addiction treatments is potentially harmful. Neither recommendation meets the standards of rigor desirable for medical treatment decisions.


Résumé :

States that permit medical marijuana as an alternative to opioids for chronic pain and for addiction are getting ahead of the evidence, according to Journal of the American Medical Association associate editor Richard Saitz, MD, MPH. Writing with Keith Humphreys of the Veterans Affairs Health Services Research and Development Center, he argues that safety and efficacy findings to date are not compelling enough to warrant policy changes. For neuropathic and other pain, the pair note, cannabis studies are characterized by small sample populations, brief followup periods, and a lack of focus on the most common causes of pain. Moreover, Saitz and Humphreys can find no prospective evidence of any benefit from treating opioid addicts with cannabis—although they say research does point to potential harms. While no one is likely to die from a cannabis overdose, there is a risk for addiction—not only with marijuana but with other substances. Results of systematic reviews also point to an elevated risk of car crashes, cognitive impairment, structural brain changes, and psychotic symptoms with marijuana. Still, the authors believe cannabis-derived medical treatment is worth investigating further—but under the same rigorous conditions that apply to other novel therapies. That means cannabis trials should follow national standards, provide comparative evidence, and delegate clinical recommendations to physicians, pharmacists, and other experts, they conclude.


suivi d’un intéressant commentaire … (selon le GRECC)
This Is Wrong!
Jacob Mirman, MD, MD, DHt, CCH, MHom | Life Medical, Private Clinic in MN, Medical Director

I totally disagree with this opinion. Consider the following facts, that are mostly agreed upon:

– We are having an opioid epidemic fueled by opioid prescriptions. Many deaths!
– Cannabis is very safe. Overdose is not an issue. No deaths from overdose.

I have certified about 1,700 patients for medical cannabis since 2015. I see them all for follow-up every year, as is MN law. The main qualifying conditions are pain, PTSD and inflammatory bowel disease. The MN Dept of Health is running a study and has already reported that cannabis is very effective in pain, a finding borne out in my practice. Many patients say their life turned around when they started on cannabis. Their pain is better, they are happier, they sleep much better, and are able to be more active. PTSD symptoms are much better and UC and Crohn’s disease essentially go into remissions in many cases. Many stop their drugs, including opioids, which were giving them side effects, or dramatically reduce them. I have never seen a single drug do so much and with a favorable side effect profile.

There are some patients who don’t like it, mostly the elderly, who get more side effects. And many people can’t afford it, which is a shame. But overall the Minnesota program is phenomenal.

All I can say to the detractors, those waiting for some big studies, is ‘Come and see.’ Once we know a treatment is safe, we can use it. And the experience in my clinic speaks for itself. It is unethical to withhold this therapy from suffering people.