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Patients with Chronic Back Pain Reduce Their Opioid Use Following Initiation of Medical Cannabis Therapy

Philadelphia: Patients suffering from chronic back pain reduce their use of prescription opioids and report improvements in their condition following medical cannabis treatment, according to longitudinal data published in the journal Cureus.

Investigators affiliated with Thomas Jefferson University in Philadelphia evaluated opioid consumption patterns in a cohort of 186 patients with chronic back pain during the six-months immediately prior to and immediately following their enrollment in the state's medical cannabis access program.

Consistent with prior studies, patients reduced their daily intake of opioids over the course of the trial. Over one-third of patients who were taking low daily doses of opioids at the onset of the study eliminated their opioid use by the trial's end. Subjects' opioid reductions were associated with improvements in pain scores and in patients' daily functions.

Authors concluded: "[P]atients with chronic musculoskeletal noncancer back pain who were certified for MC [medical cannabis] ... filled a significantly reduced amount of opioid prescriptions post-MC compared to pre-MC. Upon MC certification, patients with lower levels of baseline opioid use have a high chance of stopping opioid use altogether. Patients show improved pain scores and daily function scores following MC certification. ... Our study supports evidence that short-term opioid usage is diminished and potentially stopped within six months of MC certification."

Full text of the study, "Medical cannabis use reduces opioid prescriptions in patients with chronic back pain," appears in Cureus.

Study: Cannabis Consumers Are Not Less Motivated Than Non-Users

Memphis, TN: Regular consumers of cannabis are more likely to engage in effort-related decision making tasks than are non-users, according to data published in the journal Experimental and Clinical Psychopharmacology.

A team of researchers at the University of Memphis assessed motivation in a cohort of 47 college-aged students (25 frequent cannabis consumers and 22 controls). Subjects completed a series of behavioral tests (the Effort-Expenditure for Rewards Task) that provided participants with choices between tasks of differing degrees of difficulty and rewards.

Investigators reported that those subjects who most frequently consumed cannabis were also the most likely to select tasks that required the greatest amounts of effort.

"The results provide preliminary evidence suggesting that college students who use cannabis are more likely to expend effort to obtain reward, even after controlling for the magnitude of the reward and the probability of reward receipt. Thus, these results do not support the 'amotivational syndrome' hypothesis."

The team's findings are consistent with those of other recent studies refuting longstanding claims that those with a history of marijuana use lack motivation.

Full text of the study, "Effort-related decision-making and cannabis use among college students," appears in Experimental and Clinical Psychopharmacology.

Study: Cannabis Use Associated with Better Quality of Life Outcomes

Sao Paulo, Brazil: Cannabis consumers report better mental health and quality of life outcomes than do non-users, according to data published in the Journal of Psychiatric Research.

Brazilian investigators surveyed a convenience sample of 7,491 self-identified marijuana consumers and 839 non-users. Participants' responses were scored using standardized scales to assess anxiety, depression, quality of life, and subjective well-being.

Those respondents who identified as regular, but not problematic users of cannabis, scored highest on the scales, followed by more occasional consumers. Both groups scored higher on the scales than did those who abstained from marijuana. Those subjects who perceived their cannabis use to be problematic scored lowest on the scales.

"Even after controlling for possible confounders such as demographics and the use of other psychoactive drugs, occasional or habitual self-perception of cannabis use remained associated with better outcomes of quality of life and mental health," authors concluded.

They added, "[The] results obtained in this study are particularly relevant because they were obtained from a sample predominantly composed of habitual cannabis users from the general population, a group less frequently represented in other surveys. Except for self-perceived dysfunctional cannabis use, the association between cannabis use with an increased risk of adverse health outcomes was not observed in the present study. It is possible that these adverse outcomes, generally described in many other studies, may be due to publication bias or the fact that our survey data collection strategy predominantly targeted recreational cannabis users."

Full text of the study, "Mental health and quality of life in a population of recreational cannabis users in Brazil," appears in the Journal of Psychiatric Research.

Study: THC Levels in Blood Not Linked with Changes in Simulated Driving Performance

San Diego, CA: The detection of THC in blood is not correlated with changes in simulated driving performance, according to data published in the journal JAMA Psychiatry.

A team of investigators affiliated with the University of California, San Diego assessed subjects' simulated driving performance after inhaling either low-potency (six percent), moderate-potency (13 percent), or placebo cannabis.

Compared to their baseline performance, those subjects who smoked either low-potency or moderate-potency cannabis exhibited significant changes for a period of 3.5 hours. These changes were most acute for the first 90 minutes. Cannabis inhalation was not associated with any uptick in crash risk. Researchers identified no correlation between subjects' blood/THC levels and driving performance at any point during the study. Consistent with prior studies, authors reported, "The current results reinforce that per se laws based on blood THC concentrations are not supported [by evidence]."

Per se traffic laws make it a crime for a driver to operate a motor vehicle with trace levels of either THC or its metabolites in their blood or urine, regardless of whether there exists any demonstrable evidence that the driver is under the influence.

Most of the study's subjects perceived themselves to be safe to drive after 90 minutes despite continuing to exhibit lingering impairment for several hours thereafter. Authors reported that drivers in the THC groups exhibited no differences in performance compared to controls after 4.5 hours.

Researchers concluded: "In a placebo-controlled parallel study of regular cannabis users smoking cannabis with different THC content ad libitum, there was statistically significant worsening on driving simulator performance in the THC group compared with the placebo group. ... A lack of insight regarding driving impairments, particularly at 90 minutes, is of concern, given that users will likely self-evaluate when they feel safe to drive. ... The lack of relationship between blood THC concentration and driving performance raises questions about the validity of per se laws. ... Future research should address factors such as individual biologic differences, personal experience with cannabis, and cannabis administration methods in relation to driving impairment."

Prior studies have shown that THC inhalation is associated with changes in driving behavior, such as an increased likelihood of weaving and a decrease a drivers' average speed. These and other changes are typically less pronounced in subjects who are more habitual cannabis consumers, but they may be exacerbated when alcohol and marijuana are ingested in combination with one another.

By contrast, the ingestion of CBD-dominant cannabis strains has not been associated with similar changes in driving performance.

Full text of the study, "Driving performance and cannabis users' perception of safety: A randomized clinical trial," appears in JAMA Psychiatry.

Survey: Cannabis Companies Cite Lack of Banking Access as the "Top Issue" Facing the Industry

Portland, OR: Businesses' lack of access to traditional financial services and capital is perceived to be the greatest hurdle facing the cannabis industry, according to survey data compiled by Whitney Economics.

Researchers compiled opinions from 396 licensed cannabis companies on existing challenges in the US marketplace. Over 70 percent of respondents said that the "lack of access to banking or investment capital" was their top challenge. By comparison, only 42 percent of respondents cited "state regulations" as the most significant burden facing the industry, and only 39 percent cited the "influence of the illicit market."

Federal laws and regulations strongly discourage banks and other financial institutions from partnering with licensed cannabis companies because marijuana is classified as a Schedule I controlled substance. On five separate occasions, US House lawmakers have passed legislation, The SAFE Banking Act, to amend federal banking laws, but Senate leadership has refused to ever debate the issue.

According to the Whitney Economics survey, fewer than half of respondents (42 percent) are currently making a profit and only 40 percent believe that "the industry is heading in the right direction."

Full text of the Whitney Economics report, "US Cannabis Business Conditions Survey Report," is available for download.