Cannabis Did Not Reduce Opioid Use or Real-Time Pain in Chronic Pain Patients | Research

The takeaway

Real-time monitoring of chronic pain patients found no opioid-sparing effect of cannabis and no momentary pain reduction from cannabis-opioid co-use, though retrospective reports suggested greater perceived relief.

Chronic pain patients, pain medicine providers, cannabis researchers

No opioid-sparing effect in real-time data

What the researchers found

Using 30-day ecological momentary assessment, neither cannabis-opioid co-use nor sole use of either substance reduced pain in the next moment. However, participants retrospectively reported the highest perceived pain relief from co-use. There was no evidence of an opioid-sparing effect. The discrepancy between real-time and retrospective reports suggests recall bias.

Why it matters

The "opioid-sparing" effect of cannabis is widely discussed but rarely tested with real-time data. This study challenges the narrative by showing no moment-to-moment pain reduction or opioid dose reduction from co-use.

The numbers in context

46 participants; 30-day EMA; no momentary pain reduction from co-use; no opioid-sparing effect; retrospective reports showed perceived relief from co-use (possible recall bias)

How the study worked

Ecological momentary assessment (EMA) study of 46 adults with chronic pain using both opioids and cannabis, recruited online, completing 30 days of real-time surveys on pain, cannabis use, and opioid use.

What this study cannot tell us

Small sample (46 participants). Online recruitment may select for specific populations. EMA compliance varies. Cannot control cannabis/opioid dosing or timing.

How to read the evidence

Novel EMA methodology provides real-time data, but small sample and naturalistic use patterns limit definitive conclusions.

When this study was published

Published in 2022

The bigger picture

The disconnect between real-time data (no effect) and retrospective reports (perceived relief) is a cautionary tale for cannabis pain research that relies on patient recall rather than momentary assessment.

Questions still open

Is the perceived pain relief from co-use driven by mood effects rather than actual analgesia? Would specific cannabinoid formulations show different results than the naturalistic cannabis used here?

Common questions

Does cannabis reduce the need for opioids in chronic pain?

This real-time monitoring study found no evidence of an opioid-sparing effect. Daily opioid consumption was not lower on days when cannabis was co-used, despite participants perceiving greater relief retrospectively.

Why did patients think co-use helped if real-time data showed no effect?

The study suggests recall bias. When asked to look back, patients reported the most relief from co-use, but moment-by-moment data showed no pain reduction. Cannabis may affect mood or memory of pain rather than pain itself.

Read the original research

Real-Time Monitoring of Cannabis and Prescription Opioid Co-Use Patterns, Analgesic Effectiveness, and the Opioid-Sparing Effect of Cannabis in Individuals With Chronic Pain.

The journal of pain, 23(11), 1799-1810

View on PubMed ↗Publisher’s paper ↗

Citation

Mun, Chung Jung; Nordeck, Courtney; Goodell, Erin M Anderson; Vandrey, Ryan; Zipunnikov, Vadim; Dunn, Kelly E; Finan, Patrick H; Thrul, Johannes. (2022). Real-Time Monitoring of Cannabis and Prescription Opioid Co-Use Patterns, Analgesic Effectiveness, and the Opioid-Sparing Effect of Cannabis in Individuals With Chronic Pain.. The journal of pain, 23(11), 1799-1810. https://doi.org/10.1016/j.jpain.2022.06.009