Most Medical Cannabis Patients Reported Reducing Their Use of Opioids, Sleep, and Anxiety Medications | Research

The takeaway

In a survey of over 1,500 medical cannabis patients, 76.7% reduced opioid use, 71.8% reduced anti-anxiety medications, and 65.2% reduced sleep medications after starting cannabis.

Readers considering medical cannabis as an alternative to prescription pain, sleep, or anxiety medications.

76.7% of opioid users reported reducing use after starting medical cannabis

What the researchers found

Among 1,513 New England dispensary members surveyed, the rates of medication reduction after starting medical cannabis varied significantly by drug class. The highest reduction rates were for opioids (76.7%), followed by anti-anxiety medications (71.8%), migraine medications (66.7%), and sleep medications (65.2%).

The reduction in antidepressant use was notably lower at 37.6%, and alcohol reduction was 42.0%. The opioid, anti-anxiety, migraine, and sleep medication reductions were all statistically significantly greater than the reductions in antidepressants or alcohol (p < 0.0001).

An important social finding: patients' spouses, family members, and friends were more likely to know about their medical cannabis use than their primary care providers.

Why it matters

The opioid epidemic has driven intense interest in whether medical cannabis could serve as a substitute for prescription opioids. This study provides patient-reported data suggesting substantial medication substitution, particularly for opioids, anxiety medications, and sleep aids. However, the finding that doctors were often unaware of their patients' cannabis use highlights a gap in coordinated care.

The numbers in context

1,513 dispensary members surveyed. Reduced opioid use: 76.7%. Reduced anti-anxiety meds: 71.8%. Reduced migraine meds: 66.7%. Reduced sleep meds: 65.2%. Reduced alcohol: 42.0%. Reduced antidepressants: 37.6%. All comparisons to antidepressant/alcohol reduction: p < 0.0001.

How the study worked

Online cross-sectional survey of New England dispensary members (n = 1,513). Participants were asked about their medical history, conditions, cannabis experiences, and changes in use of other medications since starting medical cannabis.

What this study cannot tell us

Self-reported, retrospective, cross-sectional design. No verification of actual medication changes through pharmacy records or physician confirmation. Selection bias: dispensary members who found cannabis helpful may be more likely to respond. No control group of patients who tried cannabis and found it unhelpful. "Reduced use" does not necessarily mean "appropriate reduction" since some patients may need their original medications.

How to read the evidence

Moderate evidence from a large cross-sectional survey, limited by self-report and selection bias.

When this study was published

Published in 2017. The opioid crisis and medical cannabis substitution debate have continued to evolve.

The bigger picture

This study adds to the substitution hypothesis: that medical cannabis access may reduce use of other substances, particularly opioids. Prior epidemiological research found reduced opioid overdose deaths in states with medical cannabis laws. The patient-reported data here aligns with that ecological finding, though self-report and ecological studies cannot establish causation.

Questions still open

Are these self-reported reductions confirmed by pharmacy records and clinical outcomes? Do patients who reduce opioids after starting cannabis maintain adequate pain control? What are the risks of patients reducing medications without physician guidance?

Common questions

Does this prove medical cannabis can replace opioids?

No. This was a self-reported survey of patients who were already using medical cannabis, creating selection bias. Patients who tried cannabis and found it unhelpful were less likely to be dispensary members. Controlled studies comparing cannabis to opioids for pain management would provide stronger evidence.

Why was the reduction in antidepressant use lower than for other medications?

The study found that only 37.6% reduced antidepressants, compared to 65-77% for pain and anxiety medications. This suggests medical cannabis may be more effective at substituting for pain and anxiety treatments than for antidepressants, though the reasons were not explored in this study.

Read the original research

Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep.

Journal of psychopharmacology (Oxford, England), 31(5), 569-575

View on PubMed ↗Publisher’s paper ↗

Citation

Piper, Brian J; DeKeuster, Rebecca M; Beals, Monica L; Cobb, Catherine M; Burchman, Corey A; Perkinson, Leah; Lynn, Shayne T; Nichols, Stephanie D; Abess, Alexander T. (2017). Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep.. Journal of psychopharmacology (Oxford, England), 31(5), 569-575. https://doi.org/10.1177/0269881117699616