Medical cannabis patients showed changes in prescription controlled substance use over time | Research

The takeaway

Individual-level observational data showed that medical cannabis use was associated with changes in prescription controlled substance use, including potential opioid-sparing effects, but also raised questions about sedative hypnotic interactions.

Medical cannabis prescribers, pain medicine clinicians, pharmacists, and overdose prevention researchers.

Individual-level data showed opioid-sparing effects plus sedative hypnotic changes

What the researchers found

Medical cannabis participants showed changes in controlled substance prescription patterns. While potential opioid-sparing effects were observed, the data also suggested interactions with sedative hypnotic use that could affect overdose risk.

Why it matters

The opioid-sparing narrative focuses on potential benefits, but medical cannabis may also affect use of other controlled substances in ways that increase or decrease risk. Individual-level data provides more granular insight than population studies.

The numbers in context

Individual-level data combining medical cannabis use with prescription controlled substance records. Opioid-sparing effects observed alongside changes in sedative hypnotic patterns.

How the study worked

Observational study combining individual-level data on medical cannabis use with prescription controlled substance records. Analyzed changes in opioid, sedative hypnotic, and other controlled substance use patterns.

What this study cannot tell us

Observational design without randomization. Cannot attribute prescription changes to cannabis use versus other factors. Self-selection into medical cannabis. Limited ability to assess clinical outcomes (pain control, function) alongside prescription changes.

How to read the evidence

Individual-level observational data is more informative than ecological data but still cannot establish causation without randomization.

When this study was published

Published 2023.

The bigger picture

Medical cannabis does not exist in a vacuum. Patients using medical cannabis are often also taking other controlled substances. Understanding how cannabis affects the full medication profile, not just opioids, is essential for assessing net risk and benefit.

Questions still open

Does medical cannabis reduce or increase overall overdose risk when considering all controlled substance interactions? Should medical cannabis prescribing guidelines address concurrent sedative hypnotic use?

Common questions

Does medical cannabis reduce the need for other medications?

This study found medical cannabis use was associated with changes in prescription controlled substance patterns, including some opioid reduction. However, changes in sedative hypnotic use were also observed, which could have its own safety implications. The net effect on patient safety is complex.

Can medical cannabis be dangerous when combined with other medications?

Cannabis can interact with other substances, particularly sedatives and opioids, potentially increasing risks like excessive sedation or respiratory depression. This study highlights the importance of monitoring the full medication profile, not just opioid prescriptions, when patients use medical cannabis.

Read the original research

Adult Medical Cannabinoid Use and Changes in Prescription Controlled Substance Use.

Cannabis and cannabinoid research, 8(5), 933-941

View on PubMed ↗Publisher’s paper ↗

Citation

Williams, Arthur Robin; Mauro, Christine M; Feng, Tianshu; Waples, Josef; Martins, Silvia S; Haney, Margaret. (2023). Adult Medical Cannabinoid Use and Changes in Prescription Controlled Substance Use.. Cannabis and cannabinoid research, 8(5), 933-941. https://doi.org/10.1089/can.2021.0212