Many chronic pain patients are prescribed opioids at doses exceeding the current Guideline. Tapering the dose can be difficult, as patients fear a return to a state of overwhelming pain. Several factors can increase the likelihood of success: the patient’s readiness for change, psychological support, pharmacological support and careful monitoring. This pilot study addressed these four factors. Six hundred patients took part. Each was taking daily opioid doses ranging from 90-240 mg morphine equivalent dose (MED). All indicated they were prepared to reduce their opioid dose. Over a six-month period, opioid doses were tapered according to individual needs, usually 10% every 1-2 weeks. Psychological support was provided through a freely available web-based mental health and wellness tool. Medical cannabis provided pharmacological support at the rate of 0.5g/day for each 10% reduction in opioid dose, as needed. Physicians monitored patients regularly according to each patient’s needs. After 6 months, 156 patients (26%) had ceased taking opioids. An additional 329 patients (55%) had reduced their opioid use by an average of 30%. One hundred fourteen patients (19%) neither increased nor decreased their opioid use. The one patient whose opioid dose was increased had poorly controlled pain and an aggravated pain condition. The success of this medical cannabis – opioid reduction program in a large proportion of patients is grounds for further investigation.
| Published in | American Journal of Psychiatry and Neuroscience (Volume 7, Issue 3) |
| DOI | 10.11648/j.ajpn.20190703.14 |
| Page(s) | 74-77 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2019. Published by Science Publishing Group |
Opioids, Pain Management, Cannabis, Tapering
| [1] | J. W. Busse, S. Craigie, D. N. Juurlink, A. Carrasco, E. Alk, T. Agoritsas et al. Appendix 1 (as supplied by the authors): The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Appendix to Canadian Medical Association Journal [Internet]. 2017 [cited 2018 Oct 23]. 189: E659-66 [105 pages]. doi: 10.1503/cmaj.170363. Available from: http://www.cmaj.ca/content/suppl/2017/05/03/189.18.E659.DC1. |
| [2] | T. Gomes, S. Greaves, D. Martins, M. Tadrous, M. M. Mamdami, J. M. Paterson et al. Latest Trends in Opioid-Related Deaths in Ontario: 1991 to 2015 [Internet]. Toronto: Ontario Drug Policy Research Network; April 2017 [cited 2018 Oct 23]. Available from http://odprn.ca/wp-content/uploads/2017/04/ODPRN-Report_Latest-trends-in-opioid-related-deaths.pdf. |
| [3] | J. O. Prochaska, C. C. DiClemente. The transtheoretical approach. In: Norcross, JC, Goldfried, MR, editors. Handbook of psychotherapy integration. 2nd ed. New York: Oxford University Press; 2005. p. 147–171. |
| [4] | G. L. Zimmerman, C. G. Olsen, D. O. Bosworth. A ‘Stages of Change’ Approach to Helping Patients Change Behavior. American Family Physician 2000; 61 (5): 1409-1416. |
| [5] | C. Berna, R. J. Kulich, J. P. Rathmell. Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo Clinic Proceedings 2015; 90 (6): 828-42. doi: 10.1016/j.mayocp.2015.04.003. |
| [6] | Michael G. DeGroote National Pain Centre. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain; Appendix B-12: Opioid Tapering [Internet]. 2010 [cited 2018 Oct 18]. Available from: http://nationalpaincentre.mcmaster.ca/opioid_2010/cgop_b_app_b12.html. |
| [7] | J. Elikkottil, P. Gupta, K. Gupta. The analgesic potential of cannabinoids. Journal of Opioid Management 2009 Nov-Dec; 5 (6): 341-57. |
| [8] | K. F. Boehnke, E. Litinas, D. J. Clauw. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. The Journal of Pain 2016; 17 (6): 739-44. doi: 10.1016/j.jpain.2016.03.002. |
| [9] | L. Degenhardt, N. Lintzeris, G. Campbell, R. Bruno, M. Cohen, M. Farrell et al. Experience of adjunctive cannabis use for chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study. Drug and Alcohol Dependence 2015; 147: 144-50. doi: 10.1016/j.drugalcdep.2014.11.031. |
| [10] | M. A. Ware, T. Wang, S. Shapiro, A. Robinson, T. Ducret, T. Huynh et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. Canadian Medical Association Journal 2010; 182 (14): E694-E701. |
| [11] | D. I. Abrams, P. Couey, S. B. Shade, M. E. Kelly, N. L. Benowitz. Cannabinoid-Opioid Interaction in Chronic Pain. Clinical Pharmacology and Therepeutics 2011; 90 (6): 844-891. |
| [12] | P. Lucas, Z. Walsh. Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. The International Journal on Drug Policy 2017; 42: 30-35. doi: 10.1016/j.drugpo.2017.01.011. Epub 2017 Feb 9. |
| [13] | F. Zeidan, N. S. Gordon, J. Merchant, P. Goolkasian. The effects of brief mindfulness meditation training on experimentally induced pain. The Journal of Pain 2010; 11 (3): 199-209. |
| [14] | K. Rod. Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life. Pain Research and Management 2016; 2016: 8714785. doi: 10.1155/2016/8714785. Epub 2016 Mar 1. |
| [15] | College of Family Physicians of Canada. Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance from the College of Family Physicians of Canada. Mississauga, ON: College of Family Physicians of Canada [Internet]. 2014 [cited 2018 Oct 23]. Available from: https://www.cfpc.ca/uploadedFiles/Resources/_PDFs/Authorizing%20Dried%20Cannabis%20for%20Chronic%20Pain%20or%20Anxiety.pdf. |
| [16] | Health Canada. Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids [Internet]. 2013 [cited 2018 Oct 23]. Available from: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/marihuana/med/infoprof-eng.pdf. |
| [17] | A. Hazekamp, E. R. Heerdink. The prevalence and incidence of medicinal cannabis on prescription in The Netherlands. European Journal of Clinical Pharmacology 2013; 69 (8): 1575-1580. |
| [18] | E. L. Cassidy, R. J. Atherton, N. Robertson, D. A. Walsh, R. Gillett. Mindfulness, functioning and catastrophizing after multidisciplinary pain management for chronic low back pain. Pain 2012; 153 (3): 644–650. |
| [19] | K. Hopkins, P. Crosland, N. Elliott, S. Bewley, Clinical Guidelines Update Committee B. Diagnosis and management of depression in children and young people: summary of updated NICE guidance. British Medical Journal 2015; 350: h824. doi: 10.1136/bmj.h824. |
| [20] | B. Smith, K. Metzker, R. Waite, P, Gerrity. Short-form mindfulness-based stress reduction reduces anxiety and improves health-related quality of life in an inner-city population. Holistic Nursing Practice 2015; 29 (2): 70-77. doi: 10.1097/HNP.0000000000000075. |
APA Style
Kevin Rod. (2019). A Pilot Study of a Medical Cannabis - Opioid Reduction Program. American Journal of Psychiatry and Neuroscience, 7(3), 74-77. https://doi.org/10.11648/j.ajpn.20190703.14
ACS Style
Kevin Rod. A Pilot Study of a Medical Cannabis - Opioid Reduction Program. Am. J. Psychiatry Neurosci. 2019, 7(3), 74-77. doi: 10.11648/j.ajpn.20190703.14
AMA Style
Kevin Rod. A Pilot Study of a Medical Cannabis - Opioid Reduction Program. Am J Psychiatry Neurosci. 2019;7(3):74-77. doi: 10.11648/j.ajpn.20190703.14
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ajpn.20190703.14,
author = {Kevin Rod},
title = {A Pilot Study of a Medical Cannabis - Opioid Reduction Program},
journal = {American Journal of Psychiatry and Neuroscience},
volume = {7},
number = {3},
pages = {74-77},
doi = {10.11648/j.ajpn.20190703.14},
url = {https://doi.org/10.11648/j.ajpn.20190703.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20190703.14},
abstract = {Many chronic pain patients are prescribed opioids at doses exceeding the current Guideline. Tapering the dose can be difficult, as patients fear a return to a state of overwhelming pain. Several factors can increase the likelihood of success: the patient’s readiness for change, psychological support, pharmacological support and careful monitoring. This pilot study addressed these four factors. Six hundred patients took part. Each was taking daily opioid doses ranging from 90-240 mg morphine equivalent dose (MED). All indicated they were prepared to reduce their opioid dose. Over a six-month period, opioid doses were tapered according to individual needs, usually 10% every 1-2 weeks. Psychological support was provided through a freely available web-based mental health and wellness tool. Medical cannabis provided pharmacological support at the rate of 0.5g/day for each 10% reduction in opioid dose, as needed. Physicians monitored patients regularly according to each patient’s needs. After 6 months, 156 patients (26%) had ceased taking opioids. An additional 329 patients (55%) had reduced their opioid use by an average of 30%. One hundred fourteen patients (19%) neither increased nor decreased their opioid use. The one patient whose opioid dose was increased had poorly controlled pain and an aggravated pain condition. The success of this medical cannabis – opioid reduction program in a large proportion of patients is grounds for further investigation.},
year = {2019}
}
TY - JOUR T1 - A Pilot Study of a Medical Cannabis - Opioid Reduction Program AU - Kevin Rod Y1 - 2019/09/20 PY - 2019 N1 - https://doi.org/10.11648/j.ajpn.20190703.14 DO - 10.11648/j.ajpn.20190703.14 T2 - American Journal of Psychiatry and Neuroscience JF - American Journal of Psychiatry and Neuroscience JO - American Journal of Psychiatry and Neuroscience SP - 74 EP - 77 PB - Science Publishing Group SN - 2330-426X UR - https://doi.org/10.11648/j.ajpn.20190703.14 AB - Many chronic pain patients are prescribed opioids at doses exceeding the current Guideline. Tapering the dose can be difficult, as patients fear a return to a state of overwhelming pain. Several factors can increase the likelihood of success: the patient’s readiness for change, psychological support, pharmacological support and careful monitoring. This pilot study addressed these four factors. Six hundred patients took part. Each was taking daily opioid doses ranging from 90-240 mg morphine equivalent dose (MED). All indicated they were prepared to reduce their opioid dose. Over a six-month period, opioid doses were tapered according to individual needs, usually 10% every 1-2 weeks. Psychological support was provided through a freely available web-based mental health and wellness tool. Medical cannabis provided pharmacological support at the rate of 0.5g/day for each 10% reduction in opioid dose, as needed. Physicians monitored patients regularly according to each patient’s needs. After 6 months, 156 patients (26%) had ceased taking opioids. An additional 329 patients (55%) had reduced their opioid use by an average of 30%. One hundred fourteen patients (19%) neither increased nor decreased their opioid use. The one patient whose opioid dose was increased had poorly controlled pain and an aggravated pain condition. The success of this medical cannabis – opioid reduction program in a large proportion of patients is grounds for further investigation. VL - 7 IS - 3 ER -
Email: