Depression and anxiety are more widespread among patients using opioids than patients using medical cannabis

Aching joints? Old injuries? Long-term illness? If these issues ring a bell with you, you’re probably one of the millions of people suffering from chronic pain in the United States. But before you reach for that bottle of prescription pills, you should know new research suggests medical cannabis has a leg-up on traditional opioids when it comes to anxiety and depression relief.

The mental health benefit of medical cannabis

Chronic pain sufferers taking opioids exhibit significantly higher and more frequent rates of depression and anxiety than those taking medical cannabis, according to new research. The study’s findings, published in The Journal of Affective Disorders, suggest that medical cannabis may weaken symptoms of depression and anxiety.

“Accordingly, given repeated reports of higher levels of anxiety and depression among chronic pain patients in general, it is possible that MM partially attenuates these symptoms,” the study reads.

Further, the authors cite research aiming to dismiss ties between medical cannabis use and increased depression and anxiety.

“Despite repeating evidence pointing that cannabis use and depression tend to co-occur and several longitudinal studies linking cannabis use with increased risk for developing depression (Lev-Ran et al., 2013; Swift et al., 2001), it has been recently suggested that this association may be in fact attributed to clinical confounders rather than to the direct effect of cannabis use (Feingold et al., 2015; WHO, 2016). In addition, it has actually been suggested that action at cannabinoid receptors is linked to a reduction in depressive behaviors (Degenhardt et al., 2000).”

“Though cannabis has been shown to induce transient anxiety-like symptoms (D’Souza et al., 2004), a recent meta-analysis has questioned this finding (Twomey, 2017) and there is lack of data indicating increased incidence of anxiety disorders following cannabis use (Feingold et al., 2016b; WHO, 2016; Zvolensky et al., 2006). Furthermore, specific cannabinoids, particularly cannabidiol (CBD) has been reported to reduce anxiety (see for example Zuardi et al., 1982), indicating that specific cannabis strains including different ratios of cannabinoids may differentially affect anxiety.”

For decades, patients suffering from chronic pain have often been prescribed a class of drugs known as opioids; in 2012 alone, the American Society of Addictive Medicine (ASAM) noted that 259 million prescriptions for opioids were written in the U.S.

While effective painkillers, opioids are highly addictive and have no known benefit in the realm of mental health. In fact, research in 2013, published in the Journal of General Internal Medicine,  found the prolonged use of opioids increased an individual’s risk for a major depressive episode.

The 2017 study: Opioids versus medical cannabis

Chronic pain increases an individual’s risk for depression and anxiety, an issue which prompted researchers to compare medical cannabis benefits to the benefits of opioid prescriptions. Using a pool of 890 chronic pain sufferers, treated at two Israeli pain centers, participants were selected to be evaluated over a 6-month period of time.

Socio-demographic data, medical and substance abuse history, and pain levels (on a scale from 0 to 10) were collected from each patient, and researchers compared the prevalence of depression or anxiety by breaking up the results into:

  •       People who used opioids
  •       People who used medical cannabis
  •       People who used both opioids and medical cannabis

Participants were then screened for co-occurring psychiatric disorders using a 9-item depressive disorder questionnaire (known as PHQ-9), in conjunction with a 7-item generalized anxiety disorder scale (known as GAD-7).

Results from the analysis revealed:

  •       48% of patients treating their pain with opioids reported pain levels of 9 to 10, while only 33% of patients treating their pain with medical cannabis reported level of pain of 9 to 10
  •       57.1% of opioid users reported suffering from moderate, moderate to severe, and severe levels of depression
  •       Only 22.3% of medical cannabis users reported suffering from moderate, moderate to severe, and severe levels of depression
  •       48.4% of opioid users reported suffering from moderate, or severe levels of anxiety
  •       Only 21.5% of medical cannabis users reported suffering from moderate, or severe levels of anxiety

In addition, opioid users (OP) reported suffering from depression and anxiety more frequently than medical cannabis (MM) users.

“When comparing individual items in the PHQ-9 questionnaire, patients in the OP group invariably replied “almost every day” more commonly than those in the MM group (for example “how often did you suffer from poor appetite or overeating?”). Patients in the MM group replied “not at all” to all specific PHQ-9 items more commonly than those in the OP group. The same was true for individual items in the GAD-7 (for example, patients in the OP group replied “almost every day” when asked how often they felt “so restless that it is hard to sit still” more often than those in the MM group).”

Why is this important? For a country that spends $261 to $300 billion per year on treating pain, according to researchers, medical cannabis could offer a viable alternative treatment option.

Isn’t medical cannabis addictive, too?

For some, swapping opioids for cannabis feels counterintuitive. After all, cannabis was illegal for a long time, and opioids have been coming out of pharmacies for years. So why would medical cannabis suddenly be a better option for some patients?

According to the National Institute on Drug Abuse (NIDA), cannabis does carry a risk of addiction. Approximately 9-17% of users develop some level of dependence from chronic use, though the NIDA notes that dependence is not synonymous with addiction. The actual number of people addicted to cannabis is likely much lower, and the number of known deaths related to cannabis overdose is statistically minimal.

In comparison, opioid overdose is responsible for more than 3 out of 5 drug overdose deaths, according to the Centers for Disease Control (CDC), and opioid deaths have nearly quadrupled since 1999. The ASAM indicates, of the 20.5 million Americans with substance abuse disorders in 2015, 2.5 million of those disorders involved prescription painkillers and/or the opioid, heroin.

Does this make a case for the use of medical cannabis for chronic pain management? If you’re one of the many who suffers from a painful condition, that decision is up to you and your medical provider.

Educate yourself on your options and the risks associated with those choices. Medical cannabis may be a more cost-effective means of managing pain and may provide more mental health benefits, but it might not be right for your situation. Only you and your doctor can make the call.

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