Disclosures: Ari Greis, DO, FAAPMR: No financial relationships or conflicts of interest

Objective: Opioids are routinely prescribed for the treatment of chronic pain despite the opioid epidemic. Medical cannabis (MC) has shown efficacy in treating chronic pain, but there is limited evidence to show that MC can affect opioid use. This study investigates whether the use of MC in patients with chronic musculoskeletal noncancer back pain can reduce opioid usage.

Design: Retrospective cohort study.Setting : Rothman Research Department.Participants : Patients with chronic musculoskeletal noncancer back pain certified for MC access between February 2018 through July 2019.

Interventions: Medical cannabis (MC).

Main Outcome Measures: Filled opioid prescriptions was gathered from Prescription Drug Monitoring Program (PDMP) system. Average daily morphine milligram equivalents (MME) of prescriptions filled within the six months prior to access to MC was compared to the six months after obtaining access to MC.

Results: There was a significant decrease in overall average MME/day after MC prescription from 15.1 to 11.0 (n=186, p < 0.01). The percentage of patients who dropped to 0 MME/day was 38.7%. Sub-analysis of patients who started at less than 15 MME/day and greater than 15 MME/day show significant decreases from 3.5 to 2.1 (n=134, p < 0.01) and 44.9 and 33.9 (n=52, p < 0.01), respectively. Percentage of patients who dropped to 0 MME/day in those groups were 48.5% and 13.5%, respectively. Patient pain intensity, frequency, and daily function were improved compared to baseline at 3-, 6-, and 9-months. Patients who used only a single MC administration route showed an insignificant decrease in MME/day from 20.0 to 15.1 (n=68, p=0.054), while patients who used two or more routes showed a significant decrease from 13.2 to 9.5 (n=76, p < 0.01).Conclusions: Access to MC reduced opioid use for patients with chronic back pain. Patients with lower baseline opioid use have a better chance of stopping opioid use altogether. The use of multiple routes of MC administration is more strongly associated with reduced opioid utilization.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/medical-cannabis-use-reduces-opioid-prescriptions-in-patients-with-chronic-back-pain/