Use of medical marijuana to ease pain is associated with fewer visits to the hospital in people with sickle cell disease (SCD), a study suggests.
Patients given medical marijuana felt this was an effective treatment for pain relief, and also reported a reduction in the need for opioids.
The study, “Medical marijuana certification for patients with sickle cell disease: a report of a single center experience,” was published in the journal Blood Advances.
Acute and chronic pain are the most common reasons for hospital admission among people with SCD. Opioids have been the treatment of choice for managing pain, but opioid addiction has been acknowledged as a public health crisis in the U.S., highlighting the need for alternative therapies.
Cannabis, and its pharmacologically active compounds (cannabinoids), have shown potential as a non-addictive means to alleviate chronic pain. In fact, more than one-third of adult SCD patients in the U.S. have reported they rely on illicit cannabis for managing pain.
However, there is still a lack of proper studies of cannabinoid-based products as a pain treatment in SCD.
Here, researchers at the Yale School of Medicine in Connecticut investigated whether use of medical marijuana is associated with changes in healthcare and opioids use.
In Connecticut, SCD patients have been eligible for medical marijuana use since 2016. Medical marijuana contains multiple cannabinoids, such as tetrahydrocannibinol (THC) and cannabidiol (CBD). Because these substances are regulated at the federal level, physicians cannot prescribe them directly, and instead patients are certified as having a qualifying condition.
Researchers also assessed whether patients certified for medical marijuana differed from those who were not certified.
They reviewed data from 50 SCD patients certified for use of medical marijuana, 29 of whom (58%, mean age 30.9) obtained medical marijuana from a dispensary. The analysis spanned a period from June 2016 to June 2018.
Results showed that, over six months, patients who obtained medical marijuana visited the hospital more rarely compared with the 21 who were certified but did not obtain the treatment.
Reductions in hospital admissions among those who obtained medical marijuana were as high as five visits. In contrast, only one patient in the other group reduced hospital admissions by two visits.
No differences were found for the number of visits to the emergency department or infusion centers. Total healthcare utilization and opioids dispensed also were similar for both groups.
Next, the team compared the two groups of patients to 25 SCD patients selected randomly who had not requested certification for medical marijuana, who served as controls. These patients had a significantly lower use of daily opioids (0.6 mg) than any of the other two groups (19.7 mg and 18.7 mg).
The investigators found that being certified for medical marijuana was associated with illicit cannabis use: patients certified for the treatment were more likely to have a previous positive urine test for cannabinoids — 79% in the “obtained medical marijuana” group and 69% in the “did not obtain medical marijuana” group — compared to the control group (6%).
“When we offered medical marijuana as an option to our patients with sickle cell disease, we found the majority of people who were interested were already using illicit marijuana to treat pain,” Susanna Curtis, MD, said in a press release. Curtis, from Yale Cancer Center, is the study’s lead author,
The median time to obtain medical marijuana after certification was 114 days. Nineteen patients (65%) who obtained the treatment from the dispensary were still accessing it in 2019.
On average, each patient obtained 6.4 different products, including inhalable (93%), edible (60%) and topical products (7%), as well as capsules (13%).
A survey on 24 patients, including 12 who had obtained medical marijuana, showed that people who did not access the therapy pointed to two reasons as barriers: costs (66%) and difficulty in completing the application (33%).
The most common reason for marijuana use obtained from both illicit (85%) and medical certification group (83%) was pain relief. Compared to illicit users, patients using medical products were more likely to use ingested formulations, including edibles or capsules.
Four patients (33%) who obtained medical certification continued to use illicit marijuana. Of those using medical marijuana, more than half (58%) said it was effective in easing their pain and 54% reported using fewer opioids.
When asked to compare medical to illicit marijuana, most patients believed medical marijuana to be safer, since it was less likely to be mixed with other substances and to carry legal problems. Patients also believed that medical marijuana was better for controlling their symptoms.
Yet, several patients reported medical marijuana was more expensive and harder to get. In fact, race and socioeconomic status may be barriers for SCD patients in obtaining medical marijuana.
“About 80% of our clinic population identifies as Black, and another 15% as Latinx, and unfortunately people of color who visit the hospital with pain are often not believed or accused of being drug-seeking. Medical marijuana is associated with significant stigma, and stigma is already a big part of the life of a person with sickle cell,” said Curtis.
“Illicit marijuana is not regulated, so its quality and contents are not standardized,” she added. “We know that while Black and white people use marijuana at similar rates, Black people are four times more likely to be arrested for possession. We didn’t want our patients using unsafe products or being arrested for trying to control the pain of their condition.”
Overall, “our data show that obtaining medical marijuana for patients with SCD is associated with a reduction in admission rate and an increase in edible product use, but that many patients are unable to obtain medical marijuana,” the researchers wrote.
Studies using a control group are required to evaluate the potential for medical marijuana in easing pain of SCD patients.
“My patients are living with a very difficult disease that causes them a lot of pain. We need controlled trials to look at each product, and the effects of how it is taken, so that we can offer regulated, pharmaceutical-grade treatment options,” Curtis said.
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