American Journal of Psychiatry and Neuroscience
Volume 7, Issue 3, September 2019, Pages: 74-77
Received: Dec. 20, 2018;
Accepted: Sep. 6, 2019;
Published: Sep. 20, 2019
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Kevin Rod, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Toronto Poly Clinic Multi-Disciplinary Pain Management Centres, Toronto, Canada
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.
A Pilot Study of a Medical Cannabis - Opioid Reduction Program, American Journal of Psychiatry and Neuroscience.
Vol. 7, No. 3,
2019, pp. 74-77.
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