By Emily Ledger
Emergency medical physicians would prefer to use medical cannabis over opioids as a first-line treatment of medical conditions – if they were provided with the evidence of their efficacy, a recent survey has found.
Opioids have been increasingly prescribed for a large number of conditions – particularly those in which pain is a major symptom. However, opioids carry a huge risk of addiction, abuse, and overdose.
There were an estimated 446,032 opioid-related deaths between 1999 and 2018 in the US alone. Emergency medicine (EM) physicians are on the frontline of care from resuscitating overdoses to managing acute pain while counterbalancing opioid-seeking behaviour.
EM physicians are acutely aware that administering opioids in the emergency department and writing outpatient prescriptions for opioids directly contributes to the misuse and dependence on the medications. Therefore, many physicians would prefer to consider alternative treatments – according to the results of a recent survey. One such alternative therapy is medical cannabis.
Researchers distributed a survey questionnaire to US physicians who attended the largest national EM conference (American College of Emergency Physicians [ACEP] Annual Conference) in 2018. A total of 539 completed surveys were included for assessment.
Results of the Study
A majority of respondents (54.8%) were practising in states where medical cannabis is legal, while 23.1% of respondents were practising in states where both medical and adult-use cannabis is legal. A majority (70.7%) of the practitioners who completed the survey believed that cannabis has medical value.
Participating physicians were asked whether they would prefer to use cannabis or opioids as a first-line treatment of a medical condition – provided medical cannabis was legal at the federal level, was administrable in different formats (flower, pill, sublingual, and intravenous), available for use in an EM setting.
The results revealed that a majority of physicians would prefer to use cannabis if medical studies found that it was equally effective (52.3%), and more would prefer cannabis if it was found to be more effective (79.6%).
A belief that cannabis has medical value significantly increased the odds that physicians would choose cannabis over opioids – should cannabis be found to be equally or more effective. However, a significant proportion of respondents who chose “don’t know/no preference”; the researchers believe that this suggests ambivalence or lack of knowledge about medical cannabis.
The researchers of this study reported surprise at the results as they “did not expect EM physicians would be willing to use cannabis in an EM setting at this point in time given its decades of stigma as a dangerous drug.” A comprehensive review by the National Academies of Sciences concluded that medical cannabis is useful for treating adult chronic pain. Nonetheless, cannabis – even for medical uses – remains federally illegal in the US.
The researchers conclude that these results reflect EM physicians’ desire to have an alternative treatment option to the “known potentially addictive effects of opioids, understanding the gravity of the opioid epidemic.” Based on these findings, which are consistent with a similar study published in the previous year which revealed that 68.3% of physicians believe that cannabis has medical value, further study of this potential alternative/adjunctive therapeutic is warranted.
Medical cannabis is being increasingly considered as an adjunct or alternative to opioid for reducing pain – particularly chronic pain. However, the illegality of cannabis at the federal level in the US means that there is little research into whether EM physicians would consider its use in acute settings. The aim of this study was to “assess EM physicians’ preferences for using medical cannabis compared to opioids in an EM setting were it to become legalised.”