Longer Medical Cannabis Use Associated With Lower Opioid Doses in New York Cohort
A 2023 cohort study of 8,165 New York patients with chronic pain found that those who continued receiving medical cannabis for more than 30 days had substantially larger reductions in prescribed opioid doses over the following eight months than patients who stopped using cannabis sooner.
The study, published in JAMA Network Open, analyzed data from New York’s Prescription Monitoring Program and medical cannabis records collected between 2017 and 2019. All participants had been receiving long-term opioid therapy before starting medical cannabis. Researchers measured opioid exposure in morphine milligram equivalents, or MME, a standard way to compare opioid dosages.
Researchers divided the patients into two groups. The longer-use group included 4,041 people who received medical cannabis for more than 30 days. The comparison group included 4,124 people who received cannabis for 30 days or less and did not continue receiving it during the study period.
By the eighth month, patients who continued medical cannabis had reduced their average daily opioid dosage by 48% among those who began below 50 MME, 47% among those who began at 50 to less than 90 MME, and 51% among those who began at 90 MME or more. Reductions in the shorter-use group were smaller: 4%, 9%, and 14%, respectively.
The researchers also found that the difference between the groups was greatest among patients who had been taking the highest opioid doses. Compared with the shorter-use group, the longer-use group had an estimated additional monthly reduction of 1.52 MME in the lowest baseline-dose category, 3.24 MME in the middle category, and 9.33 MME in the highest category.
These findings suggest that sustained medical cannabis use was associated with lower prescribed opioid doses among patients already receiving long-term opioid therapy. They do not establish that cannabis caused the reductions. The study was observational, and the researchers could not determine whether patients chose cannabis specifically to reduce their opioid use, whether clinicians encouraged both treatments, or whether other differences between the groups influenced the results.
The analysis also measured prescriptions rather than actual medication consumption. It did not establish whether patients experienced better pain control, fewer side effects, improved functioning, or lower rates of overdose. Nor did it determine which cannabis products, doses, or cannabinoid combinations were most useful.
The results add to an evolving but mixed research base. The National Center for Complementary and Integrative Health says some cannabis-based products may provide modest short-term relief for chronic pain, while also noting that side effects are more common than with placebo and that evidence on reducing opioid use remains inconsistent. Much less is known about the benefits and risks of long-term cannabis use.
For patients taking opioids, the findings do not support stopping or sharply reducing medication without medical supervision. The CDC’s opioid prescribing guideline advises individualized, collaborative tapering when appropriate and warns against abrupt discontinuation or rapid dose reductions. Medical cannabis may be considered as one component of a broader pain-management plan, but decisions about its use and any opioid changes should be made with a qualified health care professional.
