13 Jul De-prescribing with Medical Cannabis
Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing problem across the western world and unfortunately has become the norm rather than the exception in older adults. In the UK it is estimated that around half of older adults are taking one or more medications that are not medically necessary.
The modern approach to systems-based medicine and the following of specific prescribing guidelines has clearly led to a mismatch between prescribing in clinical practice and the range of clinical complexity found in individuals.
The negative consequences associated with polypharmacy are numerous and include:
- Increased healthcare costs
- adverse drug events and drug interactions
- Medication non-adherence
- Functional decline
- Cognitive Impairment
- Increased risk of falls
Polypharmacy has a direct financial cost to the NHS, placing a significant cost burden on an already struggling healthcare system. The NHS medicines bill grew from £13billion in 2010-11 to £18.2 billion in 2017-18, an average growth of around 5% per year – clearly an unsustainable trend in the longer term.
Unfortunately, polypharmacy is just the tip of the iceberg as the number of patients prescribed unnecessary and addictive medications is also on the increase.
The Prescribed Medicine review undertaken by Public Health England highlighted that 1 in 4 adults in the UK are being prescribed an addictive medication such as a strong opioid, benzodiazepine, z drug (zopiclone/ zolpidem) or a gabanpentinoid such as pregabalin or gabapentin and that prescribing rates are higher in areas of deprivation.
One of the fears of the current Covid-19 pandemic is that imposed social and economic conditions which include rising unemployment and isolation due to social distancing may increase the prescribing rates of such medications as more people are left with a lack of support networks, rising levels of anxiety and depression and a general inability to cope.
Medical Cannabis to reduce unnecessary prescriptions
One of the many interesting properties of medical cannabis is the emergence of data demonstrating how it can help to safely reducing down and stop unnecessary prescriptions.
In regards to opioid use, cannabis has been shown to have opioid sparing properties which may allow patients to safely reduce dosages of stronger opioid medications. Unlike opioids, cannabis is safe in overdose with no reported deaths and carries a lower addiction risk.
When given access to medical cannabis, many individuals using opioids for chronic pain have been shown to significantly decrease their use of opioid use and report the benefits and side effects of cannabis preferable to opioids. Data from the US indicates there can be up to a 25% reduction in opioid prescriptions after introduction of medical cannabis for pain.
Medical cannabis is potentially more cost effectiveness than alternative prescription medications and could lead to savings on conventional treatments as well as opioid prescription costs, anti-convulsant drugs and lead to less hospital admissions such as for complications of epilepsy. In addition to opioids, medical cannabis therapy has been demonstrated to help assist discontinuation of pre-existing benzodiazepine therapy.
A recent study published in Journal of Pain Research, looked into the prevalence of patients who eliminate prescription or over-the-counter medications by substituting them with cannabis. Of a total of 2,774 patients nearly one-half (46%) of respondents reported using cannabis as a substitute for prescription drugs. Among them, the most common classes of substituted drugs were opioids (35.8%), anxiolytics/benzodiazepines (13.6%), and antidepressants. As depression and anxiety are common comorbidities in pain patients there is the potential that cannabis may be a substitute for several classes of drugs for the same patient. These findings are also an example of patients taking control of their own healthcare and are representative of the emerging field of patient-centred medicine.
There are countless anecdotal accounts of how patients across the world are utilising medical cannabis to safely reduce down dependence on unnecessary and often addictive prescription medications. Clearly there is a now an urgent need for larger scale, robust clinical studies and larger data sets to further understand and develop the wider health and economic benefits of medical cannabis treatments.
At The Primary Care Cannabis Network, we are reaching out to and are working with other organisations and societies, so we can educate and advance scientific research. The aim is to expand the knowledge of cannabis-based medical treatments and focus on academic research, education, key-papers and open discussions.