Depression and Anxiety - Clinical Study - Opiates or Marijuana?
Journal of Affective Disorders - Volume 218, 15 August 2017, Pages 1-7
"In a nutshell, when it comes to depression, opiates make matters worse overall, while cannabis helps the situation. "
STUDY: Depression and Anxiety among Chronic Pain Patients Receiving Prescription Opioids and Medical Cannabis.
Highlights of the Study
• Levels of depression and anxiety among chronic pain patients were assessed.
• Patients receiving prescription opioids and medical marihuana were compared.
• Prescription opioids use was associated with increased odds for depression.
• Prescription opioids use was associated with increased odds for anxiety.
Editor's note: Other peer reviewed studies concluded that cannabis based medicines reduce depression in individuals with pain.
High rates of depression and anxiety have been consistently reported among patients suffering from chronic pain. Prescription opioids are one of the most Medical Cannabis modalities for pharmacological treatment of pain, however in recent years Medical Cannabis has been increasingly used for pain control in the US and in several countries worldwide. The aim of this study was to compare levels of depression and anxiety among pain patients receiving prescription opioids and Medical Cannabis.
“I am in that temper that if I were under water I would scarcely kick to come to the top.”
- John Keats
Participants were patients suffering from chronic pain treated with prescription opioids (Opiate Patients, Number = 474), Medical Cannabis (Number = 329) or both (Opiate Patients Medical Cannabis, Number = 77). Depression and anxiety were assessed using the depression module of the Patient Health Questionnaire (PHQ9) and the Generalized Anxiety Disorder scale (GAD7).
Prevalence of depression among patients in the Opiate Patients, Medical Cannabis and Opiate Patients Medical Cannabis groups was 57.1%, 22.3% and 51.4%, respectively and rates of anxiety were 48.4%, 21.5% and 38.7%, respectively.
After controlling for confounders, patients in the Opiate Patients group were significantly more likely to screen positive for depression (Adjusted Odds Ratio = 6.18; 95% CI = 4.12–9.338) and anxiety Adusted Odds Ratio = 4.12;CI = 3.84–5.71)) compared to those in the Medical Cannabis group. Individuals in the Opiate Patients Medical Cannabis group were more prone for depression (Adusted Odds Ratio for depression = 3.34;CI = 1.52–7.34)) compared to those in the Medical Cannabis group.
"It has actually been suggested that action at cannabinoid receptors is linked to a reduction in depressive behaviors (Degenhardt et al., 2000). Though cannabis has been shown to induce transient anxiety-like symptoms (D’Souza et al., 2004), a recent meta-analysis has questioned this finding (Twomey, 2017) and there is lack of data indicating increased incidence of anxiety disorders following cannabis use (Feingold et al., 2016b; WHO, 2016; Zvolensky et al., 2006).
Furthermore, specific cannabinoids, particularly cannabidiol (CBD) has been reported to reduce anxiety (see for example Zuardi et al., 1982), indicating that specific cannabis strains including different ratios of cannabinoids may differentially affect anxiety.”
Cross sectional study restricts very confident inference of causality (cause and effect).
Levels of depression and anxiety were higher among chronic pain patients receiving prescription opioids as compared to those who received Medical Cannabis. These findings should be taken into consideration when deciding on the most appropriate treatment modality for chronic pain, especially with those who are predisposed to the risk for depression and anxiety.
“Accordingly, given repeated reports of higher levels of anxiety and depression among chronic pain patients in general, it is possible that MM partially attenuates these symptoms,”
Ariel University, Ariel, Israel
Dual Diagnosis Clinic, Lev-Hasharon Medical Center, Pardesiya, Israel
Pain Center, Sourasky Medical Center, Tel Aviv, Israel
Pain Center Sheba Medical Center, Tel Hashomer, Israel
Department of Dual Diagnosis, Abarbanel Mental Health Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
“That's the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it's impossible to ever see the end.” - Elizabeth Wurtzel, Prozac Nation
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According to the National Institute on Drug Abuse (NIDA), cannabis does carry a risk of addiction. Approximately 9-17% of users develop some level of dependence from chronic use, though the NIDA notes that dependence is not synonymous with addiction. The actual number of people addicted to cannabis is likely much lower, and the number of known deaths related to cannabis overdose is statistically minimal.
In comparison, opioid overdose is responsible for more than 3 out of 5 drug overdose deaths, according to the Centers for Disease Control (CDC), and opioid deaths have nearly quadrupled since 1999. The ASAM indicates, of the 20.5 million Americans with substance abuse disorders in 2015, 2.5 million of those disorders involved prescription painkillers and/or the opioid, heroin.