Medical Cannabis Significantly Reduced Use of Opioids and Other Rx Drugs

By Pat Anson 

A new survey of cannabis users in Germany found a significant reduction in their use of painkillers, sleep medications, anti-depressants and other prescription drugs after starting medical cannabis treatment.

Over 3,500 cannabis patients participated in the online survey, published by Bloomwell, which found an average 84.5% decrease in the use of medications overall. Over half of respondents (58.9%) said they stopped taking at least one medication completely.

The reduced consumption of prescription drugs led to a corresponding change in side effects. Over 60% of patients said they no longer had any medication-related side effects, while nearly 38% said their side effects were reduced. 

Less than 2% said their side effects remained the same or intensified after they started using medical cannabis.

“Cannabis is often portrayed as dangerous and addictive, even though the most severe side effects and addiction potential have only been proven with other prescription medications,” said Julian Wichmann, MD, co-founder and CEO of Bloomwell, one of the leading providers of medical cannabis in Europe.

The reduced use of prescription drugs was associated with major improvements in quality of life and productivity. Most patients reported better concentration (67.8%), more social interactions (61.9%), and fewer days of missed work (53.9%) after they started using medical cannabis.

“Patients benefit significantly when they are able to replace other prescription drugs with medical cannabis. The often completely absent side effects are also associated with a marked improvement in quality of life and work performance. This is likely the most important finding of our survey,” said Wichmann.

The steepest reduction in the use of a prescription drug class was for sleep medications; 93.6% were able to reduce their use of sleeping pills by at least half, and 75.5% were able to discontinue them completely. 

Patients who took the stimulant methylphenidate (Ritalin) reported an average reduction of 88.4% after starting medical cannabis, while 77.3% were able to discontinue it completely. 

Patients were able to reduce their use of opioids by an average of 83.9%, while 61% were able to completely discontinue opioids.

That finding mirrors those of other studies in the US and UK. 

A large 2022 survey of medical cannabis users in Florida found that those who have chronic pain were able to reduce or even stop their use of opioids. Patients reported less pain and better physical and social functioning once they started using medical cannabis. 

A recent survey of UK adults prescribed medical cannabis for anxiety, depression, insomnia, PTSD and other mental health conditions found that 97% said it improved their well-being and happiness, while 68% said it enabled them to work.

Germany first legalized medical cannabis in 2017, allowing patients with certain medical conditions to access it with a prescription. In 2024, the German Narcotics Act declassified cannabis as a narcotic and allowed adults to possess and cultivate limited amounts for recreational use.

According to Bloomwell, cannabis reforms in Germany have led to significant reductions in the price of cannabis flowers and an increase in cannabis prescriptions.  

Vertanical, a German pharmaceutical company, hopes to soon get regulatory approval in Europe and the UK for the first cannabis-based medicine for chronic pain. In clinical trials, the full spectrum cannabis extract provided better pain relief for low back pain in a head-to-head comparison with low doses of opioids.

What We Can Learn from Germany About the Opioid Crisis

By Roger Chriss, PNN Columnist  

Germany doesn’t have an opioid crisis. As NBC News reported, 10 times as many Americans as Germans die from drug overdoses, mostly opiates. And while opioid addiction rates in the U.S. have risen dramatically, in Germany they’re flat.

The story of Germany challenges much of the narrative about the American opioid crisis. If addiction moves in lockstep with opioid prescribing, then Germany should have high addiction rates. If prescription opioids lead to heroin use, then Germany should be seeing rising rates of heroin use. And if overdoses are an inevitable consequence of addiction, then Germany should have high overdose rates.

But this is not what is happening. According to a recent PLOS One study, opioid prescriptions in Germany are rising, but there is no “opioid epidemic.”

“Even though patterns of opioid prescription follow trends observed in other developed countries, there are no signs of an opioid epidemic in Germany. Therefore, this review could currently not find a need for urgent health policy interventions regarding opioid prescription practices,” the study concluded.

A report from the European Monitoring Centre for Drugs and Drug Addiction shows that drug overdoses in Germany are falling. There were 1,926 overdose deaths in Germany in 2006 and 1,272 in 2017. Overdoses peaked in Germany over a decade ago.

Rates of drug use in Germany show that cannabis and MDMA (ecstasy) have been trending upward in recent years, amphetamine use is stable, and cocaine use is falling among young adults. In people seeking drug treatment, addiction to cannabis and cocaine are rapidly rising, but opioid addiction fell sharply in 2016 after a rise in the preceding decade.

Yet Germany has the second-highest prescription opioid rate in the world. And if current downward prescribing trends hold in the United States, Germany will have the highest rate by late 2020.

Easier Access to Rx Opioids

But Germany simply isn’t having an opioid crisis, which one expert attributes to the country’s well-established social security network and full health insurance coverage.

“Many specialist pain treatment centres by now will report cases of chronic pain patients with inappropriate opioid therapy, who then have to be weaned off the medication. However these are only isolated cases and there is no increase in inappropriate use of opioids in Germany in general,” Lukas Radbruch, a palliative care physician at University Hospital Bonn in Germany, explained in the BMJ.

Radbruch belongs to an expert committee that regulates and monitors opioid use in Germany.

“In Germany regulations for opioid prescription have been changed throughout the years to allow easier access to these medicines - for example, extending the maximum amount per prescription or the maximum duration of each prescription,” he wrote. “There is consensus in the committee that there is no indication of anything similar to the opioid crisis in the US, and no indication of an increase in inadequate prescribing of opioids in Germany.”

Rhetoric about prescription opioid risks rarely includes the details of prescribing. But it turns out that if patients are given non-opioid options first, then screened and monitored during opioid therapy as is done in countries like Germany, the risks are far lower. The risks are lower still when problems of misuse and signs of addiction are caught early and addressed medically.

In other words, maybe the U.S. has an opioid crisis as a result of doing virtually everything wrong. From excess pharmaceutical marketing and poor patient management to a lack of multimodal pain treatment and addiction care, we almost couldn’t not have had an opioid crisis.

And once the crisis got started, we failed to respond quickly with best practices, in particular the overdose rescue drug naloxone and harm reduction policies. Instead, we embraced doomed tactics like abstinence programs and forced tapering of medications.

The most recent data from the CDC does show some encouraging news. From March 2018 to March 2019, the overdose death rate fell by 2.2 percent. The provisional counts for 2019 show an overall flattening of overdose deaths, but no sustained downward trend.

Most of this progress is in fewer fatalities linked to prescription opioids. But illicit fentanyl is spreading westward, and from San Diego to Seattle a rise in overdose deaths has been seen throughout 2019, much of it caused by counterfeit medication. So the “gains” of last year may quickly evaporate. Fentanyl is cheap to make, easy to distribute, and getting into the entire drug supply. Meth and cocaine are resurging, too.  

The drug overdose crisis is evolving fast. Most overdoses involve multiple substances, often with inadvertent exposure or as a result of counterfeit or tainted drugs. And some are suicides. Now in the vaping outbreak we are seeing the impact of new technologies and new chemicals used in novel ways.

As the RAND Corporation noted in its September report on fentanyl, we need new options fast. Germany’s preventative healthcare, proactive public health monitoring, and coordinated harm reduction policies may provide sound ideas for a sensible response to the rapidly evolving drug crisis in the U.S.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

This column is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.