Cannabis for Pain Chronic Pain

Research shows No Negative effect from Using Medical Marijuana for Pain (2020)

A recent study examined the effect of long‐term medical cannabis (MC) use in middle-aged and older patients with chronic pain to see if there is an effect on brain health, particularly cognitive function.

The use of medical cannabis is growing in this age group, the authors noted. In the United States, people aged 60 and over are about 20% of patients using medical cannabis; in Israel, about a quarter of patients using medical cannabis are over age 65.

Current knowledge about the effect of cannabis on the brain come from studies of adolescents and young adults; these studies show that cannabis is linked with long‐term cognitive impairment, particularly in those who start using cannabis at younger ages. Although the effect on cognition on older adults is unknown, the authors pointed out that older brains are fundamentally different, as they have already gone through many changes in terms of global and regional volumes and neural activity patterns.

In addition, they cited some other early studies indicating that some benefit to the brain and neurocognition may be gained from cannabis as well as cannabidiol (CBD) and delta‐9‐tetrahydrocannabinol (THC).

The current study was carried out in Israel on patients aged 50 and above, with and without permission to use medical cannabis, through the country’s licensing procedure. Chronic pain is particularly prevalent among older adults and makes up the largest group of medical cannabis patients in Israel, so researchers recruited patients from the Rambam Institute for Pain Medicine in Haifa, Israel. The sample included 63 patients with a license for medical cannabis and 62 without.

The average age of the group was 61.37 [5.93] years and 61 (48.8%) were men.

Patients using medical cannabis were slightly older than those without a license (63 [6] vs 60 [5] years, respectively; P = .003).

They were also more likely to have cardiovascular disease (11% vs 3%, respectively, P = .025) and depression (21% vs. 7%, respectively, P = .003).

There was no significant difference in other characteristics between the 2 groups, including education level or use of alcohol and tobacco.

Cognition was assessed through the use of CogState, a brief computerized series of tests to assess performance of psychomotor reaction, attention, working memory and new learning.

Patients were asked to abstain from cannabis use 3 hours before the test, but the average amount of time patients abstained for was 11 hours.

Results showed there was no significant difference in cognitive performance between the 2 groups; in addition, in an analysis of only the licensed cannabis users, there was no difference when looking at years of medical cannabis use, frequency of use, hours since last use, number of strains used, THC/CBD concentration, or dose.

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The study had certain limitations—it was observational with a cross‐sectional design and no cause‐effect inferences can be made; the cognitive assessment was brief, and no information about other pain-relieving drugs or psychoactive medicines was collected.

Given an aging population, longer life expectancy, shifting public attitudes about medical cannabis, and growing evidence about the benefits of medical cannabis for certain chronic health conditions, the authors argued that their findings “could be a first step towards a better risk–benefit assessment of [medical cannabis] MC treatment in this population.


Sznitman SR, Vulfsons S, Meiri D, Weinstein G. Medical cannabis and cognitive performance in middle to old adults treated for chronic pain. Drug Alcohol Rev. Published online September 22, 2020. doi: 10.1111/dar.13171

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