Medical Marijuana Leads to Fewer Hospitalizations in Sickle Cell Disease Study
People with sickle cell disease who use medical cannabis products to treat their pain may need fewer visits to the hospital, a new study has suggested.
Published today in Blood Advances, the study examined data from 50 people with sickle cell disease at the Adult Sickle Cell Program at Yale New Haven Hospital who received certification for medical cannabis use.
The researchers from the Yale School of Medicine and Yale Cancer Center found that those patients who went on to obtain medical cannabis visited the hospital less frequently over the following six months. The patients were also more likely to use edible cannabis products compared with inhaled products.
Treating sickle cell disease
Sickle cell disease (SCD) is the name for a group of inherited blood cell disorders that affect the body’s red blood cells, and is most common among people with African, Caribbean, and Mediterranean ancestry.
With SCD, the red blood cells responsible for carrying oxygen around the body are unusually shaped – closely resembling a sickle – and can become hard and sticky. These sickle cells are also much shorter-lived than healthy cells, causing a constant state of red blood cell shortage. The sickle cells can get stuck and form blockages in smaller blood vessels, obstructing the blood flow through the body, which can cause a person great pain.
This pain is the prime cause of most SCD hospitalizations or emergency room visits. While some people with SCD may find relief with over-the-counter pain medications, many others experience severe pain, which is treated using a daily opioid regimen, alongside other medications.
With the risks associated with opioid use and dependence, the researchers behind the new medical cannabis study believe that there is an urgent need to investigate alternative treatment options for SCD-related chronic pain and to expand the breadth of clinical data available on these options.
Medical cannabis patients more likely to use edible products
Of the 50 patients who were seen through the Adult Sickle Cell Program in this study, 29 went on to actually obtain medical cannabis products.
By comparing the patient data from these 29, the 21 who chose not to obtain medical cannabis, and a random sample of 25 patients who did not request any medical cannabis certification, the researchers found that those who used medical cannabis were admitted to hospital less frequently than the others. In some cases, these patients recorded four or five fewer visits than average over the subsequent six months after receiving cannabis.
They also noticed other interesting trends within the study groups. More than two-thirds of the patients who requested medical cannabis were already using illicit cannabis products, but they did not use cannabis more frequently after certification. Additionally, while hospitalizations were reduced for the medical cannabis users, there were no changes seen in emergency department admissions or infusion center use.
“When we offered medical marijuana as an option to our patients with sickle cell disease, we found the majority of people who were interested were already using illicit marijuana to treat pain,” said the study's lead author Susanna Curtis of the Yale School of Medicine and Yale Cancer Center, in a statement.
“Illicit marijuana is not regulated, so its quality and contents are not standardized. And particularly for people with sickle cell disease, many of whom identify as Black, we know that while Black and white people use marijuana at similar rates, Black people are four times more likely to be arrested for possession. We didn't want our patients using unsafe products or being arrested for trying to control the pain of their condition.”
A fall in hospitalizations coupled with no change in the utilization of other healthcare services may suggest that there was little change in the number of pain crises that would normally require visits to a medical center, added Curtis. But with access to medical cannabis, more of these incidents could be resolved at home by the patients themselves.
A patient survey revealed that many felt that the medical cannabis they were accessing was stronger and more effective in tackling their symptoms than illicit products. The medical cannabis patients were also more likely to use edible products than inhaled products. It is thought that factors such as the differing time of onset and length of effects seen with cannabis edibles could have contributed to this reported effectiveness.
Barriers to access for SCD patients
This patient survey also sought to better understand the patients’ use of medicinal and illicit cannabis products.
Many patients reported having problems in accessing medical cannabis products, which drove their illicit cannabis use. Expense and inconvenience were two of the most major factors noted. In Connecticut, where the treatment clinic was based, patients are expected to pay a $100 annual registration fee to access medical cannabis products, plus the out-of-pocket costs of the products themselves. There was no dispensary located in the same town as the clinic, an inconvenience that also presented its own set of travel expenses.
“About 80 percent of our clinic population identifies as Black, and another 15 percent as Latinx, and unfortunately people of color who visit the hospital with pain are often not believed or accused of being drug-seeking,” added Dr Curtis. “Medical marijuana is associated with significant stigma, and stigma is already a big part of the life of a person with sickle cell.”
In terms of further study, Curtis highlighted the need for future research to understand the efficacy, side effects, and drug interactions of various cannabis products on SCD treatment. “My patients are living with a very difficult disease that causes them a lot of pain. We need controlled trials to look at each product, and the effects of how it is taken, so that we can offer regulated, pharmaceutical-grade treatment options.”
In addition to Dr Curtis’ endorsement, another recent study, conducted at the University of California, San Francisco, also found that cannabis could be a promising pain medication for patients with SCD.
Described as“the first randomized, placebo-controlled clinical trial of vaporized cannabis in participants with SCD and chronic pain,” the research found that the mean pain scores of cannabis-using participants were regularly lower than the mean pain scores of the placebo group.
But, partially due to the small number of participants in the study, the variability around these means consistently overlapped. So, ultimately, no firm conclusions about marijuana’s possible pain-relieving effects could be made.
Yet, despite this mute outcome, the researchers remarked that the cannabis was well tolerated by the participants. And, in light of the “opioid epidemic” and the subsequent interest in alternative pain medications, cannabis, they say, still has good potential as a SCD treatment.
“People with SCD are often using multiple medications,” they wrote in the study’s conclusion, which was published in JAMA Network Open.
“Since no significant adverse effects were observed, this proof of principle study has the potential to encourage and guide future larger and longer investigations into the potential use of cannabis-based interventions in chronic pain that could help to attenuate the ongoing public health crisis related to opioid use.”