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It was uncertain whether the potential benefits of cannabis or cannabis oil were greater than the potential harms. Some people using cannabis or cannabis oil had improvements in symptoms, but some had undesirable side effects. There was no difference between the cannabis/cannabis oil and placebo groups in clinical remission of the disease. A 2018 review looked at 3 studies (93 total participants) that compared smoked cannabis or cannabis oil with placebos in people with active Crohn’s disease.The symptoms can range from mild to severe, and they can come and go, sometimes disappearing for months or years and then returning. Symptoms may include abdominal pain, diarrhea, loss of appetite, weight loss, and fever. Ulcerative colitis and Crohn’s disease are the most common types. Inflammatory bowel disease is the name for a group of conditions in which the digestive tract becomes inflamed.

Thus, people with access to medical marijuana did not appear to be substituting it for prescription opioids.

An analysis of survey data from 2004 to 2014 found that passing of medical marijuana laws was not associated with less nonmedical prescription opioid use.

An analysis of data from 1999 to 2010 indicated that states with medical marijuana laws had lower death rates from overdoses of opioid pain medicines, but when a similar analysis was extended through 2017, it showed higher death rates from this kind of overdose.

However, data from a national survey (not limited to people on Medicare) showed that users of medical marijuana were more likely than nonusers to report taking prescription drugs.

States with medical marijuana laws were found to have lower prescription rates both for opioids and for all drugs that cannabis could substitute for among people on Medicare.

Researchers have looked at statistical data on groups of people to see whether access to cannabis (for example, through “medical marijuana laws”-state laws that allow patients with certain medical conditions to get access to cannabis)-is linked with changes in opioid use or with changes in harm associated with opioids.

The results were inconsistent, and none of the high-quality studies indicated that cannabinoids could lead to decreased opioid use. There were 9 studies (750 total participants), of which 3 (642 participants) used a high-quality study design in which participants were randomly assigned to receive cannabinoids or a placebo. These studies were designed to determine whether cannabinoids could make it possible to control pain with smaller amounts of opioids.

A 2017 review looked at studies in people in which cannabinoids were administered along with opioids to treat pain.

There’s evidence from studies in animals that administering THC along with opioids may make it possible to control pain with a smaller dose of opioids.

However, the average number of patients who reported at least a 30 percent reduction in pain was greater with cannabinoids than with placebo.

A 2015 review of 28 studies (2,454 participants) of cannabinoids in which chronic pain was assessed found the studies generally showed improvements in pain measures in people taking cannabinoids, but these did not reach statistical significance in most of the studies.

People taking cannabis-based medicines were more likely than those taking placebos to drop out of studies because of side effects. However, the data could not be considered reliable because the studies included small numbers of people and may have been biased. A 2018 review of 16 studies of cannabis-based medicines for neuropathic pain, most of which tested a cannabinoid preparation called nabiximols (brand name Sativex a mouth spray containing both THC and CBD that is approved in some countries but not in the United States), found low- to moderate-quality evidence that these medicines produced better pain relief than placebos did.Adverse events (side effects) were more common among people taking cannabis/cannabinoids than those taking placebos. The difference may be too small to be meaningful to patients. Twenty-nine percent of people taking cannabis/cannabinoids had a 30 percent reduction in their pain whereas 26 percent of those taking a placebo (an inactive substance) did. A 2018 review looked at 47 studies (4,743 participants) of cannabis or cannabinoids for various types of chronic pain other than cancer pain and found evidence of a small benefit.Research has been done on the effects of cannabis or cannabinoids on chronic pain, particularly neuropathic pain (pain associated with nerve injury or damage).