The MEMO Study Shows Medical Cannabis Associated with Reduced Opioid Use in Adults with Chronic Pain

A recently published study provides evidence that participation in a regulated medical cannabis program is associated with reduced prescription opioid use among adults with chronic pain (1). The Medical Marijuana and Opioids (MEMO) Study followed 204 patients for 18 months, revealing a 22% reduction in opioid dosing. This prospective study examined what happens when adults with chronic pain and opioid prescriptions engage with a tightly regulated, clinician- and pharmacist-supervised medical cannabis program.

What Makes The MEMO Study Different

Unlike previous cross-sectional surveys, the MEMO study used a prospective longitudinal design tracking individual patients over time. This methodological approach addresses limitations of earlier research.

Researchers at Montefiore Medical Center and Albert Einstein College of Medicine accounted for a confounding factor that previous studies overlooked: unregulated cannabis use. By controlling for “street” cannabis consumption through biweekly surveys, investigators could isolate the specific impact of participating in a highly regulated medical cannabis program.

The study utilized objective data from the New York State Prescription Monitoring Program rather than relying on self-reported opioid use. This approach eliminated recall bias and provided precise measurements of both medical cannabis dispensed and opioids received.

The research team measured the use of non-program cannabis. It used marginal structural models to adjust for both baseline characteristics and time-varying factors like prior-month opioid dose and unregulated cannabis days. Using these models, researchers demonstrated that patients dispensed a 30-day supply of medical cannabis experienced a reduction of 3.53 morphine milligram equivalents (MME) per day compared to months without medical cannabis.

While 3.53 MME might seem modest (equivalent to less than one 5mg hydrocodone tablet), this finding reveals something important about how medical cannabis works. Rather than acting as an "on/off switch" for opioid replacement, cannabis functions more like a "dimmer switch," enabling gradual, sustainable reductions over time. This aligns with CDC guidelines recommending slow opioid tapering rather than abrupt cessation.

The New York Model: Pharmacist-Directed Care

A distinguishing feature of this research was its setting within New York State's medical cannabis program, where pharmacists independently evaluate patients and determine appropriate products and dosing intervals. This healthcare-integrated model contrasts with programs in which medical and recreational markets blur without consistent clinical oversight.

Key findings about cannabis product usage:

·       43% of dispensed products were ingested (edibles) or oromucosal (tinctures, oral sprays)

·       33% were oils or flower for vaporization

·       22% were flower products for combustion

·       78% of products were high THC, 14% balanced THC/CBD, 8% high CBD

Clinical Implications for Healthcare Providers

The 22% reduction in mean daily MME observed over 18 months, from 73.3 to 57.4 MME, represents a meaningful change in opioid exposure. For perspective, this overall reduction is roughly equivalent to eliminating one or two oxycodone doses daily. These weren't dramatic overnight changes but rather steady reductions that patients could tolerate while managing their chronic pain.

This gradual tapering approach aligns with current pain management guidelines emphasizing slow, patient-centered opioid reduction. The modest monthly effects compound over time, suggesting that medical cannabis doesn't destabilize pain management but rather makes gradual dose reductions more achievable. For healthcare providers, these findings support considering medical cannabis as part of a comprehensive pain management strategy, particularly within structured programs with clinical oversight.

The study population, predominantly unemployed, publicly insured, with significant pain burden and mental health comorbidities, represents real-world chronic pain patients often seen in clinical practice. Mean baseline pain scores of 6.6/10 for severity and 6.8/10 for interference demonstrate that medical cannabis may benefit patients with substantial functional limitations.

Moving Forward

This research provides evidence that properly implemented medical cannabis programs with healthcare provider involvement may help address the opioid crisis. The modest but consistent reductions enhance the study's credibility. These findings demonstrate that medical cannabis can be integrated into existing pain management plans as a complementary tool that makes opioid tapering more tolerable.

For healthcare professionals discussing cannabis with patients, this study offers evidence-based support for medical cannabis as a potential opioid-sparing strategy when accessed through regulated, clinically supervised programs. The "dimmer switch" effect suggests patients and providers can work together toward gradual, sustainable reductions in opioid use.

Reference

1. Slawek DE, Zhang C, Dahmer S, et al. Medical Cannabis and Opioid Receipt Among Adults With Chronic Pain. JAMA Intern Med. Published online December 08, 2025. doi:10.1001/jamainternmed.2025.6496