It is clear that there is a current opioid epidemic of unprecedented scale in the US.
It has been shown that cannabis and cannabis-derived compounds can be effective for treatment of chronic and neuropathic pain.
What does one statement have to do with the other?
A growing number of studies have reported that cannabis use can diminish the negative and addictive effects of opioid use without sacrificing pain relief. The implications are staggering and may lead the way for advanced pain treatment options while providing respite from this devastating crisis.
The biology behind the results
Medicinal cannabis contains many cannabinoids which affect endocannabinoid signalling in the body. Although the presence of cannabinoid receptors CB1 and CB2 are present in many tissue types and the exact mechanisms for how cannabinoids influence nerve activity are not yet clear, it is clear that cannabis is much less addictive and has far fewer physical side effects than oxycodone, codeine, and other opioid drugs.
Addiction is the key term here as the physically addictive properties of opioids (and opiates) are the main drivers for habituation and overdose. The main indication for which opioids are used, pain relief, becomes exacerbated as the individual attempts to quit opioid use and goes through a painful withdrawal process – a cruel irony indeed.
The addictive properties of cannabis appear to be of much lower potential and occur through largely psychological processes. The definition of cannabis addiction is somewhat contentious and articles on cannabis use disorder can shed further light on the issue. Moreover, there have been no reported cannabis overdoses to date, further supporting it’s use as both an effective and safe pain therapeutic.
Recent research has shown that the combined administration of cannabis results in lower effective opioid dosages required for the desired therapeutic effects. In other words, cannabis can substitute for opioids when used as an analgesic treatment, thereby lower the chances of opioid addiction.
One step further, cannabidiol (CBD) has different mechanisms of action than THC without the side effects of intoxication. CBD has been shown to reduce drug cravings and opioid withdrawal symptoms as well thereby providing an effective, safe, and non-intoxicating alternative to THC.
Potential Pain Therapeutics
As mentioned, one way that cannabis can help alleviate the negative effects of opioids is through lowering the dosages needed for pain relief. This can potentially lower the threshold required for treatment while also assisting patients in weaning off of opioid use by lessening drug cravings. It is in fact the cravings following opioid withdrawal that steer users back into relapse, thus perpetuating the cycle. Minimizing the chance of relapse significantly lessons the chances for long-term addiction.
In a recent poll of pain therapy patients, a large percentage of respondents stated that cannabis use lowered the necessary dose of opioid required, diminished opioid side effects, and made the residual effects more tolerable. A sizable proportion stated that cannabis was equally and in some cases more effective than opioids. Importantly, greater than 70% of respondents reported that they prefer cannabis and would use more if they were available.
It seems pretty clear that further research into pain management and further development of cannabis therapeutic regiments are likely to have significant impacts on the current epidemic – a situation for which relief cannot come fast enough.