The biology of cannabis vs. opioids for pain relief

Opioids have recently gained infamous notoriety from news headlines, TV news feature stories, as well as medical studies and published scientific articles about the epidemic facing the country over their addictive nature. Opioids have become the poster child of drug addiction lately as reports of abuse and overdoses permeate the media.

Opioids are drugs that relieve pain by working on the nervous system to reduce symptoms. Unfortunately, their ongoing use and subsequent abuse has led to a crisis of physical dependency and unpleasant physical reactions upon disuse. Opioids come in tablet, capsule or liquid form, and can be identified by some well-known brand names, like Robitussin A-C, Tylenol with Codeine, and Demerol to name a few1.

Cannabis is also known for its pain relief capability and analgesic qualities. But the primary difference is that opioids have the potential of fostering exceedingly addictive usage. This is reflected in data that shows the sales of opioids by prescription quadrupling between 1999 and 20142. And because of the addiction and overdosing issues associated with opioid drugs increasing, there are accelerated efforts to find a medicinal substitute where there is less potential for addiction and overuse.

In substituting cannabis for a pain-relieving opioid drug, factors such as safety, pain reduction ability, addiction risk, symptom relief, availability and the degree of approval have to be taken into consideration. In determining if cannabis is an acceptable substitute for an opioid drug, it needs to be able to surpass it in terms of performance, safety, availability and resistance to enabling addiction.         

Evidence of medicinal cannabis replacing opioid medication is mounting and pointing to a diminishing use of opioids in states where medicinal cannabis has become legal. Proof of this is in the data showing that prescription medications in Medicare decreased by over $165 million after some states legalized medicinal cannabis3.

There are independent studies4 showing that the substitution of medicinal cannabis over prescribed medications is more than already underway, with correlations to the decrease in the rates of prescription drugs.

In terms of biology, the effectiveness of medicinal cannabis as a pain reliever and opioid drug alternative lies in the analgesic effectiveness of the THC (Tetrahydrocannabinol) in cannabis. The analgesic effects in opioid drugs also work similarly to block the signals for pain that originate from the nervous system. While the THC may be known more for the euphoric feeling it gives when cannabis is consumed, THC cannabinoids unite with endocannabinoid system’s CB1 and CB2 receptors of the body, which is a biological system that interacts with chemical compounds that are active ones, like THC. In the case of the opioids, they simply attach to other opioid receptors in the body.

The cannabinoid CBD (cannabidiol) in cannabis has an effect on the body that is known to be therapeutic. There are many receptors that it bonds with located in the brain which can diminish the effectiveness of THC. CBD cannabinoids have an impact on the yearning for opioid drugs and the withdrawal from them. This sheds more light on the possibility that CBD could play a part in treating an addiction to opioid drugs.

Together, opioid medications and THC have an equally beneficial effect on the relief of pain versus the effectiveness of only an opioid medication. The implications of this finding is that the interactive combination might be useful in leading patients away from opioid drugs and help them make a transition to medicaments that are more directly derived from cannabis. Opioids and cannabis can also work together to bring about the same amount of relief from pain at a lower dosage. This is because through the co-administration of the cannabis and opioids, together they alter accompanying pain relief effects. As a result, the potential for addiction and dosage side effects are diminished5.

Another example is a situation where cannabis and morphine are combined to manage pain. As it turns out, the level of relief from the combined medications is noticeable even at lower dosage levels, compared to the relief level if morphine was used alone6.  

By putting this manner of pain management into practice, the ill effects of excessive opioid use and addiction could be minimized, which in turn could help patients lower their doses of opioid medication. With additional research, more specific learning and insight into how opioids and cannabinoids interact and are understood, treatment regimens for patients who suffer with chronic pain can be established with lower risks of addiction.

CBD shows great potential in helping to stem the pattern of opioid addiction in that it is non-addictive7. CBD’s benefits include its ability to lessen pain, anxiety, cravings, and changes in mood. With a full-blown opioid epidemic gripping the country, the need for a solution is greater than ever. Medical cannabis has proven itself to be a viable substitute or companion drug in helping to manage chronic pain and addiction. In states where medical cannabis is legal, these reductions have been noticed. And although more research is necessary, there is promise that the combination of THC and CBD could hold the key to combating pain and opioid drug dependency.    

 

1http://www.drugfreeworld.org/drugfacts/prescription/opioids-and-morphine-derivatives-effects.html

2https://www.leafly.com/news/science-tech/medical-marijuana-opioid-pain-relief-substitute

3https://www.leafly.com/news/science-tech/medical-marijuana-opioid-pain-relief-substitute

4https://www.ncbi.nlm.nih.gov/pubmed/28496355

5https://www.leafly.com/news/science-tech/medical-marijuana-opioid-pain-relief-substitute

6https://www.leafly.com/news/science-tech/medical-marijuana-opioid-pain-relief-substitute

7https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604178/

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