Cannabis reduces the use of opioids

by Dr. Adie Wilson-Poe

In 2016, the Centers for Disease Control and Prevention (CDC) introduced a set of guidelines with the goal of reducing the incredibly high number of painkillers prescribed by physicians. One of the recommendations was that “opioids should not be considered first-line or routine therapy for chronic pain.” The reason for that is pretty simple: Opioids simply don’t work for chronic pain management.

And yet opioids still remain the gold standard for treating chronic pain. Since the early 1900s, health care providers have written as many as 250 million prescriptions for opioid pain medication—”enough for every US adult to have a bottle of pills.

Certainly, they’re commonly sought after for their euphoric properties, but for the millions of Americans who take prescription drugs solely for pain, their experience falls far short of euphoric.

Opioids are a short-term solution when chronic pain needs a long-term plan

Pain is a message your body sends to your brain warning you that you’ve been hurt. When you’re injured, you expect to feel pain until your injury has healed. When the pain lasts only as long as the injury itself, that’s called “acute pain.”

When you feel pain after your injury has healed — past the point of recovery — this is considered “chronic pain.” Chronic pain continues weeks, months and, in some cases, years after the initial injury, affecting day-to-day wellbeing and mental health. It can feel like a disease.

Dating back to ancient civilizations, we’ve used opioid-based medicines as incredibly powerful tools in the treatment of severe, acute pain. But the hallmark of opioid therapy is dosage must be increased over time for the drugs to work the way they did initially. That’s because the body and the brain develop a tolerance to opioids extremely quickly, forcing patients to increase their consumption to maintain any measurable amount of relief.

Making matters worse, opioids produce a potent sense of euphoria along with pain relief, and the rate of tolerance is very quick for euphoria and pain relief — but very slow for respiratory depression (slowed breathing). These varying rates of tolerance create an extremely dangerous situation, and help explain why 115 Americans die every day from accidental opioid overdoses¹⁹.

Unfortunately, there’s absolutely no substitute for the powerful pain relief opioids provide. Nothing on earth comes close. But how can we possibly continue to use these drugs in the face of all the danger that the development of tolerance presents?

The answer comes from another of our planet’s ancient pain relievers: cannabis.

Opioids and cannabinoids: Greater than the sum of their parts

When certain drugs are taken at the same time, they interact. This is why every bottle of nighttime cold medicine says “do not take with alcohol” on the label. Both substances make you drowsy, so taking them together could make you dangerously drowsy. These effects can be merely additive (2+2 = 4) or greater than additive (2+2 = 7). The latter has a specific name in the scientific study of drugs: synergy.

Scientists have extensively studied the combined administration of opioids and cannabinoids—active molecules from the cannabis plant—for decades. Across all species, all routes of administration and nearly every specific opioid and cannabinoid molecule studied, these drugs produce synergistic pain relief when taken together.

So what does this mean for patients?

If cannabis enhances the pain relief provided by opioids, then patients should need lower doses of opioid-based medicines to relieve their pain. In fact, exhaustive studies have found this is exactly what happens when chronic pain patients are given access to cannabis. From Ann Arbor to Jerusalem, time and time again, experts have found that patients reduce their daily dose of opioids by half after they start using cannabis⁴ ⁵.

Patients also reported a huge improvement in their day-to-day lives due to cannabis’ ability to minimize the mental fog and other unpleasant side effects of opioids⁶. Any strategy that reduces the overall use, side effects and harm of opioids is more desirable than relying on the ineffectiveness of opioids alone. Cannabis offers an extremely safe way to implement this strategy.

Why patients should consider using cannabis before starting opioid therapy

These are incredibly promising findings for individuals who are already using opioids for chronic pain, but what about those who haven’t yet been injured? Should people with upcoming surgeries be worried about the dangerous prescriptions they’re about to get?

Maybe not. Pre-clinical studies in animals have shown that cannabinoids could actually prevent the development of opioid tolerance¹¹. This is true whether cannabinoids are administered alone, or in combination with opioids. Although this effect has not yet been tested in a human laboratory setting, it could be a major factor in cannabis’ ability to improve a patient’s quality of life.

Bottom line: Cannabis’ ability to relieve pain synergistically and to prevent the development of opioid tolerance warrants its use as a first-line treatment for chronic pain, rather than a last resort “alternative” approach.