Cannabis as an adjunct to or substitute for opioid abuse in the treatment of chronic pain?
More South Africans are being prescribed opioids to treat pain, and the result is a dangerous trend in opioid abuse.
It’s a common misconception that abusing prescription medications is safer than using cannabis.
Prescription drug abuse involves taking a prescription medication that isn’t yours or taking your own prescription medication in a way that differs from your doctor’s instructions. Abusing prescription medications is very dangerous, and can even be deadly. The potential to overdose on a prescription medication or become addicted is very real.
Prescription drug abuse is responsible for 60% of overdose-related deaths. Opioid painkillers are responsible for the most deaths followed by benzodiazepines. About 1.4 million emergency room visits can be attributed to prescription drug abuse each year. Men are twice as likely to die of an overdose compared to women. People between the ages of 45 and 49 have the highest death rates from drug overdoses.
The opioid epidemic is arguably the greatest health-care crisis of the 21st century. In 2015 alone, its economic cost in the United States was estimated at more than $500 billion, largely driven by health-care costs, criminal justice expenses, and lost productivity. This crisis has brought more attention to the growing collection of research examining the relationship between cannabis and opiates, particularly when it comes to reducing opioid dependence in patients.
A major contributor to this opioid abuse crisis is the doctor’s prescription pad. Over prescription of narcotic pills or refills, and “doctor shopping” (finding another doctor when one won’t refill a prescription) are common. There are even websites in South Africa now where one can purchase scheduled opioids without a doctor’s prescription.
There is a growing body of evidence to support the use of medical cannabis as an adjunct to or substitute for prescription opiates in the treatment of chronic pain. When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective. Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates. Despite a lack of regulatory oversight by federal governments in North America, community-based medical cannabis dispensaries have proven successful at supplying patients with a safe source of cannabis within an environment conducive to healing, and may be reducing the problematic use of pharmaceutical opiates and other potentially harmful substances in their communities.
What’s more, in additional investigations of cannabis and opiates, scientists have studied the combined administration of opioids and cannabinoids, or active molecules from the cannabis plant. This research has been ongoing 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.
In other words, cannabis and opiates work together, with cannabis enhancing the pain relief provided by opioids. That means patients should need lower doses of opioid-based medicines to relieve their pain.
CBD is painkilling and has other beneficial effects, THC is more directly painkilling – and they work very well for chronic pain. The other benefit, unlike with opioid abuse, is that you cannot die of a cannabis overdose.
Despite the 2020 rescheduling of cannabis for medicinal use, many doctors are still unable or reluctant to prescribe cannabis-based medicinal products due to lack of proper education, unclear guidelines, and the need for formal approval.
What South Africa urgently needs is its own observational clinical trial to see if medical cannabis has the potential to treat chronic pain and thus reduce opioid dependence.
Healthcare providers, whether they are pro-, neutral, or anti-medical cannabis, need to leave their prejudices outside the exam room. Doctors need to create a climate where patients feel they can be open, so that we can know if and how they are using medical cannabis. Physicians can be in a position to advise them on the risks and benefits of safe usage, and meaningfully contribute to the conversation. Once we are all on the same page, guided by evidence in new studies about reduced opiate use and adding medical cannabis to the pain relief arsenal, we can start helping patients to minimize their use of opiates.
Has cannabis helped you or someone you know become less dependent on prescription painkillers? We’d love to here more.