(Part 1) Practical Strategies for Using Medical Cannabis to Reduce Harms Associated With Long-Term Opioid Use

Recent evidence suggests that using medical cannabis in combination with opioids to treat chronic pain may provide better treatment of pain and allow for a lower dose of opioids. It is important we find other tools that can be used to help improve the treatment of pain while keeping patients safe.

This is the first of a three-part series drawing from a paper outlining practical strategies for using medical cannabis to reduce harms associated with long-term opioid use in chronic pain.

There is little evidence for the long-term use of high dose-opioids for the treatment of chronic pain that is not cancer related. More worrisome, however, is the significant increase in the risk of serious side effects and death associated with opioids.

Recent evidence suggests that using medical cannabis in combination with opioids to treat chronic pain may provide better treatment of pain and allow for a lower dose of opioids to be used (Nielson et al., 2022). This could make using opioids safer because the risk of serious side effects or deaths is higher when higher doses of opioids are used.

Why is this important?

Chronic pain affects approximately 20% of the adult population (Andrew et al., 2014). People with chronic pain may have a harder time completing daily activities (including work) and may have worsened mental health. Chronic pain can be hard to treat because the reason for the pain is often different depending on the person.

First-line treatments include gabapentinoids, tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors. If first-line treatments do not work, opioids may be used. Depending on the severity of pain, these options may not provide enough pain relief while also being associated with unwanted side effects. For example, side effects of opioids include constipation, nausea, falls, confusion, respiratory concerns, sedation and addiction. Higher opioid doses are associated with greater harm, including the risk of dying from an opioid overdose. Due to this risk, it is important we find other tools that can be used to help improve the treatment of pain while keeping patients safe.

Stay tuned for the next post of this blog series to learn more about how cannabinoids can be used to improve the treatment of chronic pain.
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References:  

Andrew, R., Derry, S., Taylor, R. S., Straube, S., and Phillips, C. J. (2014). The Costs and Consequences of Adequately Managed Chronic Non-cancer Pain and Chronic Neuropathic Pain. Pain Pract. 14 (1), 79–94. doi:10.1111/papr.12050

Nielsen, Suzanne, et al. "Opioid-sparing effect of cannabinoids for analgesia: an updated systematic review and meta-analysis of preclinical and clinical studies." Neuropsychopharmacology 47.7 (2022): 1315-1330

Dr. Caroline MacCallum is a specialist in internal medicine with expertise in complex pain and cannabinoid medicine. In addition to serving as an advisor to EO Care, she is a clinical instructor in the Department of Medicine; Adjunct Professor in the Faculty of Pharmaceutical Sciences program; and associate member of the Dept. of Palliative Care at the University of British Columbia. An avid researcher, Dr. MacCallum is primary author of Primary Considerations for Medical Cannabis Administration and Dosing, and assistant for Cannabinoids and Pain.

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