(Part 1) Cannabinoids as a Substitute for Opioids: Basic Science and Clinical Evidence

The lack of pain relief combined with the risk of dangerous side effects, including death, has led to a need for alternative options to help treat chronic pain. Recently, there has been growing interest in the possibility that cannabis may be useful in combination or as a substitute for opioids in people with chronic pain.

This is the first part of a three-part series discussing the use of cannabis as a substitute for opioids.

The opioid overdose crisis has caused thousands of deaths worldwide. In 2020, 68,630 deaths resulted from opioid overdoses in the United States alone (Centers for Disease Control and Prevention, 2021).

Opioids are commonly used as a treatment for chronic pain. However, many people do not experience sufficient pain relief with opioids alone, which can result in the need to continuously increase their dose. The lack of pain relief combined with the risk of dangerous side effects, including death, has led to a need for alternative options to help treat chronic pain. Recently, there has been growing interest in the possibility that cannabis may be useful in combination or as a substitute for opioids in people with chronic pain.

Why is this important?

When compared to opioids, cannabis is a much safer option for the long-term management of chronic pain. There have been no overdose deaths directly attributed to cannabis, and the side effects associated with cannabis use are much less severe than those associated with opioid use. When used in combination, under medical supervision, the addition of cannabis can often lead to a reduction in the dose of opioids required for pain relief (Bushlin et al., 2010; Cichewicz etal., 2003; MacCallum et al., 2021). Unlike opioids, the dose of cannabis required for pain relief does not need to be escalated over time.

Stay tuned for the second part of this blog series to learn more about how cannabis may be useful in improving the treatment of chronic pain.

References:

Bushlin I, Rozenfeld R, Devi LA. Cannabinoid–opioid interactions during neuropathic pain and analge- sia. Curr Opin Pharmacol. 2010;10(1):80–6.

Cichewicz DL, McCarthy EA. Antinociceptive synergy between Δ9-tetrahydrocannabinol and opioids after oral administration. J Pharmacol Exp Ther. 2003;304(3):1010–5.

“Death Rate Maps & Graphs” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2 June 2022.

Narouze SN, MacCallum CA. eds. Cannabinoids and Pain. Springer; 2021 Chapter 27; Cannabinoids as a Substitute for Opioids: Basic Science and Clinical Evidence.

Authors: Caroline A. MacCallum, Lauren de Freitas, Lauren Eadie, and Samer N. Narouze

Running Title: Cannabis vs. Opioids for Chronic Pain

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‍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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