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Opioids vs. Medical Cannabis — Which Is Better For Chronic Pain?

With his recent announcement that opioid abuse amounted to a public health emergency, President Trump acknowledged a fact already sadly apparent to millions of Americans. In 2016, 64,000 people died from drug overdoses (with prescription and illicit opioids responsible for the majority of drug overdoses). For Americans under 50, drug overdose is the leading cause of death.

2017 - Fatal Drug Overdoses in United States Opioids vs. Cannabis

With some 140 Americans dying each day from opioids — and the powerful dependance patterns long-term users develop — finding a solution is no simple task. (Notably, while opioid-induced fatal drug overdoses are skyrocketing, the Drug Enforcement Agency notes that no death from cannabis overdose has ever been reported.)  

Given the comparative low toxicity and low potential for abuse of cannabis, is cannabis superior to opioids to treat chronic pain?

Medical Cannabis May Save Lives Lost to Opioid Addiction

From a public health perspective — given the relative safety of cannabis compared to opioid medications — it seems clear: With a much lower risk of dependence than opioids and virtually no risk of fatal overdose, cannabis trumps opioids. Hands down.

To underscore the point, earlier in 2017, WeedMaps, a California company that publishes an online dispensary rating guide, launched a creative billboard marketing campaign. On a simple black background on the billboards, the text read:

“States that legalized marijuana had 25% fewer opioid-related deaths.”

The message was stark and unforgettable, and it sparked heated controversy in some neighborhoods hard hit by the opioid crisis.

The WeedMaps data was based on a 2014 study published in JAMA Internal Medicine. Dr. Mark S. Brown and Marie J. Hayes, opioid abuse researchers and authors of the study, commented: “The striking implication is that medical marijuana laws, when implemented, may represent a promising approach for stemming runaway rates of unintentional opioid-analgesic-related deaths.”

Cannabis in History: A Long Track Record as Safe Medicine

Neither cannabis nor opium—the plant from which synthetic opioids are derived—are new additions to the medicine cabinet. Cannabis has been used to treat chronic pain, stomach ailments, anxiety and a host of other conditions for at least 4,000 years.

Opium’s medical use dates back even further, to at least 3400 BCE. If it was recognized early for its powerful pain-killing properties, it was also understood to be habit-forming by at least the 18th century, if not long before.

By comparison, cannabis remained in the American pharmacopoeia as an accepted folk remedy until the early 20th century, when the rising tides of both the Temperance movement and anti-immigrant sentiment—marijuana was widely linked with an influx of Mexican migrant workers—led to its being banned in most states, and eventually on the federal level in 1937.

Marijuana Medicine: Is it “Strong Enough” to Stop Pain Compared to Opioids?

While cannabis has a long and historical track record of being used to treat a variety of ailments, and the evidence clearly suggests cannabis is far safer, less addictive, and less potentially destructive than opioids, the question remains:

Can cannabis actually treat chronic pain more effectively than opioids?

With the wave of medical cannabis legalization showing no signs of stopping, a flood of research is uncovering cannabis’ potential as a treatment for chronic pain. And it turns out the physicians of millennia past were on to something.

Let’s look at the science:

Patients seem to prefer using cannabis in place of opioids, many claiming it works better for them than opioids. A paper published in the Journal of Cannabis and Cannabinoid Research used data from a group of 2,897 medical cannabis patients.

  • 34 percent reported having used opioid pain medication in the previous six months. A majority of patients reported that cannabis was just as effective or more effective than opioids — but without undesirable side effects.
  • Of the patients reporting having used opioids, 97 percent reported having been able to reduce or eliminate opioids.
  • And, 81 percent reported using cannabis alone was more effective opioids.

The authors of the study concluded: “Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain.”

A 2015 Harvard-led review (a meta-analysis) of 28 studies examining the efficacy of cannabinoids to treat various pain and medical issues, drew similar conclusions. The authors concluded, “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence.”

The following year, a study by the University of Michigan found that cannabis, among other things:

  • Decreased the side effects from other medications
  • Improved subjects’ overall quality of life
  • Reduced use of opioids, on average, by 64%

Findings from recent research validate the vast amount of anecdotal evidence strongly supporting cannabis’ efficacy in treating chronic pain.

Cannabis Can Take a Little Trial and Error

While cannabis may seem like a godsend — and for many patients it is — for some it takes a little bit of trial and error to find the right cannabinoid ratio and intake method. Cannabis is not a single drug; it’s a highly complex plant with hundreds of cannabinoids and terpenes working together synergistically to influence its effects.

For chronic pain, we find most patients opt for products higher in THC. I caught up with Dr. Stephen Dahmer, Vireo’s chief medical officer, and asked him what most chronic pain patients experiences were like:

What we’ve seen in chronic pain is that a patient will gravitate a little bit more towards a higher THC product. They’ll move in that direction if they’re not responding to the treatment that’s given. So, generally, in terms of dosing, we’ll slide them towards higher THC, but also increase the amount of CBD. That could potentiate [extend the duration of] the THC while offsetting potential side effects.

In pain, most of the scientific research is going to back this up. If you look at the randomized double-blind control studies done specifically with neuropathic pain, it’s higher THC strains that have the best evidence behind them. But, we will also find in practicality if a patient is not responding to increasing levels of THC, sometimes we’ll flip things upside down and give them a high CBD, and particularly in inflammatory disorders, patients might respond well to that, where they may not respond well to a higher THC.

So, a combination of science and trial and error, and a lot of feedback. Very close feedback with the patient, making sure they’re getting the most optimal effects with the fewest side effects.

So while most patients seem to respond better to products with higher THC levels, others find a 1:1 (THC:CBD) or a high CBD product works great. Likewise, some people prefer inhalation (finding vaporizing delivers the fast relief). Others find inhalation can exacerbate their pain, and prefer oral administration (e.g. capsules or tinctures).

There’s no “one size fits all,” but at Vireo we developed the Vireo Spectrum to make it easier finding the right cannabinoid profile (cannabinoid profiles are color coded correlating to the levels of THC and CBD). Dr. Dahmer explains: “[The Vireo Spectrum] provides a visual, allowing us to maximize efficacy in terms of treatment of the symptoms that they’re bringing to the table while minimizing side effects.

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