Treatment

Marijuana vs. Opioids: Which is More Effective for Treating Pain?

April 23, 2021 08:17 am ET
Marijuana vs. Opioids: Which is More Effective for Treating Pain?

Note: Veriheal does not intend to give this as professional medical advice. Do not attempt to self-diagnose, or prescribe treatment based on the information provided on this page. Always consult a physician before making any decision on the treatment of a medical condition. 

This blog is a compilation of articles written by Samantha Velez, Anthony Dutcher, and Ashley Priest.


Opioids, like cannabis, are derived from a plant species. Although opioids are naturally derived, it is a misconception that they are completely safe for consumption, because of the addictive side effects. Opioids are commonly prescribed to patients who are in need of pain management, chronic or otherwise, but they may not be aware that the opioids they’re about to consume are most likely synthetic. For decades, the addictive side effects of opioids have been claiming lives. Therefore, there has never been a better time to consider an alternative like medical cannabis

  1. What is an Opioid?
  2. Using Opioids for Pain Management
    1. Side Effects of Prescription Opioids
    2. Opioid Dependency
      1. Symptoms of Misuse, Dependence or Addiction
      2. Effects of Opioid Misuse, Dependence or Addiction
  3. The Difference Between Opioids and Cannabis
    1. Is Cannabis an Opiate?
    2. Substance Dependence/Addiction 
    3. Mortality Rates
    4. Benefits and Uses
  4. How Exactly Does Medical Cannabis Work?
    1. Medical Cannabis Properties
    2. Conditions Alleviated with Medical Cannabis
  5. How Does Cannabis Help Pain?
    1. Can Cannabis Effectively Help Improve Pain?
    2. Cannabis for Replacing Opioids
    3. Why is Cannabis Preferred Over Opioids for Pain Management?
      1. Cannabis for Opioid Misuse, Dependence, Addiction and Withdrawal
  6. Conclusion

What is an Opioid?

The Mayo Clinic explains that opioids are pain-relieving drugs that work by interacting with the opioid receptors in cells. Some opioids, such as morphine, are made from the poppy plant, while others, like fentanyl, are synthetic and made in a laboratory. When opioids are consumed, they travel through the blood and attach themselves to opioid receptors, which are located in the brain cells. The cells then send out signals that block pain perception, and in turn, increases the feeling of pleasure. 

Prescription opioids have been given commercial names as well as street names on the basis that opioids can be highly addictive and are largely used for recreational purposes along with being prescribed to manage pain. Some of the commercial names of prescription drugs categorized as opioids, opium or opiates include codeine, fentanyl, sublimaze, vicodin, lorcet, methadone, morphine, oxycodone, oxymorphone, and more. Street names include cody, sizzurp, apache, vike, oxy, percs, O bomb, demmies and octagons. Many may even be surprised to know that the street drug heroin, notorious for being addictive and claiming lives, is a man-made version of morphine. 

opiate addiction

Using Opioids for Pain Management

Pain management and alleviation is one of the main reasons why healthcare practitioners continue prescribing opioids, despite the risks of addiction. When doctors write a prescription for opioids, they may even refer to it as an opiate or narcotic, since they are made from opium found in the poppy plant. Even though morphine and codeine are the only two natural products derived from opium, the rest are man-made or synthetic. 

While taking opioids on a short-term basis is considered safe, the feelings of pleasure or euphoria induced by them often leads to misuse. Opioids, like many other pharmaceuticals, still have potential adverse side effects, where the risks increase the longer they are consumed. 

Side Effects of Prescription Opioids

The National Institution on Drug Abuse, or the NIH, has stated that the possible side effects of consuming prescription opioids include: (1) drowsiness, (2) confusion, (3) nausea, (4) constipation, (5) euphoria, (6) slowed breathing, (7) risk of misuse or addition and (8) risks of overdose, hypoxia (not enough oxygen reaches the brain, which could lead to a coma) and even death.  

Opioid Dependency

The NIH goes on to differentiate between opioid tolerance, dependence and addiction. Opioid tolerance refers to getting used to the pain medication over time, thus requiring higher or more frequent doses, resulting in over-prescribing medication, in order to benefit from the same level of alleviation. Opioid dependence refers to when an individual has consumed the drug for a long time and now needs the drug since its absence causes physiological reactions. Whereas addiction to opioids is considered a chronic disease, where one compulsively, uncontrollably and willingly seeks to consume the drug despite the consequences. If one is not careful with opioids, their use for pain management could turn into dependence or addiction. While an argument can be made on the misuse of cannabis, the effects associated with opioid-misuse are far more severe, life-threatening and grave.

Addictive Pharmaceutical Scheme

Symptoms of Misuse, Dependence or Addiction

One may be abusing or may even be dependent and addicted to the drug without realizing it before it is too late. In order to prevent this from happening, understanding the symptoms is a good way to identify whether you, or someone close to you, may be beginning to develop an opiate problem. These symptoms include: (1) increased tolerance to opioids, (2) inability to stop using, (3) withdrawal symptoms, such as changes in mood, restlessness, shakiness, tremors, sweating, etc., (4) use is impacting quality of life including relationships, (5) spending excess resources on the drug and (6) extreme weight loss or gain. 

Effects of Opioid Misuse, Dependence or Addiction

The short-lived feeling of pleasure or euphoria, which often leads to the misuse of the drug, also has some severe side effects if one continues to misuse the drug. Opiate abuse, addiction or dependence can have negative consequences on the mind and body, which may include (1) nausea, (2) vomiting, (3) weakened immune system, (4) slow breathing rate, (5) coma, (6) hallucinations, (7) collapsed veins or clogged blood vessels, (8) risk of choking and (9) increased risk of contracting diseases such as HIV and hepatitis. There is also the high risk of mortality from an overdose, whether on purpose or accidental. 

The Difference Between Opioids and Cannabis

Let’s take a closer look at some of the differences between opioids and cannabis in the following table and video. 

Opioids Both  Marijuana
Opium poppy is a botanical that produces psychoactive alkaloids like opiates Marijuana is a botanical containing cannabinoids, like CBD and THC
Has limited benefits Effective in alleviating pain   Has an ever-increasing list of benefits
Legal with a prescription  Gaining legalization and decriminalization across the globe, but is still considered illegal under United States federal law
High risk of addiction Low risk of addiction
Claims thousands of lives  Never has, or will, claim a life. 
Used for medicinal purposes and in food. 
Synthetic versions exist 
Doctor’s choice Patient’s choice with a doctor’s recommendation for medical marijuana 
Analgesics which block pain signals in the brain. 

Is Cannabis an Opiate?

Many individuals have wondered whether cannabis, or maijuana, is an opiate. While they both have medicinal purposes and stem from plants, cannabis is not an opiate. Opiates are narcotics that can suppress activity in the central nervous system to reduce pain and induce sleep. Opiates stem from a different plant, the poppy plant, and they bind to opioid receptors (mu opioid receptors known as MORs) in our bodies. Cannabis, on the other hand, contains cannabinoids that bind to the endocannabinoid receptors (CB1 and CB2) of the endocannabinoid system throughout the human body. 

Substance Dependence/Addiction 

While individuals can be dependent on cannabis, meaning that one relies on it for some sort of alleviation, the side effects associated with being dependent on cannabis are mostly hypothesized. But even then, the risks only include feeling lethargy, anxious, paranoid, etc. Additionally, there is a common misconception that using marijuana will lead to harder drugs, such as cocaine and heroin. However, the opioid crisis continues to make news headlines as more people continue to become addicted and pass away. 

Mortality Rates

While the number of deaths from opioid overdose is alarming, the deaths from cannabis overdose remain at 0. Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. An argument for potential cannabis misuse can be made, but the effects of opioid misuse are much more grave and life-threatening.

Benefits and Uses

Opioids are mainly used to treat pain and poppy is used for seasoning on food. Opioids contain chemicals that can assist with getting the body to feel relaxed and probably even “high,” too. Cannabis is used for alleviating pain, reducing inflammation, promoting homeostasis in the body and even acts as a neuroprotective agent, alongside being used recreationally. Not to mention, all the different uses in food (e.g. spice, medical enhancement), as material (e.g. hemp-plastics, hemp-concrete) and as textiles (e.g. hemp-paper, clothing).

How Exactly Does Medical Cannabis Work?

Cannabis, or marijuana, comes from a plant called cannabis ruderalis. It is considered psychoactive with various mental and physical effects that occur in the body after it is smoked, vaped, used in lotions, or orally consumed. Cannabis contains 483 known compounds with tetrahydrocannabinol (THC) and cannabidiol (CBD) being the most well-known. Cannabis must be heated up in a process called decarboxylation in order to feel the intoxicating effects of THC.

Medical Cannabis Dispensary

Cannabis science is one of the fastest moving frontiers of medicinal sciences in the world. The studied pharmacology behind it has been accelerated by the realization that endocannabinoids and endocannabinoid receptors are naturally occurring in the human body. Endocannabinoids help regulate many physiological processes such as your mood, memory, appetite, pain, immune function, metabolism, and bone growth to name a few. These endocannabinoids can be found in one’s endocannabinoid system (also known as the ECS), which has receptors located all over the body. Cannabis has potential benefits for any species with an endocannabinoid system, since  cannabinoids found in cannabis bind to the ECS receptors, thus further encouraging homeostasis in the body. 

Medical Cannabis Properties

The interactions of cannabis with the body are still being researched and are not fully understood. Once research is able to portray how these interactions work to deliver benefits, we may better understand how one plant is able to offer so much relief. Some of the medical properties of cannabis include:

  • Anti-inflammatory
  • Pain Alleviating
  • Assists with Addiction
  • Neuroprotective
  • Anxiety and Stress Alleviation
  • Improves Lung Capacity
  • Assists with Alleviating Depression
  • Assists with Bone Regrowth 

Conditions Alleviated with Medical Cannabis

The list of conditions cannabis may be used to alleviate continues to grow. For the sake of deciding whether to choose cannabis over opioids, let’s have a look at some of the top conditions characterized by chronic pain, which can be managed with either substance. It is important to always consult with a healthcare professional before trying medical cannabis and/or CBD. Do not attempt to self-diagnose, and keep in mind that everyone responds differently to medications in general. 

  1. Arthritis
  2. Back Pain
  3. Migraines
  4. Multiple Sclerosis
  5. Fibromyalgia
  6. Shingles
  7. Neuropathy (Nerve Damage)
  8. Irritable Bowel Syndrome
  9. Post-surgery Pain
  10. Cancer Pain

How Does Cannabis Help Pain?

Interestingly enough, marijuana and opioids are both analgesics, which block pain signals in the brain and central nervous system. Both also block pain by binding to receptors in the brain. However, that is where their similarities end. 

opiates and cannabis

To find out exactly how marijuana blocks pain, Oxford researchers studied a group of healthy participants using doses of THC and an MRI machine. What they found was somewhat surprising. According to the researchers, marijuana doesn’t kill pain as much as it makes it more bearable, which makes sense since the cannabinoids block pain perception in the brain. 

Can Cannabis Effectively Help Improve Pain?

The short answer to this question is yes. In fact, cannabis is already being used to help alleviate  chronic pain in states where new medical marijuana laws have made it legal. There has even been a staggering 64 percent decrease in opioid use in those states, according to a 2016 study published in the Journal of Pain. Most notable though was the decrease in unwanted side effects experienced by participants in the study. There’s a vast difference in the side effects reported by marijuana users versus opioid users. 

A systematic review published in Therapeutics and Clinical Risk Management concludes that cannabinoids are generally well tolerated by patients and shows great promise as a treatment for pain. And last but not least, the first and largest study done on the long-term safety of medical cannabis for patients with chronic pain shows that daily cannabis users experienced significant improvement in their pain levels, symptom distress, mood and quality of life compared to participants who did not consume cannabis. Also, the cannabis users had no greater risk than non-users for serious adverse effects. The study, published in the Journal of Pain, found that patients didn’t experience any harmful effects on cognitive function or blood tests.

Medical Marijuana

Cannabis for Replacing Opioids

A pilot study conducted by Dr. Kevin Rod was recently published in the American Journal of Psychiatry and Neuroscience. The study investigated whether or not cannabis can help with opioid withdrawal. The Toronto-based chronic pain specialist recruited 600 patients with chronic pain that he had served at his practice known as Toronto Poly Clinic. Among these patients, their average dose of daily prescribed opioids was equal to that of 120 mg of morphine. Of those 600 patients, 95 of them were taking anywhere from 180 to 240 mg daily to manage their pain. 

The patients he recruited for the pilot study were ordered to taper their daily dosage of opioid pharmaceuticals by roughly 10% every 1 to 2 weeks, and they were asked to consume THC and CBD products having a range of 4-6% concentration. The specific doses for each individual patient were the equivalent of a half gram of cannabis a day for every 10% reduction in their opioid dose. Patients consumed these products either through vaping or sublingual consumption methods. The Medical Cannabis Opioid Reduction Program pilot study concluded after six months that 26% of patients ceased taking opioids at all and an additional 55% of patients reduced their opioid consumption by 30%. 

Steven Kinsey, Ph.D., a biomedical researcher in neuroscience, says, “Patients do respond well to cannabis, but it is dependent on the level of pain. Cannabis doesn’t have the same side effects (as opioids). There could be some future there.” He also expressed interest in seeing more studies on cannabinoids working with other pain-relieving drugs to help the pain-relieving effects be stronger.

Cannabis has been reported anecdotally as a successful option for migraines, nerve pain, and other chronic pain. It’s time to look at the numbers and risks of this opioid epidemic and start looking at alternatives for pain management, even if cannabis has been unfairly labelled and stigmatized in the past.

Why is Cannabis Preferred Over Opioids for Pain Management?

Cannabis is preferred over opioid therapy for pain management, because patients are able to benefit from the pain alleviating effects of cannabis without exposing themselves to the addictive risk common with the use of opioids. In other words, cannabis is preferred over opioids because (1) there is a reduced risk of addiction, especially when needing pain alleviation on a long-term basis and (2) there are fewer side effects and risks. No one has ever overdosed from cannabis. Medical marijuana use is becoming more accessible and widespread throughout the United States and could help lower the rising opioid overdose deaths  related to substance abuse and addiction.

A personal report, from Crystal Hampton in South Florida, on experience with chronic pain that led to opioid addiction revealed that (1) many doctors are indifferent over your pain experience and even tell patients they may just have a low pain threshold, (2) one may need to push doctors in order to for them to find out what is really causing the pain and that (3) when doctors hear ‘pain,’ they are quick to prescribe opioids, which may quickly lead to addiction. Hampton explains that one should always trust one’s instincts, especially when it comes to something being wrong in the body, and to never be afraid to advocate for oneself. When you know something is as harmful as opioids can be, it’s no wonder why one would likely be more satisfied with any alternative that works. 

Even if cannabis is not quite as effective for pain management as opioids, cannabis may be helpful as an adjunct to pain therapy. A study in Cannabis and Cannabinoid Research investigated whether patients prefer opioids or medical marijuana for pain relief and found that patients preferred marijuana. Many of the patients in the study also noted that medical marijuana is just as effective for them as a pain reliever as the opioids. Some of the study participants were able to cut back on prescription opioid use when they added medical marijuana to their pain treatment protocol, which resulted in fewer unwanted side effects than they were seeing with opioids alone. 

Cannabis for Opioid Misuse, Dependence, Addiction and Withdrawal

The most effective way to use cannabis to combat addiction is to use it as a preventative measure. Opioid drugs account for the larger statistics of drug addiction and are common causes of overdose deaths. Just for the record, it is physically impossible to overdose on cannabis. In fact, the consumption of cannabis for pain management can prevent the development of opioid addiction in the first place. 

Cannabis is amazing for pain relief and can be taken as an alternative to painkillers containing opioids. Pain killers can be held accountable for the beginning of many addictions. The use of cannabis as a pain killer would reduce the number of addictions by eliminating the need for opioid use in the first place. In terms of using cannabis for addiction, dependence or withdrawal, cannabis can reduce anxiety and depression, help manage impulse control, and can reduce the severity of physical effects including reducing nausea, pain management and improving appetite. 

Cannabis can even be used to reduce the risk of having an overdose. A recent study found that “fentanyl was detected in a majority of participants with lower prevalence among individuals with urine drug tests positive for tetrahydrocannabinol (THC).” The study included 819 participants and concluded by stating that “cannabis use was independently associated with reduced likelihood of being recently exposed to fentanyl.”

Dr. Eugenia Socías, lead author on the study, stated that, “These new findings suggest that cannabis could have a stabilizing impact for many patients on treatment, while also reducing the risk of overdose…With overdoses continuing to rise across the country, these findings highlight the urgent need for clinical research to evaluate the therapeutic potential of cannabinoids as adjunctive treatment to OAT [ Opioid agonist therapies] to address the escalating opioid overdose epidemic.” 

Opioid Dependence Reduced By MMJ

Conclusion

As you can see, cannabis is a viable option when seeking alternatives to prescription opioids for pain management. Public health opinion is changing with regards to medical marijuana and soon medical cannabis laws will catch up. There’s evidence showing how patients can benefit from the pain alleviating effects of medical cannabis as well as benefit from its other medical properties, such as stress relief. Fortunately, if you would like to consult a professional about medical cannabis use, Veriheal has made the process of consulting a medical marijuana doctor simple and easy.

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