South African Research Team Says Cannabis is ‘Very Promising’ as an Opioid Replacement
by Bethan Rose
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 risk of lethal respiratory depression and 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 and now recently increasing, 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.
The Mayo Clinic explains that opioids are pain-relieving drugs that work by interacting with the opioid receptors on 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 specific opioid receptors (μ-opioid receptors) which are located on nerves and brain cells. The cells then send out signals that block pain perception, and in turn, increase 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 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.
Pain management and alleviation are the main reasons why healthcare practitioners continue prescribing opioids, despite the risks of addiction. When doctors write a prescription for opioids, they may also 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 easily lead to misuse. Opioids, like many other pharmaceuticals, still have adverse side effects, where the risks increase the longer and more heavily they are consumed.
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 addiction and (8) risks of overdose, hypoxia (not enough oxygen reaches the brain, which could lead to a coma) and even death.
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.
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 begin 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 the quality of life including relationships, (5) spending excess resources on the drug and (6) extreme weight loss or gain. In this case, it is best to reach out to the person’s doctor to express concern. They may not be able to give out personal health information without their permission, but still may be able to help the person access counseling or other resources.
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 multiple 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.
Let’s take a closer look at some of the differences between opioids and cannabis in the following table and video.
|The 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||Often state-legal with 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||Zero overdose deaths|
|Used for medicinal purposes and in food. Opioid peptides occur naturally in food or can be eaten in the form of poppy seeds (15).|
|Synthetic versions of both exist|
|Doctor’s more common prescription choice||Patient’s choice with a doctor’s recommendation for medical marijuana|
|Analgesics that block pain signals in the brain and nerves|
Many individuals have wondered whether cannabis or marijuana, 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 and in our brainstem, causing respiratory depression. Cannabis, on the other hand, contains cannabinoids that bind to the endocannabinoid receptors (CB1 and CB2) of the endocannabinoid system throughout the human body but does not cause respiratory depression, likely explaining the lack of overdose deaths (5).
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 non-lethal. Cannabis has a low-moderate risk of dependence potential, still less than the moderate risk of becoming addicted to alcohol and far less than the very high risk of heroin or methamphetamine dependence (6). But even then, the risks only include feeling lethargy, anxious, paranoid, etc.
It is not recommended in pregnancy or when breastfeeding due to its effects on fetal and child development. It is also riskier if cannabis use/abuse begins in adolescence before the brain fully develops because then there is potential for long-term psychological effects. However, this has not been shown to be true in adulthood based on animal models and epidemiology (6).
Additionally, there is a common misconception that using marijuana will lead to harder drugs, such as cocaine and heroin. The Drug Policy Alliance reviewed multiple studies and states that “Research shows that marijuana could more accurately be described as a ‘terminus’ drug because the vast majority of people who use marijuana do not go on to use other illicit drugs…Simply stated, people who have used other drugs are more likely to have also used marijuana. Not the other way around (4).” Meanwhile, the opioid crisis continues to make news headlines as more people continue to suffer addiction and tragically pass away.
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.
For comparison, a paper in American Scientist from 2006 titled “ The Toxicity of Recreational Drugs” compared the lethality to effective dose ratio for commonly used psychoactive drugs and alcohol. It demonstrates that heroin has the closest ratio of lethal-to-effective dose, indicating that toxic doses are only about 5 times more than the usual dose for 50% of the population (10). Alcohol is toxic at about 10 times the effective dose, easily more lethal than most illicitly used psychoactive substances including cocaine, MDMA, DMT, mescaline, ketamine, psilocybin, LSD, and cannabis in last place. Cannabis, with no known lethal dose, was estimated to be >1,000 times the effective dose to be toxic. Cannabis’ safety rating is literally off the chart, while heroin is the exact opposite.
Opioids are mainly used to treat pain and poppy seeds are used for seasoning on food. Opioids contain chemicals that can assist with getting the body to feel relaxed and probably even “high,” too. Poppy seeds contain minuscule amounts of opioid alkaloids that are reduced when treated and shouldn’t exceed the acceptable food safety doses if sourced properly (3). Certain food proteins also cause the release of endogenous opioids and have some opioid receptor activity themselves. These foods by themselves shouldn’t cause a high when taken in normal amounts (15).
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).
Medical cannabis, or marijuana, comes from Cannabaceae plants. 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 hundreds of known compounds with tetrahydrocannabinol (THC) and cannabidiol (CBD) being the most well-studied and known. Cannabis must be heated up in a process called decarboxylation in order to feel the intoxicating effects of THC.
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, enzymes, and other receptor types, thus further encouraging homeostasis in the body.
The interactions of cannabis with the body are still being researched and are not fully understood. Once the 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 potential medical properties of cannabis include:
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.
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.
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 cannabinoids block pain perception in the brain. The endocannabinoid system allows cells to tone down pain signals on their own and reduce inflammation that makes the pain worse.
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% 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 show great promise as a treatment for pain. The first and largest cohort 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.
Recently in 2021, a first-of-its-kind publication from experts around the world presented consensus guidelines on how to treat chronic pain with specific doses of medical cannabis and cannabinoid medicine pain management strategies.
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 Family Physician certified in chronic pain treatment recruited 600 patients with chronic pain that he had served at his practice known as Toronto Poly Clinic (11). Among these patients, their average dose of daily prescribed opioids was equal to that of 120 morphine-equivalent doses (MEDs). Of those 600 patients, 95 of them were taking anywhere from 180 to 240 mg daily to manage their pain.
The patients Dr. Rod 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%.
Experts have also convened to make a practical guide for prescribers to help taper patients off of opioids. A 2021 publication offers specific clinical recommendations to help doctors reduce their patients’ opioid doses with cannabis. Professional guidance and advice like this may go a long way in preventing opioid misuse and overdose deaths (13).
Cannabis has been historically used and 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 labeled and stigmatized in the past.
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 high addictive risk common with the use of opioids. In other words, cannabis is preferred over opioids because (1) there is a greatly 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 anecdote, 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 an 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. 81%of the patients in the study also noted that medical marijuana is even more effective for them as a pain reliever than 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.
The most effective way to use cannabis to combat addiction is to use it as a preventative or adjunctive 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. The consumption of cannabis for pain management may prevent the development of opioid addiction in the first place.
Cannabis is amazing for pain relief and can be safely taken as an alternative to painkillers containing opioids. It can also be added to opioid-curbing medications like methadone or suboxone if their dose is adjusted properly by a doctor since cannabis can raise their levels. If you are using these medications with medical marijuana, it is important to let your physician know as the dosages may need to be increased.
Pain killers can be held accountable for the beginning of many addictions. The use of cannabis as a pain killer could 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, the lead author of 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.”
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 and healthcare provider education 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.
Note: The content on this page is for informational purposes only and is not intended to be professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided. Always consult a physician before making any decision on the treatment of a medical condition.
1. Bhaskar, A., Bell, A., Boivin, M. et al. Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process. J Cannabis Res 3, 22 (2021). https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-021-00073-1
2. Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. The Journal of Pain, 17(6), 739–744. https://www.jpain.org/article/S1526-5900%2816%2900567-8/abstract
3. Carlin, M. G., Dean, J. R., & Ames, J. M. (2020). Opium alkaloids in harvested and thermally processed poppy seeds. Frontiers in Chemistry, 8. https://www.frontiersin.org/articles/10.3389/fchem.2020.00737/full
4. Drug Policy Alliance. (2017, February). Debunking the “Gateway” Myth. New York. https://drugpolicy.org/sites/default/files/DebunkingGatewayMyth_NY_0.pdf
5. Ebbert, J. O., Scharf, E. L., & Hurt, R. T. (2018). Medical cannabis. Mayo Clinic Proceedings, 93(12), 1842–1847. https://www.mayoclinicproceedings.org/article/S0025-6196(18)30709-2/fulltext
6. Fugh-Berman, A., Wood, S., Kogan, M., Abrams, D., Mathre, M. L., Robie, A., Raveendran, J., Onumah, K., Mehta, R. S., White, S., Kasimu-Graham, J., & D’Antonio, P. (n.d.). An Introduction to the Biochemistry & Pharmacology of Medical Cannabis. Washington DC; Department of Health. http://docplayer.net/36028206-Medical-cannabis-adverse-effects-drug-interactions.html
7. Lee, M. C., Ploner, M., Wiech, K., Bingel, U., Wanigasekera, V., Brooks, J., Menon, D. K., & Tracey, I. (2013). Amygdala activity contributes to the dissociative effect of cannabis on pain perception. Pain, 154(1), 124–134. https://www.sciencedirect.com/science/article/pii/S0304395912005453
8. National Institute on Drug Abuse. (2021, July 1). Prescription opioids Drugfacts. National Institute on Drug Abuse. Retrieved March 7, 2022, from https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
9. Reiman, A., Welty, M., & Solomon, P. (2017). Cannabis as a substitute for opioid-based pain medication: Patient self-report. Cannabis and Cannabinoid Research, 2(1), 160–166. https://www.liebertpub.com/doi/full/10.1089/can.2017.0012
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