(Part 3) Cannabinoids as a Substitute for Opioids: Basic Science and Clinical Evidence

Studies have shown low doses of cannabis may allow for lower doses of opioids to be used, leading to reduced side effects, improved symptoms and improved quality of life. Therefore, the combined use of cannabis and opioids may be a viable option for treating chronic pain in some individuals.

In the last two posts of this blog series, we discussed the potential issues of treating pain with opioids and how cannabis may be used to reduce or replace opioid use while improving treatment of chronic pain. The third-part of this blog series provides an overview of the benefits and reasoning behind cannabis for pain treatment.

Studies have shown low doses of cannabis (specifically and primarily THC) may allow for lower doses of opioids to be used, leading to reduced side effects, improved symptoms and improved quality of life (Mucke. Et al, 2018, Johal et al., 2020, Wong et al., 2020, Vulfson et al., 2020). Therefore, the combined use of cannabis and opioids may be a viable option for treating chronic pain in some individuals.

What this might mean for you:

1. If you are using opioids to treat chronic pain but are not experiencing enough pain relief or have undesirable side effects from opioid use, medical cannabis might be helpful in reducing the amount of opioids used, and in turn reduce the risks and side effects.

2. Patients considering the use of medical cannabis for reducing opioid use should discuss this with their health care provider prior to use or any changes in prescribed medications.

References:

Johal H, Devji T, Chang Y, Simone J, Vannabouathong C, Bhandari M. Cannabinoids in chronic non-can- cer pain: a systematic review and meta-analysis. Clin Med Insights Arthritis Musculoskelet Disord. 2020;13:1179544120906461.

Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuro- pathic pain in adults. Cochrane Database Syst Rev. 2018;3:CD012182.

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

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Vulfsons S, Minerbi A, Sahar T. Cannabis and pain treatment—a review of the clinical utility and a practical approach in light of uncertainty. Rambam Maimonides Med J. 2020;11(1):e0002.

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Wong SSC, Chan WS, Cheung CW. Analgesic effects of cannabinoids for chronic non-cancer pain: a sys- tematic review and meta-analysis with meta-regres- sion. J Neuroimmune Pharmacol. 2020;15(4):801–29.

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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.

Here's where you can find Dr. Caroline MacCallum online:

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- Website: https://drcarolinemaccallum.com/