Adults with chronic pain are often prescribed prescription pain medications, including opioids, for pain relief. However, there are risks to pain medications, including the crisis of the opioid epidemic, which has claimed millions of lives around the world.
An estimated 20% of adults have chronic pain. Many people are looking for alternative options, like plant-based compounds (PBCs) and cannabinoids.
Read on to learn about cannabinoids, what we know about safety, and if they can be used instead of opioid medications for chronic pain.
What are plant-based compounds?
Plant-based compounds (PBCs) are the naturally occurring molecules in plants that have been studied for their medicinal properties. This includes their use in chronic pain.
PBCs include a large number of bioactive compounds that can improve our health. They can be found in:
- Fruits
- Vegetables
- Nuts
- Grains
A few examples are:
- Polyphenols
- Flavonoids
- Antioxidants
- Terpenes
- Alkaloids
PBCs are also found in herbs, like cannabis.
What are cannabinoids?
Cannabinoids are compounds that are found in the cannabis plant. These include the most researched cannabinoids: cannabidiol (CBD) and tetrahydrocannabinol (THC).
Along with CBD and THC, there are a number of minor cannabinoids and terpenes found in the cannabis plant that impact the body.
What THC and CBD medications are approved for use?
In 1985, the Food and Drug Administration (FDA) approved two synthetic THC medications for nausea and vomiting from chemotherapy: dronabinol (Marinol) and nabilone (Cesamet).
In 2018, the first-ever CBD medication, Epidiolex, was approved for two seizure conditions, Lennox Gastault and Dravet Syndrome.
Clinical trials are ongoing worldwide to look into the use of cannabis products for chronic pain. One medication, nabiximols, which has a 1:1 ratio of CBD to THC, has shown promise for its use in chronic cancer pain. The medication is prescribed in more than 20 other countries and is currently in clinical trials in the U.S.
But THC may not be the right option for all types of chronic pain. For example, this study showed no difference between THC and a placebo for chronic abdominal pain. More research is needed to verify these findings.
What research is there on using cannabinoids for chronic pain?
In 2017, the National Academies of Science, Engineering, and Medicine (NASEM) determined that there is evidence for cannabinoids to be used for chronic pain in adults. NASEM called for larger studies and long-term safety data.
For non-cancer chronic pain, two review articles evaluating 2,000 patients showed the benefit of cannabis and its pain-relieving effects. For example, cannabis improved pain-related symptoms such as:
- Problems sleeping
- Muscle discomfort
- Quality of life issues
- Patient satisfaction
Are cannabinoids safe for treating chronic pain?
Many people are turning to CBD and other cannabinoids to treat a range of conditions, including chronic pain. However, there are possible risks and side effects from using THC and CBD, including:
- Drowsiness
- Decreased appetite
- Insomnia
- Poor quality sleep
- Fatigue
- Breathing problems
- Increased heart rate
- Extreme nausea and vomiting
Certain medications shouldn’t be taken with cannabinoids, due to possible negative interactions. A few of these are:
- Anticoagulants like warfarin (Coumadin)
- Antiseizure medications like clobazam (Onfi)
- Antidepressants like amitriptyline (Elavil) and mirtazapine (Remeron)
- Pain medications like tramadol (Ultram)
- Transplant medications like tacrolimus (Prograf) and cyclosporine (Neoral)
More research is needed to determine whether cannabis can be used safely in people who are pregnant and breastfeeding, as well as in infants.
As we said above, only a few cannabis products have been approved by the FDA. That means many other, non-regulated ones are being used. These have a higher risk of contaminants, pesticides, and heavy metals. This is why it’s important to use cannabis products from trustworthy brands that publish their lab test results.
Cannabis therapy varies according to different people’s needs. Reach out to your healthcare provider before starting to take any cannabinoids.
Can I use cannabinoids as an alternative to opioids?
For some conditions, cannabis may provide an alternative to opioids. Studies have not yet shown cannabis to be helpful for acute pain. However, for chronic pain — and particularly nerve and neuropathic pain — there may be benefits.
There is promising research for the use of THC in neuropathic pain. This shows promise for its use as a single cannabinoid. These studies showed that even a small amount of THC decreased chronic neuropathic pain. However, it worked better when inhaled, rather than taken by mouth.
One study from 2020 looked at adults who were reliant on opioids for chronic pain for a decade. With cannabinoids, half of the adults were able to stop all opioids. A third cut back on them. Patients have said they prefer cannabinoids over opioids because of:
- Less severe side effects
- Lower effects from withdrawal
- Easier accessibility
- Better outcomes
Can I use cannabinoids in combination with opioids?
Studies have shown taking cannabis can decrease the use of opioids for chronic pain by 40% to 60%. When taking both of these medications as a part of their chronic pain therapy plan, patients experienced fewer side effects and a better quality of life with cannabis use.
CBD may also help with addiction to substances like:
CBD may also be helpful for people trying to taper off of opioids.
Preliminary studies in animals have shown that cannabis may help reduce the symptoms and negative effects of opioid withdrawal. Using a combination of naltrexone and dronabinol, an FDA-approved synthetic THC medication, has been shown to improve symptoms associated with withdrawal-like symptoms, such as problems sleeping, low appetite, and low energy. Other studies have shown similar results when using cannabis in combination with fentanyl and morphine.
Are cannabinoids more or less habit-forming than opioids?
People consuming cannabis regularly can become dependent on it, but it is less habit-forming than opioids. You can become tolerant to both cannabinoids and/or opioids if you use them regularly, and you can experience side effects with both if you stop taking them. The overuse of both can lead to substance use disorders. Cannabis use disorder is uncommon. Less than 10% of cannabis users will develop this disorder in their lifetime.
While stopping cannabis abruptly is not lethal, some symptoms may include:
- Appetite changes
- Weight loss
- Sleep disturbance
- Irritability
- Anger
- Anxiety
Unlike opioids, there have been no reported deaths due to the overdose of cannabis.
What else can I do to treat chronic pain?
Adults are becoming increasingly more interested in unconventional, non-prescription therapies. For chronic pain, research has shown that people taking opioids for chronic pain have also found other activities helpful, such as:
- Massage therapy
- Chiropractic adjustments
- Acupuncture
- Yoga
- Stretching
- Plant-based diets
More studies are needed to see if these therapies can reduce the amount of opioids or cannabinoids needed to relieve chronic pain.
The bottom line
Early research shows that cannabis can be effective for chronic pain, and it may be an alternative to opioid medications. Cannabis may have fewer side effects and risks when compared to opioids, but it also has some important risks of its own. Larger studies and more long-term data is needed. Make sure to discuss the specific benefits and risks to you with your healthcare provider.
