More chronic pain patients are choosing cannabis over opioids
Studies show that living with chronic pain significantly decreases quality of life, worsens chronic disease and psychiatric disorders, and reduces productivity which can result in lost wages, according to StatPearls. Statistics also showed chronic pain patients have a “significantly increased risk for suicide and suicidal ideation.”
In February 2023, researchers using a chronic pain module introduced by the National Health Interview Survey found that 50.2 million adults in the U.S., or 20.5%, report having pain most or every day. To combat these deadly side effects and perhaps some of the pain itself, many patients are choosing to treat pain with cannabis.
Traditional treatments for chronic pain
According to the Mayo Clinic, the most common first-line prescription for chronic pain is acetaminophen, a generic form of Tylenol. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are another commonly prescribed pain medication.
Taking the prescribed dose of NSAIDs can cause nausea, stomach pain, stomach bleeding, ulcers or reflux, and kidney disease. Taking more than prescribed carries a risk of kidney problems, fluid retention, and high blood pressure. COX-2 inhibitors are an NSAID developed to combat these side effects, but taking them carries a risk of stomach bleeding.
Some doctors prescribe antidepressants to block the part of the brain that feels pain. And for nerve pain, anti-seizure medication prescriptions can quiet pain signals. These are both considered low-risk medications with minimal side effects, but treatment is not always successful.
Opioids are the final line of pharmaceuticals prescribed to chronic pain patients. They are meant to stop pain signal transmission to the brain. Prescription opioids can provide powerful relief in moments of severe pain, but they are also highly addictive.
The Mayo Clinic notes that within one week of use, patients using prescribed opioids could suffer addiction, overdose, tolerance and dependence, nausea, constipation, and drowsiness.
Due to the high risk for addiction and death, opioids are not recommended as a first step to treat severe pain– but the country is still reeling from decades of overprescription. A StatPearls paper revealed that 11 million of the 25 million people prescribed pain relievers from 2002 to 2011 misused the prescription.
By 2017, six out of ten overdose deaths in the United States were due to both prescription and nonmedical opioid use, and the U.S. declared the opioid crisis a national epidemic. Two years later, 22.1% of adults were still using prescription opioids for noncancer chronic pain.
Can cannabis reduce opioid dependence in pain patients?
For many, opioids can feel like the only outlet for relief–but a growing number of patients are turning to medical cannabis as an alternative.
In January 2023, researchers surveyed adult chronic pain patients living in states with legal cannabis. A screener survey identified people with chronic pain; researchers then assessed self-reported use of cannabis, pharmacologic treatments, common nonpharmacologic treatments, and substituting cannabis for these treatments.
The study found that over half of adults who used cannabis to manage pain reported a decrease in prescription opioids, non-prescription opioids, and over-the-counter pain medications; less than 1% reported an increase in opioid use. In addition, 38.7% of respondents shared that cannabis treatment led to decreased physical therapy visits.
Researchers concluded that patients with access to regulated cannabis products seek cannabis as an analgesic treatment. These findings persist despite the knowledge gap between Western medicine and medical cannabis. But this knowledge gap must be closed for the medical community to accept cannabis as a viable pain treatment.
Western medicine can eventually catch up
Doctors learn to follow evidence-based research in medical school, but cannabis research is sparse due to its federal scheduling under the Controlled Substances Act. But recently, clinicians in Canada, where cannabis is federally legal, published clinical practice guidelines to help doctors navigate cannabis as a treatment for chronic pain.
Lead author Alan Bell, MD, assistant professor of family and community medicine at the University of Toronto told Medscape Medical News, “But I would strongly argue that I would use cannabis-based medicine over opioids every time. Why would you use a high potency-high toxicity agent when there’s a low potency-low toxicity alternative?”
Guideline authors assessed 70 articles, 19 systematic reviews, and 51 original research studies on cannabis and cannabinoid-based medicines to provide policies for route of administration, dosage form, type of dosing, how cannabinoids differ, drug interactions, adverse effects, and risks.
The authors also considered the tapering off of associated analgesics during cannabinoid therapies and the risk of cannabis use disorder. These guidelines provide traditional medicine with tangible research that can benefit chronic pain patients in Canada.
Doctor protocol in the U.S. will not change without evidence-based research, however, which will most likely require federal de-scheduling. Even so, these guidelines help normalize cannabis as a viable pain management tool as chronic pain patients seek alternatives to highly addictive prescriptions with unwanted side effects.