Exit Strategy

CBD-rich cannabis should be considered as a first-line treatment for pain rather than as a medication of last resort.

Everyone knows opiates are a problem. Overdoses have increased sharply over the last five years. In 2017, more than 72,000 Americans died from drug overdoses—more than from car crashes or guns. In fact, more Americans died from drug overdoses last year than in the entire Vietnam War. It’s gotten to a point where opiates are lowering the US life expectancy rates.

It’s a plague, and it’s getting worse.

Given the risks and dangers, one would hope that—at the very least—opiates would provide effective, long-term pain management for those who need it. But the evidence suggests otherwise.  

In 2015, the Annals of Internal Medicine looked at 34 studies on adult chronic pain patients who were using opioids for more than three months. The authors were unable to find a single study that compared opioid use for more than a year to placebo, non-opioid treatments, and/or to no therapy. The article concluded: “Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain in function.” 

What the researchers did find—unequivocally—was an increased risk of serious harm associated with long-term opioid use, including fractures, heart attacks, sexual dysfunction, and overdose. 

Care By Design’s 2016 survey of over 800 pain patients found similar outcomes: A striking number of patients (around half) reported that opiates had a negative impact on overall wellbeing, resulting in worsening mood, energy, functional ability, and sleep.


Safe and Effective Pain Relief with Cannabis

More than 45 studies have looked at cannabis and pain related to chronic diseases such as cancer, diabetes, fibromyalgia, multiple sclerosis, HIV, rheumatoid arthritis, and spinal injuries. The majority of the studies showed an improvement in pain relief in comparison to a placebo or to other traditional pain medications. Equally importantly, because it is non-toxic cannabis isn’t associated with the same damaging side effects, in particular overdoses. There have been no documented overdose fatalities due to cannabis. 

Cannabis May Reduce Opiate Usage

Researchers are also finding that cannabis may be helpful when used in combination with opiates. A UCSF study found that when cannabinoids were added to opiate-based pain regimens, patients were able to decrease the amount of opiates they used without any increase in pain. In other words, cannabis appeared to make opioid treatment more effective at lower doses with fewer side effects. This is supported by numerous observational studies that have noted that many patients voluntarily decrease the number of opiates they are using—or go off opiates completely—when they use them in conjunction with cannabis. 

Cannabis Correlates to Reduced Opioid Deaths

The Journal of the American Medical Association published a study that looked at various interventions to address the opioid problem and assessed how many opioid overdose deaths these interventions could prevent. Patient monitoring programs did not have any significant effect on reducing opioid overdose deaths. Increased state oversight of pain management clinics had no significant effect either. But simply passing a state medical cannabis law on average reduced opioid overdose deaths by 24.8 percent. Whether this decrease in mortality is the result of cannabis’ meeting patients’ pain management needs directly or indirectly through enhancing the efficacy of opiates hardly seems important. What is important is fewer lives are lost and fewer families destroyed in states that have medical cannabis laws enacted.

Cannabis May Protect Addicts

There is also evidence suggesting that cannabinoids may protect the brains and bodies of those suffering from addiction. A recent study published in Liver International suggested that cannabis use is associated with a reduced incidence of liver disease in alcoholics. Another study of young binge drinkers showed less brain damage in alcohol users who also used cannabis than in alcohol-only users.

Cannabis Helps with Withdrawal

In addition to replacing or reducing opioid use, improving the pain relief that opioids provide, and preventing opioid dose escalation and tolerance, some researchers suggest that cannabis can treat the symptoms of opioid withdrawal: nausea, vomiting, diarrhea, abdominal cramping, muscle spasms, anxiety, agitation, restlessness, insomnia, and minor symptoms like a runny nose and sweating. 

Cannabis May Reduce the Risk of Relapse

And, finally, cannabis may help reduce the risk of relapse in addicts trying to abstain from opiates. In recent animal studies, researchers found that the heroin-seeking behavior of self-administering rats decreased when the animals were given CBDPreclinical data further suggests that CBD inhibits the reward-facilitating effect of opiates by disrupting the reconsolidation of cue-induced memories that reinforce addiction.

Gateway to Health

A tenet of healthcare in the United States is “First, do no harm.” Patient reports of cannabis’ efficacy together with its low side effect profile suggest that it should be considered as a first-line treatment for pain and/or as an adjunct treatment to opiates rather than as a medication of last resort. The short version is this: Access to cannabis may save lives.

Participate in the Project CBD and Care By Design pain survey here.

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