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Can cannabis replace opioids? | Leafly

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In 1995, the president of the American Pain Society called for pain to be added as a fifth vital sign evaluated and managed by physicians—body temperature, heart rate, respiration, and blood pressure are the original four. Measuring pain subsequently became a widely accepted practice among clinicians. With 20% of adults experiencing chronic pain, prescription opioids soon doubled and Americans began consuming 80% of the global opioid supply.

President Trump officially declared the opioid crisis a “public health emergency” in October 2017. By then, the United States was approaching 50,000 opioid overdose deaths total and nearly 60% of them were due to illicit synthetic opioids such as fentanyl or tramadol. The problem has continued to escalate. Last year, there were more than 80,000 opioid overdose deaths with roughly 90% resulting from highly potent synthetic forms. This crisis is not getting better, and new strategies are needed to solve the problem.

Does legalizing cannabis reduce opioid use?

There are several reasons why legalizing cannabis seems like a promising strategy to combat the ongoing opioid crisis. For one, early population reports found that states that legalized medical cannabis saw a reduction in opioid overdose deaths. However, those findings no longer hold when the timeline of analysis is extended to the present day; any benefit that cannabis legalization has on reducing opioid overdose seems to be short lived.

States that legalized recreational cannabis saw an initial reduction in opioid-related emergency room visits by 7.6% compared to states that did not legalize cannabis, but this difference was gone within 6 months. It remains possible that cannabis may serve as a substitute for common prescription opioids like oxycodone, codeine, or hydrocodone, but can’t overcome the severity of dependence to more potent illicit opioids like fentanyl or heroin that are being abused at escalating rates.

Some studies point to notable reductions in prescription opioid use among patients who also use cannabis, but this benefit disappears in rigorously controlled clinical trials. These clinical trials fail to find consistent results on cannabis co-use with prescription opioids, despite most patients saying that they prefer cannabis over opioids.

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How Cannabis Enhances the Effects of Opioids

How might cannabis replace opioids?

There are currently 15 ongoing clinical trials investigating the ability of cannabis to reduce opioid need. These clinical trials are driven by hard-to-ignore evidence from animal studies that look at the pain-relieving interactions between the endocannabinoid system, which is stimulated by cannabinoids like THC, and the opioid system.

Pain experiments in rodents have consistently found that THC reduces the need for opioids. Across seven different studies, THC reduced the effective dose of morphine by 3.5 times. This beneficial effect is supported by three key pieces of evidence:

  1. Many cannabinoids, such as THC, stimulate CB1 receptors in the endocannabinoid system, which are found in the same pain-processing brain areas as opioid receptors and may also contribute to pain reduction.
  2. CB1 receptors in the body interact with opioid receptors to boost their pain-relieving effect in rodent studies.
  3. CB2 receptors, another cannabinoid target, can stimulate the release of the body’s own opioids which activate pain-relieving opioid receptors.

So why is there inconsistency between these ongoing clinical trials and the population studies mentioned above?

A direct reason is unclear. Some argue that a sense of control over pain management, as one experiences when they choose to use cannabis, can promote better outcomes. This effect could explain why patients who could choose to co-use cannabis in certain trials, as opposed to randomized clinical trials, reduced their need for opioids.

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What is the endocannabinoid system and what is its role?

It’s also possible that these benefits result from the placebo effect, where people can boost their opioid levels without drugs and dampen pain simply because they think they’re receiving an active pain medication.

Adding confusion to results, cannabis’ opioid-reducing effects may go away with the prolonged use of high-potency THC products, which are increasingly common in legal markets. Rodent studies of THC’s opioid-reducing effects are often short in duration, usually lasting only several days, whereas human use is often chronic—people use for weeks or longer. Repeated use of high-potency THC leads to tolerance, which often results from a reduced number of CB1 receptors and weaker overall endocannabinoid signaling.

The development of THC tolerance would therefore hinder the ability of CB1 and opioid receptors to work together to reduce pain. This could explain why short-duration rodent studies show opioid-reducing benefits of THC, and how these effects are often lost in long-term human clinical trials.

Further, this phenomenon could explain the initial drop in opioid overdoses when states legalize cannabis, but with the eventual onset of tolerance over several months, the opioid-reducing effects of cannabis in the population disappear.  

Considering all the current evidence, there’s no clear consensus over whether cannabis can replace or reduce the need for opioids in pain management.

Are there risks of using co-using cannabis and opioids?

In some cases, the combination of cannabis with opioids was associated with worsened mental health, and this combination may be worse for those over 65 years old. Yet other safety issues, like opioid’s suppression of breathing, were not made worse with co-use of cannabis, at least alleviating some concern.

And in most cases, co-use of cannabis does not increaseopioid use, dispelling the idea that cannabis is a gateway drug, a warning spouted by many anti-drug campaigners.

Can CBD help with opioid dependence?

Despite the lack of clinical evidence that cannabis can replace opioids, CBD is emerging as a potential strategy to help those trying to overcome from opioid use disorder.

Italy unintentionally legalized CBD-rich cannabis in 2017 (essentially “hemp” by United States legal standards), and saw a reduction in opioid use, suggesting that CBD-rich cannabis may replace opioids in the short-term.

Several clinical studies have found that CBD reduces cues that trigger opioid cravings, and dampens the increased stress response that accompanies cravings. Insight from rodent studies shows that CBD diminishes many of the negative changes in behavior, anxiety, and genetic expression that accompany opioid withdrawal and lead to relapse.

These studies have set the stage for additional clinical trials (for example one that’s to take place at the Tarzana Treatment Center in Los Angeles) to study CBD’s potential as an adjunctive therapy for opioid use disorder.  

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The complete guide to CBD (cannabidiol)

Can cannabis replace opioids?

The jury is still out. Most patients report that they’d prefer to use cannabis over opioids for pain relief and believe it to be an effective alternative. However, the range of use patterns, product options, cannabinoid and terpene content, and reasons for needing pain medication make this a particularly challenging research question to empirically study.

Control over the types of cannabis products being used together with optimized formulations for pain management (with moderate THC potencies!) will lead to a clearer picture of cannabis’ potential to replace opioids.

Josh Kaplan's Bio Image

Josh Kaplan

Josh Kaplan, PhD, is an Associate Professor of Behavioral Neuroscience at Western Washington University. He is a passionate science writer, educator, and runs a laboratory that researches cannabis’ developmental and therapeutic effects.

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anxiety

CBD vs. THC for Anxiety Relief: New Study Finds the Answer

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A groundbreaking study conducted by the University of Colorado Boulder reveals that strains of cannabis high in cannabidiol (CBD) and low in tetrahydrocannabinol (THC) are most effective at alleviating anxiety. This research, the first to examine the acute and extended effects of legal market cannabis products on anxiety symptoms, underscores the therapeutic potential of CBD, offering a safer alternative to THC-dominant strains and prescription medications for anxiety relief.

Cannabis has long been a subject of debate due to its varied effects on different individuals, with some experiencing relaxation and others facing heightened paranoia and anxiety. This study provides scientific backing to the anecdotal evidence, pinpointing CBD as the key compound for anxiety relief without the adverse effects associated with THC.

The research team embarked on a first-of-its-kind experiment involving 300 participants with anxiety, assessing their responses to different strains of cannabis with varying levels of THC and CBD. The study categorized the cannabis strains into three groups: THC-dominant, equal parts THC and CBD, and CBD-dominant, alongside a control group with no cannabis use.

Over the course of four weeks, participants reported their experiences, with those using CBD-dominant strains experiencing significant reductions in tension and anxiety without the impairment or paranoia linked to higher THC levels. Notably, even the THC-containing strains did not exacerbate anxiety over the long term, suggesting that THC’s anti-anxiety effects might still be beneficial compared to abstaining from cannabis use altogether.

This research, published in Cannabis and Cannabinoid Research, offers compelling evidence of CBD’s role in anxiety management, potentially guiding legal prescriptions and product development in countries that have embraced medical cannabis.

Why It Matters: The findings highlight the importance of understanding cannabis’s chemical composition for therapeutic use, particularly for anxiety treatment. By distinguishing the effects of CBD from THC, this study paves the way for safer, more effective anxiety treatments that harness the benefits of cannabis without the risk of exacerbating anxiety symptoms.

Potential Implications: This study could significantly impact the medical cannabis industry, influencing the development of CBD-dominant products for anxiety relief. It may also inform regulatory policies and consumer choices, encouraging a shift towards strains and products that provide the therapeutic benefits of cannabis without the negative side effects associated with high THC levels.

Source: ScienceAlert



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animal health

CBD and THC for Animals

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The Genetic Literacy Project reports on the emerging trend of using medical marijuana, specifically CBD and THC, for treating pets and zoo animals. This innovative approach, already legal and widespread for human medical treatment in various countries and U.S. states, is beginning to gain attention in veterinary medicine. Studies and anecdotal evidence highlight cannabis’s potential benefits for animals, addressing conditions like seizures, pain, anxiety, and more. However, the veterinary application faces hurdles such as legal restrictions, drug stigma, and a lack of comprehensive studies.

Medical cannabis has found its place in human healthcare, offering relief from various ailments. Its potential is now being explored beyond humans to include our animal companions. Veterinarians in some parts of the world, where it’s legally permissible, are beginning to administer cannabis and its compounds to a wide range of animals, from domestic pets to zoo inhabitants like parrots, turtles, and hyenas. The primary focus has been on treating conditions such as seizures, pain, and anxiety, especially in dogs, with many pointing to significant benefits.

Despite these promising developments, the path to integrating cannabis into veterinary practices is fraught with challenges. Legal ambiguities and prohibitions in many countries, including the U.S., create significant barriers to research and clinical use. Furthermore, the lingering stigma associated with cannabis and a lack of education on its medical applications in animals compound the issue, alongside a scarcity of peer-reviewed scientific studies to back up its efficacy and safety.

California represents a beacon of progress, with laws gradually opening the door for veterinary cannabis. This shift has sparked a movement among a small yet expanding group of international veterinarians. These professionals are dedicated to bringing cannabis into the veterinary mainstream through concerted efforts in education, research, and advocacy, aiming to overcome the hurdles that currently restrict its use.

Why It Matters: The exploration of medical marijuana in veterinary medicine represents a significant shift towards more holistic and potentially effective treatments for animals. This approach could revolutionize how veterinarians manage pain, anxiety, seizures, and other conditions, offering a new avenue of relief where traditional medications may fall short or produce undesirable side effects.

Potential Implications: As veterinary cannabis gains traction, we may see changes in legislation and an increase in research funding, leading to a broader acceptance and understanding of cannabis’s role in animal healthcare. This could result in improved treatment options for pets and zoo animals alike, enhancing their quality of life.

Source: Genetic Literacy Project



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Cannabis

Smoking Marijuana Linked to Higher Risk of Heart Attack & Stroke

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Recent research suggests that using cannabis, whether by smoking, eating, or vaping, may elevate the risk for heart attack and strokes. The study, published in the Journal of the American Heart Association, analyzed survey data from over 434,000 U.S. adults, revealing that cannabis users had a higher risk for cardiovascular problems, independent of tobacco use or other cardiovascular risk factors.

The American Heart Association News reports a significant finding concerning cannabis use and cardiovascular health. According to a study published on February 28, 2024, in the Journal of the American Heart Association, individuals who consume cannabis in any form might face an increased risk of experiencing heart attack and strokes. This research, led by Dr. Abra Jeffers from Massachusetts General Hospital, emphasizes the growing concern over the cardiovascular disease risks associated with cannabis use, especially as its perception as a harmless substance diminishes.

The study meticulously analyzed data from the Centers for Disease Control and Prevention, spanning from 2016 to 2020, involving 434,104 U.S. adults. It aimed to investigate the correlation between cannabis usage and self-reported cardiovascular outcomes, such as coronary heart disease, heart attack, and strokes. Remarkably, the findings indicated that any level of marijuana use was associated with a heightened risk for these cardiovascular events. Notably, daily cannabis users had a 25% increased likelihood of having a heart attack and a 42% greater chance of experiencing a stroke compared to non-users.

Dr. Jeffers highlighted the potential additional risks posed by smoking cannabis, the most common method of consumption, due to the inhalation of particulate matter. The study’s revelations are particularly timely, given the rising number of marijuana users in the U.S., where recreational use has been legalized in 24 states and the District of Columbia.

Why It Matters: This study sheds light on the critical need for awareness regarding the potential cardiovascular risks associated with cannabis use. It challenges the diminishing perception of harm and underscores the importance of considering the health implications of marijuana, particularly for those at risk of heart disease.

Potential Implications: The findings from this study could influence public health policies and clinical practices, emphasizing the need for healthcare providers to discuss cannabis use with patients and consider its potential cardiovascular risks. It may also spark further research into understanding the mechanisms behind cannabis-related cardiovascular risks and how to mitigate them.

Source: Heart.org



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