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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 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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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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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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Researchers say cannabis may help treat Covid-19

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Researchers have been investigating cannabis as a possible treatment for Covid-19 since the pandemic began in 2020. They directed much of their attention towards cannabis’ ability to dampen the immune system and quell cytokine storms, a dangerous and potentially deadly immune response that occurs in severe Covid-19 cases and leads to respiratory distress and organ failure. Since then, scientists have identified a variety of ways cannabis might be helpful in fighting the disease. 

https://www.leafly.com/news/science-tech/researchers-say-cannabis-can-help-treat-covid-19?utm_source=blast&utm_medium=email&utm_campaign=trf-nl-all



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Medical pot patients’ lives improved during 1-year study

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A recent study conducted by a group of UK-based researchers found that medical cannabis was associated with improvements in health-related quality of life, anxiety, and sleep quality. This research adds to the growing body of literature suggesting that medical cannabis can help patients with chronic health conditions improve their well-being. The study also observed a reduced use of opioid medications among cannabis patients, and found that patients prescribed dried cannabis flower (versus tinctures and lozenges) were most likely to show clinical improvement.

The complex and nuanced task of studying cannabis

The cannabis plant is an incredibly complex and variable medicine. It contains over 400 chemical compounds, more than 100 of which have known medical effects. These chemicals are present in different amounts and combinations in cannabis, depending on numerous factors: The particular strain, the way it was grown, the way it was processed, and the way it is consumed. 

The authors of this study took a different route: They studied the effects of specific regimens of medical cannabis and their effects on patients’ well-being.

When observational studies investigate cannabis use, they often capture results from a wide variety of different substances, not just cannabis. More controlled studies—there aren’t many—tend to focus on one or two isolated components of cannabis. While these studies provide more specific results, they don’t tell us much about how the various compounds interact with each other. This makes cannabis extremely challenging to study. 

The authors of this study, however, decided to take a different route: They studied the effects of specific regimens of medical cannabis and their effects on patients’ well-being. By keeping track of the particulars of the medical cannabis in question, they hoped to gather data that could give us more specific information about cannabis’ effects.  

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Can cannabis improve quality of life? 

In this study, the researchers analyzed data from a cohort of 1,378 medical cannabis patients in the UK. About 40% of the patients were already consumers when the study began; the rest were not. 

These patients had been prescribed a variety of specific cannabis options, including inhaled dried flower, sublingual oils, or a combination of the two (based on the medical needs of the patient).

At the start of the study, researchers collected information about patients’ demographics, conditions, medications, and occupations, as well as their history with cannabis, other drugs, and alcohol. Patients’ primary reasons for using cannabis varied, but the most common reasons were chronic pain, neuropathic pain, fibromyalgia, and anxiety.  

The authors found statistically significant improvements from baseline on all measures—anxiety, sleep quality, and health-related quality of life—at each benchmark.

Once the study began, patients were given a variety of self-reporting assessments they could use to describe their health-related quality of life, anxiety, and sleep quality. The first assessment was given before patients began their cannabis regimen. Patients were given additional assessments 1, 3, 6, and 12 months into the program. 

After analyzing the data from the year-long study, the authors found statistically significant improvements from baseline on all measures—anxiety, sleep quality and health-related quality of life—at each benchmark. The data suggested that cannabis was benefiting these patients. 

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Patients in the study who used opioid medications also reported reducing their opioid use during the study. The greatest reduction (5.66%) occurred after one year of cannabis use. 

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Dried cannabis flower showed the biggest improvements

In an interesting twist, the study also found that patients prescribed dried cannabis flowers—rather than sublingual cannabis options, like tinctures or lozenges, alone—experienced more substantial improvements. Dried flowers are the raw form of cannabis, usually consumed by smoking or vaporizing. Sublinguals, on the other hand, are a more processed form of cannabis which can be absorbed through the mucosal membranes in the mouth. 

While patients who used both cannabis flowers and sublingual cannabis saw similar results to those using cannabis flowers alone, patients using solely sublinguals had less significant improvements. Those patients nonetheless saw improvements from baseline at each check-in. 

While roughly one-fifth of the patients did experience negative side effects from cannabis, the majority of those side effects were moderate or mild. Researchers observed that the most common side effects were fatigue, somnolence (excessive sleepiness), dry mouth, lethargy, and headache. One of the 1,378 patients experienced a single episode of psychosis. Lastly, the patients who were already using cannabis at the onset of the study demonstrated less negative side effects than those who had been abstinent.

We need more cannabis research

While this study provides valuable insight—and supports the idea that cannabis can improve our quality of life—it does have some limitations. As an observational study, it cannot prove that cannabis caused the improvements, only that a correlation exists. Additionally, since many patients were already cannabis consumers, the study may be biased towards them, since cannabis is evidently effective for them. Future research should include randomized and controlled double-blind studies. 



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Study: More older adults are using cannabis post-pandemic

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Hunter Boyce | (TNS) The Atlanta Journal-Constitution

A new study, published in the Cannabis and Cannabinoids Research journal, found more older Americans are using cannabis today than before the pandemic. According to researchers with the University of Michigan’s Institute for Healthcare Policy and Innovation, roughly 1 in 8 Americans over 50 currently use the substance.

“As the stress of the pandemic and the increased legalization of cannabis by states converged, our findings suggest cannabis use increased among older adults nationally,” addiction psychologist and study lead Anne Fernandez told the University of Michigan.

Read the rest of this story on BostonHerald.com.



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