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How Does Cannabis Compare to Opioids for Killing Pain?

Christine Kielhorn PHD
cannabis or opioids offered in white cups

Cannabinoids and opioids definitely have similarities, and may even interact in killing pain and enhancing analgesia. 

Cannabinoids (THC, CBD, etc) and opioids have some important similarities. They are both plant-based medicines, both psychoactive, and both used effectively in killing pain.  Cannabinoid and opioid molecules both work by binding to G-protein coupled receptors that are primarily located in the synapses of neurons and in areas of the brain known for regulating pain. Once activated, cannabinoid and opioid receptors work down similar signaling pathways, such as the MAP kinase pathway. Not only are the cannabinoid receptors, especially CB1, frequently found in the exact same tissues as the opioid receptors, there are some hypotheses that the two receptors may even come together and interact physically.

How Treatments Killing Pain Function

The precise mechanisms of relief are also similar. Cannabinoids work by dampening the pain signaling from the injured tissue. This mechanism essentially reduces your sensitivity, effectively killing pain by making you feel less. In the neural synapses, both cannabinoids and opioids interfere with pain signaling by preventing the release of particular neurotransmitter.

In the case of pain relief, there is definitely crosstalk between the cannabinoid and opioid signaling systems as combining cannabinoid and opioid medicines simultaneously, enhanced the pain relieving potential, greater than either medicine alone.  Studies in animals have indicated that cannabinoid receptor activation by delta-9-tetrahydrocannabinol (THC) triggers the release of endogenous opioids, which may be behind this enhancement effect.

THC chemical structure over cannabis leaf, pain treatment

But Here’s Where They Part Ways

Tolerance to cannabinoids and opioids develops over time, requiring dosages to increase in order to maintain effects. The potential for abuse in opioids is very high.  Studies found, however, that cannabis use reduced opioid withdrawal symptoms. Cannabinoids could therefore be used to help reduce opioid dependence.

One of the major differences between cannabis and opioids, especially when used for pain, is that the side effects of opioids are typically more difficult to bear. Especially more so than those that associate with cannabis. Cannabis has no ill side effects, aside from slight lightheadedness or relaxed feelings.  More critically, overdosing with opioids can result in death, while overdosing with cannabis will never. Respiratory depression is usually the cause of death in opioid overdoses. This is because many opioid receptors appear in the brainstem, which controls heart rate and respiration.

Cannabis and opioids work in similar ways within the central nervous system to cut the brain’s response to hurt. Cannabis is now one of the leading contenders to replace opioid drugs in pain management. This is because of the lower risks and fewer side effects. In addition, the simultaneous use of cannabinoid and opioid medicines may also be a valuable tool for effectively managing pain. It does so while reducing the risk for developing tolerance and addiction.

How has cannabis brought you relief?

Christine Kielhorn
  • Avatar
    Paul Boehme

    I appreciate Good Science, Written Understandably.
    Same Entourage Effects noted between THC & CBD.
    Ccannabis use helpedme WANT TO GET OUT OF BED, Something Opioids NEVER DID!
    Opioids in fact, made me want to Cocoon.
    Cannabinoids made me Curious, made meWant to Grt Up!
    Regain Balance, Relearn to Walk, relearn to Swallow, Regain Will to Live!

    December 15, 2017 at 3:47 pm Reply
    • Jennifer Grant

      That’s really great, Paul! Cannabis is amazing for managing chronic pain and still allowing one to “live”. We are happy you have found that balance. Thank you for sharing!

      December 15, 2017 at 4:50 pm Reply
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      Jim Grayson

      Hi, Paul. I thank God you are better than you were. I am awaiting the legislators in Kentucky to finally get around to making medicinal cannabis legal. I’ve had four failed spinal fusions and have been in constant nerve pain since February 3, 1989. I’m not able to say what my pain management doctor prescribes but it has made a mess of me and my colon. I’m sure you know what I mean. Apart from the back pain, I have had congestive heart failure following a heart attack in 1993 (I’ve had three separate heart bypass surgeries since the heart attack), numerous joint problems on which I’ve had arthroscopic surgeries. I have hypothyroidism, which started as hyper but I had to have mt thyroid removed to help get it under control. I have other problems as well which I won’t go into.
      I know the feeling of not wanting to get up any more. Part of it is my heart but a great deal of it is not wanting to face the pain which ramps up as soon as I get out f my recliner. That’s where I have to sleep.
      Anyway, my friend, I’m so happy for you, truly, for finding what I know would help me. I used it illegally for six years in the 1990’s and those were the happiest years I’ve had since my back pain started. Medical cannabis works. I wish the big pharma companies which are paying off the lawmakers to keep cannabis illegal would burn down. Truly. I hate to say that but my life is a wreck as it is now. I was able to get out ONCE this year on an outing unrelated to doctors, not counting two brief trips to the library where I used a wheel chair to get around.
      Paulo, may the Lord bless and keep you and your loved ones, and may you continue to feel better and better, in the Name of Jesus.

      December 17, 2017 at 4:48 pm Reply
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    Brad Garner

    I’m using combination of both at moment to control extreme pain .I find it as effective & less stress on the body in general

    December 17, 2017 at 12:22 pm Reply
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    So I’m curious about one thing, does all cannabis contain some amount of CBD?

    December 17, 2017 at 2:32 pm Reply
    • Jennifer Grant

      Hi Randy, each cannabis strain will have its unique CBD concentration. You can purchase or grow high CBD strains (such as AviDenkel and Charlotte’s Web) that have very low THC; you can have a 1:1 ratio of THC to CBD (like Sour Tsunami and Cannatonic; and then there are the high THC strains (Blue Dream and Ghost OG).

      December 17, 2017 at 8:52 pm Reply

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