Cannabis and Opioids are Unlikely Partners in Harm Reduction
Cannabis and opioids can work together to reduce pain and lower opioid prescriptions.
According to the National Institute on Drug Abuse, opioid overdose deaths rose from 15,000 to almost 50,000. Even more terrifying is the jump in deaths associated with Fentanyl. For the same time frame, Fentanyl overdose deaths went from a few thousand per year to roughly 30,000!
On average, 115 people die in the U.S every day from an opioid overdose. Sadly, approximately eighty percent of people with a heroin addiction start out with a prescription for an opiate for pain relief. Over the course of the prescription, the essential characteristics of the drug lead to abuse and dependency.
Cannabis has been replacing opioids in many legal states, but for some patients, it’s not enough to manage the pain. A recent study out of Columbia University, however, shows that cannabis and opioids can work together. This will reduce the number of opioids needed, thereby reducing harm to the patient.
Cannabis, Opioids, and the CB1 Receptor
Everyone has an endocannabinoid system. It is a network of receptors and chemical messengers, such as anandamide, that are present in almost every part of your body. This network is responsible for regulating pain, digestion, memory, the immune system, inflammation, and mood. There are two primary receptors, CB1 and CB2. The endocannabinoid system works to fight off infection, to trigger pain relief, to produce an anti-inflammatory response, as well as maintain homeostasis.
The chemical compounds in cannabis, such as THC and CBD, interact with this system in much the same way. The many cannabinoids each have a unique role in turning these receptors on or off, to mimic the chemicals produced by our own bodies. Of primary concern for pain relief is THC’s unique relationship with the CB1 receptor, located mainly within our brains. Like a hand fits into a glove, THC fits perfectly into this receptor. Opioids, while intimately linked to our opioid receptors, also interact with the endocannabinoid system, through the CB1 receptor. Their relationship to one another is interesting, to say the least. Cannabis and opioids can work synergistically.
The Cold-Pressor Test
A study by researchers — published in Neuropsychopharmacology (2018) — explored the relationship between opioids, cannabis and CB1 receptors. The team of researchers gave participants different doses of cannabis, oxycodone, or some combination of the two, then subjected to them Cold-Pressor Test (holding their hands in a bucket of cold water). The results are enough to make many ask, is there a place for cannabis alongside treatment with prescription opioids?
This double-blind, placebo-controlled, and first of its kind, study determined that cannabis improved the pain alleviation of oxycodone. Although the optimal dose of oxycodone by itself was 5 mg, this dose could be cut in half if participants were also given cannabis. Interestingly, by itself, neither cannabis nor the half dose of oxycodone was enough to reduce the experience of pain, but together they had a similar effect as an entire dose (5mg) of an opioid.
The Role of Cannabis in the Opioid Crisis
Some scientists believe that the ability of THC to monopolize the CB1 receptor is part of the reason why it works so well with opioids. The CB1 receptor is responsible for the feelings of euphoria (among other things) caused by opiates and cannabis. There is also an idea that opioid receptors and the CB1 receptor communicate and interact with one another. Although this friendly relationship is still poorly understood, it may be why there is such synergy between cannabis and opioids. Finally, there is also evidence that THC promotes the body’s own opioid response, relieving the need for external opioids.
There are three ways in which cannabis mitigates the need for high doses of opioids. First, it interacts with the CB1 receptor to boost mood. Second, because it activates the CB1 receptor, it promotes increased communication to the opioid receptor — a synergistic relationship. Thirdly, it increases the body’s ability to reduce its own pain through naturally increased opioid production.
Cannabis is Helping the Opioid Epidemic
While researchers continue to get to the bottom of the opioid-cannabis relationship, there is already evidence that cannabis is helping to fight the opioid epidemic in states with legal access to cannabis. It’s still early days, but statistics strongly suggest that increased legalization will reduce the need for heavy duty opioid prescriptions.
A study released — published in the Journal of Health Economics (2014) — certainly suggests states with legal access to medical cannabis appear to have lower rates of mortality from overdose. Certainly, the relationship between cannabis regulation and overdose needs more investigation. This study, however, gives good evidence that cannabis partners with opioids on killing pain. If patients require lower doses of oxycodone, and cannabis helps to mitigate the risk of addiction, perhaps it’s why fewer patients are dying. As always, further research must happen to approve these theories and claims.