Cannabis as a substitute for opioids and other medication in the treatment of chronic pain

by Dan Kaufman, GCSOM, MBS 2019
Mentor: Dr. Brian Piper, PhD

 With the recent opioid epidemic striking the United States and the number of people dying from opioid overdose increasing, the treatment of chronic pain with opioids is something that has come under scrutiny. Studies have shown that compared to drugs such as non-inflammatory steroids and acetaminophen (the main ingredient in Tylenol), opioids were not as successful in treating chronic pain of the back, neck, knee, or hip.

So, if opioids are not as effective in treating chronic pain, then why are they still being prescribed by health care providers?

There are several reasons of why this could still be occurring. Including, but not limited to, the influence of the big pharma companies, the compensation provided to the health care provider, or patients unable to get off opioids, leading to long term treatment.

What if there was something more natural than the synthetically made opioid pharmaceuticals with less risk of dependence, overdosing, and death, which has also been shown to be better at treating (chronic) pain?

In 1996, the cannabis plant was legalized for medicinal purposes in the state of California. Ever since then, states have been following their path by either legalizing marijuana for either medicinal or recreational purposes. As of 2018; thirty-three states have legalized marijuana for medicinal purposes. This, along with ten states (and D.C.) that have legalized cannabis for recreational purposes, have shown states have accepted the medicinal properties of the drug. This is still not the case with the federal government still classifying marijuana as a Schedule I drug, which can be interpreted as the drug containing no medicinal qualities.

Among the states that have legalized medicinal access to marijuana, some have even started to implement programs where health care providers prescribe marijuana as a substitute for opioid treatment in the cases of long-term pain management and opioid use disorder. If doctors are starting to prescribe cannabis instead of opioids, it is reasonable to believe there is significant evidence on the long-term health effects of marijuana, but this is not the case. This begs the question if marijuana is suitable, appropriate, and safe for the long-term use and treatment of chronic pain.

Research has shown that the combination of psychoactive and non-psychoactive components of marijuana are indeed effective in treating pain, but the side effects of long-term treatment with marijuana is something that has not been extensively studied. With research not predicted to be available for the long-term health effects of marijuana for quite some time, the question as to whether marijuana should be a replacement for opioids for long term usage. Even without the research, arguments can be made for cannabis as a substitute. One of these arguments consists of the fact that there have been an increasing number of opioid overdoses resulting in death over the past decade while the number of deaths resulting from the overdose of marijuana has remained constant at 0. Although the long-term health effects of marijuana may still be a mystery to researchers, one thing is for certain; marijuana is far less deadly than opioids.