Cannabis and Opioids: Friends or Foes?
Despite recent shifts in research and public opinion, opioids continue to be widely prescribed to patients suffering from debilitating chronic pain conditions. Although opioids are known to be helpful for managing chronic pain symptoms, they are often accompanied by side effects when used long-term and in high doses. These side effects include constipation, nausea, tolerance, respiratory depression and addiction. A recent article published by the Journal of American Medical Association concludes that long-acting opioids increase the risk of unintentional overdose deaths as well as cardiorespiratory death.
If the side effects of opioids are potentially severe and life-threatening, what might be the reason for the continued use of opioids?
What’s more, physicians and patients often lack access to information about the ways in which opioids and cannabinoids can work together to help manage chronic pain and improve patients’ quality of life.
Cannabis and opioids have been shown to work together through a variety of pathways, to help each other maximize pain relief while minimizing unwanted side effects. This is because they both share signal transduction pathways, as well as receptor distribution in the brain that is instrumental in pain signalling.
What exactly does this mean?
It means that cannabinoids and opioids work in syngergy with one another. This synergy is a two-way street: cannabis maximizes the effects of opioids, and vice versa.
When delta-9-tetrahydrocannabinol (THC) is administered, it causes the release of endogenous opioids–natural opioids created by the body. This release stimulates the same receptors as opioid medication would, and results in greater pain relief. Opioids taken in low doses–doses much lower than those usually taken for relief–can also significantly increase the analgesic effects of THC, along the same pathway. Cannabidiol (CBD) provides pain relief in a different way than THC does, and can also be helpful in providing protection from potential neurotoxicity caused by chronic opioid use.
In addition to maximizing the effects of opioids, cannabis has the potential to help manage other symptoms often experienced by patients suffering from chronic pain. Cannabis has also been shown to help manage GI symptoms and relieve nausea, and can therefore be helpful in alleviating some of the side effects of opioids. What’s more, because cannabinoids do not pose a risk to unintentional overdoes or cardiorespiratory death, as opioids have been shown to, cannabis can help minimize the risk of opioid-related death by providing an alternative option for pain relief.
-Katarina Kostovic, Research Coordinator