Growing evidence that cannabis could reduce reliance on prescription opiates for chronic pain | Research

The takeaway

A review found that cannabis used alongside opiates produced greater pain relief allowing opiate dose reduction, prevented opiate tolerance, and could potentially reduce problematic opiate use.

Read this if you use opiates for chronic pain and want to know whether adding cannabis could help reduce your opiate dose.

Cannabis could "rekindle" opiate effectiveness after tolerance

What the researchers found

This review compiled evidence from preclinical and clinical sources on using cannabis as an adjunct to or substitute for opiates in chronic pain. When used together, cannabinoids and opiates produced greater cumulative pain relief than either alone, allowing patients to use lower opiate doses and experience fewer opiate side effects.

Cannabioids could prevent the development of opiate tolerance and withdrawal, and could even restore opiate effectiveness after tolerance had developed ("rekindling" opiate analgesia). Novel research suggested cannabis might also help treat problematic substance use more broadly.

The review noted that community-based medical cannabis dispensaries had been successful at providing patients with safe cannabis access and might be reducing problematic opiate use in their communities.

Why it matters

As the opioid epidemic was emerging, this review highlighted cannabis as a potential harm-reduction strategy. If cannabis could reduce opiate doses and prevent tolerance, it might reduce the cascade from prescription opiates to dependence and overdose.

The numbers in context

Cannabinoids enhanced opiate analgesia. Prevented opiate tolerance and withdrawal. Could rekindle opiate effectiveness after tolerance. Community dispensaries associated with reduced opiate use.

How the study worked

Narrative review of preclinical studies, clinical evidence, and community-level observations on cannabis-opiate interactions for chronic pain. Covered both pharmacological synergies and public health implications.

What this study cannot tell us

Narrative review with advocacy perspective. Much evidence was preclinical. Clinical data on cannabis-opiate substitution was limited. Community dispensary observations were ecological, not controlled studies. Did not address cannabis-specific risks.

How to read the evidence

Narrative review drawing on mixed-quality evidence. Preclinical synergy evidence was strong; clinical and community evidence was preliminary.

When this study was published

Published in 2012. Subsequent ecological studies have found associations between medical cannabis laws and reduced opiate prescriptions and overdose deaths.

The bigger picture

This review was prescient. Written as the opioid crisis was building, it identified cannabis as a potential off-ramp from problematic opiate use. Subsequent population-level studies found reduced opiate prescriptions and overdose deaths in states with medical cannabis laws.

Questions still open

Does medical cannabis access actually reduce opiate overdose deaths at the population level? What cannabis formulations work best as opiate adjuncts? Are there risks to dual cannabis-opiate use that offset the potential benefits?

Common questions

Can cannabis help reduce the need for opiates?

This review found preclinical and some clinical evidence that cannabis enhances opiate pain relief, allowing lower opiate doses. It can also prevent tolerance and may even restore effectiveness of opiates that have stopped working. However, clinical evidence was limited at the time.

Is it safe to use cannabis and opiates together?

The review focused on potential benefits but did not fully address risks. Both substances affect breathing, consciousness, and judgment. Any combination should be discussed with a doctor and carefully monitored. The potential to reduce opiate doses is the key safety argument.

Read the original research

Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain.

Journal of psychoactive drugs, 44(2), 125-33

View on PubMed ↗

Citation

Lucas, Philippe. (2012). Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain.. Journal of psychoactive drugs, 44(2), 125-33.