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Chronic pain is a widespread issue globally, affecting up to 55% of people, with higher rates in low- and middle-income countries. Â As trends have continued to shift over recent years in how chronic pain treatment is managed, opioids remain one of the major drug families that are considered an element of a treatment plan.Â
According to Deloitte Access Economics, there are 3.24 million Australians who are living with chronic pain. It also projected that by 2050, the number of Australians experiencing chronic pain is projected to reach 5.23 million.
However, this drug class carries with it a highly addictive nature, which means they’re not recommended for integration into long-term plans, which are often required as a part of chronic pain treatment. The inherent risk of prescription of this particular type of drug class is evident in the ongoing opioid epidemic in the US and other countries, which claims many lives daily through misuse. Cannabis use as a medical alternative to opioids has increased and patients have limited options.
Thankfully, we can learn from the mistakes made by the pharmaceutical and medical industries in their contributions to this ongoing national crisis. As the Australian patient population is largely aware of the issues that correlate to opioid prescription, the need for pain-relieving alternatives is evident.
Opioids, also known as narcotics, are medications prescribed by doctors to manage persistent or severe pain. They are commonly used by individuals with chronic headaches and backaches, patients recovering from surgery, those experiencing severe pain from cancer, and both adults and children who have been injured in sports, falls auto accidents, or other incidents.
Medical marijuana, or medical cannabis, involves using the cannabis plant or its compounds to treat medical conditions. It comes in forms similar to recreational marijuana, but there are also highly purified and lab-made versions specifically for certain medical uses.
Opioids are potent medications that alleviate pain by affecting the nervous system. They are highly addictive, often leading to withdrawal symptoms. In 2021, opioids were responsible for 75% of all drug overdose deaths, affecting 3 million Americans with opioid use disorder.
Medical cannabis presents a potential alternative to addictive opioids. A survey of nearly 3,000 medical cannabis users revealed that 30 percent had used opioids in the past six months. Among these users, 81 percent believed or strongly believed that cannabis alone was more effective than when combined with opioids. Furthermore, 97 percent agreed or strongly agreed that they could reduce their opioid usage with the help of cannabis.
Cannabinoids have demonstrated the ability to inhibit pain responses in almost every laboratory pain model studied. In models of acute or physiological pain, cannabinoids effectively alleviate thermal, mechanical, and chemical pain, showing potency and efficacy similar to opioids. In models of chronic pain, cannabinoids have shown effectiveness in managing both inflammatory and neuropathic pain.
In a case study from the Journal of Pain and Symptom Management, here is an example involving a 47-year-old woman with chronic progressive multiple sclerosis who used small doses of smoked marijuana in combination with an opioid. She experienced debilitating symptoms including joint pain, spasticity, and insomnia despite various treatments like morphine and muscle relaxants.
After receiving legal access to smoked marijuana, she found relief with nightly doses of 2–4 puffs. Over six months, her morphine intake decreased, and she reported improvements in pain, spasticity, bladder issues, and sleep, with minimal side effects.
Combining a cannabinoid with opioids may result in reduced opioid needs. In a single-subject trial, oral THC alleviated familial Mediterranean fever pain, leading to a notable decrease in the necessity for breakthrough opioids for pain management.
Recently, in Canada, the Medical Marijuana Access Program permits patients to request Health Canada’s approval for accessing dried cannabis for medicinal use. While smoking cannabis isn’t the ideal method of delivery, it is effective and produces plasma concentration curves similar to those observed with intravenous administration.
Chronic pain is ongoing pain that lasts beyond the typical recovery period or accompanies a chronic health issue like arthritis. It can be intermittent or constant, severely impacting a person’s ability to work, eat properly, engage in physical activities, or enjoy life.
Medical professionals can attest to the fact that managing chronic pain doesn’t occur via an isolated or simple diagnosis. Treatment plans will often include multidisciplinary practices in the process of providing a patient with as much pain relief and pain management as possible, with highly individualized plans allowing for a custom approach to be shaped for each patient.
This can include trial-and-error solution processes, where the appropriate drug dosage and the combination are shaped through a narrowing down of options – a long list that can include anticonvulsants, antidepressants, NSAIDs, muscle relaxants, corticosteroids, and topical medicines.Â
Each of these drugs varies in effectiveness and side effects, making the journey long and frustrating for patients. They must remain patient throughout the trial-and-error process while also dealing with the impact of chronic pain daily.
As Australia’s aging popularity faces associated aging comorbidities, there’s an urgent need for effective chronic pain control that provides a more optimal solution than mixed results that require weeks, months, and years to see any lasting difference.
The medical cannabis program introduced in Australia has seen a huge uptake of cannabis for chronic pain (60-70% of patients). Patients are driving the demand for access because there are no alternatives or registered medicines recommended by the TGA for chronic pain. Whilst there are still many issues with the program it’s clear that patients are getting results from this medical cannabis program.
For the system to flourish:Â
While the evidence base for medical cannabis is currently behind in comparison to that of other drugs which may present as pain treatment alternatives, this is in part due to the complexity of the plant itself (along with a compounding mix of social, cultural, historical, political and financial issues).
Alongside THC and CBD, hundreds of cannabinoids and other compounds provide a wide array of potential interactions, producing further still active ingredients. Purification methods play a central role in improving our collective scientific, medical, and societal understanding of how to effectively use cannabis for medical purposes.
However, when it comes to chronic pain, THC is a major compound of interest. With several high-quality clinical trials already underway, practitioners in the field have begun prescribing the drug for their patients on the back of current research findings and the results of many case studies.
Doctors who prescribe cannabis who truly believe in supporting the patient and research should be supporting companies who invest in clinical research to help them not only manage patients better but also give patients access to subsidized medication for chronic pain. In part two, we’ll examine how medical cannabis compares to opioids, unpacking areas of concern and uncertainty that patients may have without access to current information.
Treatments other than opioids better manage long-term, non-cancer pain. Experts no longer recommend opioids for most patients dealing with chronic pain.If prescribed, you will receive information on potential side effects, risks, and necessary monitoring for your safety.
No, weed or cannabis is not classified as an opioid. However, THC indirectly affects opioid receptors, potentially contributing to its observed pain-relieving effects.
Cannabis plants produce both CBD (cannabidiol) and THC (tetrahydrocannabinol). Sellers commonly market CBD as an oil, which lacks psychoactive effects and offers medicinal benefits.In contrast, THC is the primary psychoactive component in marijuana.
Marijuana and opioids both interact with the body’s pain management systems but in different ways. Opioids bind directly to opioid receptors in the brain to relieve pain, while marijuana, particularly its THC component, indirectly affects these receptors, which may contribute to its pain-relieving properties. Additionally, CBD, another compound in marijuana, has medicinal benefits without the psychoactive effects associated with THC. Both substances relieve pain, but they work differently and have unique side effects.
Taste, smell and no chemicals is just the start
There are about 80,000 patients in Australia who are taking medical cannabis for chronic pain, anxiety, and various other conditions with the support of their
Chronic pain is a widespread issue globally, affecting up to 55% of people, with higher rates in low- and middle-income countries. Â As trends have continued
Addiction One of the key urgencies in moving away from an opioid-based long-term treatment plan is their addictive nature, and the potential for this addiction
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