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Solving One Drug Problem With Another: Cannabis + Opioids to Stop Pain

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Solving One Drug Problem With Another: Cannabis + Opioids to Stop Pain

Approximately 20 percent of U.S. adults had chronic pain in 2016, according to the CDC. This data was recorded and released at a time when the nation’s opioid epidemic was worsening—with pain management a part of the equation. Twelve percent of people who are prescribed opioids for their pain go on to develop opioid disorder. To make matters worse, 80 percent of heroin users started abusing prescription opioids first.

Therefore, strategies are necessary to curb reliance on opioids for pain relief. Some researchers have, ironically, looked to another drug for help.

There are more than 700 hypothesized medical uses for cannabis and cannabinoids, with pain relief recognized as one of the most common. Most recently, researchers have explored the idea of cannabinoid-opioid synergy to reduce pain without psychoactive effects.

However, according to Ziva Cooper, research director of the UCLA Cannabis Research Initiative, these studies have multiple limitations—chief among them the lack of double-blind placebo study designs.

“Previously published studies have a limited duration of hours, not days or weeks.”

“Additionally, the cannabis used in the studies was far lower in strength compared to what is in dispensaries now. It was 1 to 9.4% THC with no CBD. The strains in dispensaries now are over 30% THC.”

Ziva Cooper

So, Cooper and her colleagues at the UCLA Cannabis Research Initiative designed a controlled environment, double-blind placebo study of cannabis users to test the effect of the plant therapeutically, paying special attention to adverse effects, including intoxication or a “high.” Working with study participants who smoked more than 12 marijuana cigarettes per day, Cooper evaluated the difference in individual pain levels after ingesting cannabis, opioids (oxycodone), and cannabis with an opioid.

The researchers did not see a significant difference between pain levels for those that received oxycodone alone versus those that received a placebo. However, participants that smoked active cannabis, or cannabis with THC in it, experienced a 20 percent increase in their pain tolerance. Moreover, Cooper and her team saw a “robust increase” in the pain tolerance of the individuals who consumed cannabis + opioid.

Participants that took the placebo reported no high feeling nor relief of pain. Meanwhile, users who took active cannabis with THC reported substantial pain-relieving effect, but also significant intoxication.

“There does seem to be a suggestion that opioids and cannabis, specifically THC, can act synergistically to have a pain-relieving effect,” Cooper said. “However, we need to be very mindful of the adverse effect and figure out strategies to capitalize on the synergies we see with pain relief while decreasing intoxication. Perhaps instead of smoking cannabis, [users] can take capsules, which have already been shown to produce decreases in intoxication and abuse liability.”

Even with these results, Cooper stressed there is a lot more research that needs to be done to understand cannabis and how it may or may not play a role in reducing the opioid epidemic. For example, the cannabinoid CBS has shown preclinical success, but there is no evidence in animal models yet. The terpenes myrcene and BCP have also shown preclinical support for pain management with minimal adverse behavioral effects. A team at Columbia University is currently examining whether myrcene and BCP can work together to lower THC dose needed to decrease both pain and intoxicating effects.

“BCP can act synergistically with opioids to relieve pain, just like THC,” Cooper said. “BCP acts similarly as CBD to reduce the abusive potential of opioids. That gives promise to BCP as a potential therapeutic.”

Ultimately, the key to advancing cannabis research is two-fold:

  • 1) double-blind placebo studies that leverage the therapeutic effects of cannabis/cannabinoids while developing strategies to mitigate their adverse effect.
  • 2) the development of impactful studies whose results translate from animal to human to population.

More about Cannabis Medical:

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