When hearing about the opioid crisis worldwide, the first questions that occur naturally are “what is opioid?” and “what’s the problem, anyway?” Let’s clarify what is the real cost of pain relief today.

According to statistics, one in five adults in Europe suffers from chronic pain nowadays. Hundreds of thousands of people lose their ability to work, suffer from depression, lose sleep, appetite, and other joys of life without adequate pain relief.

All pain can be divided into two broad categories — chronic and acute pain. Let’s see what the main difference between these types is.

Acute pain

The cause of pain is generally known.

Short term (3–6 months)

Accompanied by anxiety

Responds well to meds

Red tissue

Chronic pain

The cause of pain is often unknown.

Long term (6 months and longer)

Accompanied by depression

Doesn’t respond to meds well

White tissue

To be able to live a normal life, people suffering from chronic or acute pain are often prescribed strong painkillers — opioids. Opioids represent a diverse class of moderately strong painkilling drugs, including:

oxycodone (commonly available under the names OxyContin or Percocet);

hydrocodone (Norco, Vicodin);

fentanyl.

Fentanyl is a powerful painkiller that is synthesized to resemble other opiates such as heroin and opium-derived morphine. The main problem related to opioids has gained such a scale that received a particular name — the opioid epidemic. An opioid epidemic occurs when addictive opioid drugs become misused or overused (in the majority of cases), causing significant medical, economic, and social consequences, including the overdose deaths.

The efficiency of opioids, together with their availability worldwide, have made them extremely popular both as medical treatment and as recreational drugs. Even despite the high risk of addiction and overdose, these substances are still the most popular and effective painkillers worldwide. Opioids are the most potent for acute pain treatment, while they are less useful for treating long-term chronic pain, as related risks often outweigh the drug’s benefits.

The opioid crisis (opioid epidemic) appeared in the United States in the 1990s and slowly began to grow. The extensive overdose of opioids, both from medical prescriptions and various illegal sources, has led to an enormous increase in opioids use in recent years. For the moment, the number of drug overdose deaths in the US overstepped the mark of 70 000, placing the opioid crisis on the top of the global problems.

The opioid epidemic is one of the worst drug crises in the US as the prescription rates there are 40 times higher than in other countries. The opioid crisis causes more deaths annually than guns or car crashes. Canada is the second-highest per-capita user of prescription opioids, where 3987 opioid-related deaths were recorded in 2017. The terrifying fact is that 92% of all these deaths were unintentional. In the United Kingdom, the opioid crisis problem is pronounced less than in other comparable countries. Nevertheless, 4359 deaths related to drug poisoning were recorded in 2018, and the opioids constituted the bulk of them.

Another problem related to opioid drug use is its availability worldwide. According to statistics, more than 25.5 million people per year, including 2.5 million children, die worldwide without pain relief. The majority of these cases occur in low and middle-income countries. The accessibility gap of the strong painkillers between various countries is enormous. The United States produces and imports 30 times as much pain relief drugs as it needs, but countries with a low-income, such as Nigeria, receive less than 0.2% of medications they need. The world’s wealthiest countries use 90% of all the opioids in the world.

A powerful alternative to opioids? CBD for chronic and acute pain relief.

Despite the impressive scale of the opioid crisis problem, the perspective solution has loomed on the horizon. One of the latest studies has revealed an ability of cannabidiol (or CBD) to create pain-relieving molecules that are much stronger than aspirin. It offers excellent potential for cannabis to become a worthy alternative to opioids.

Recently, the opioid crisis was classified by the Canadian government and the US Department of Health and Human Services as a public health emergency of the 21st century. To date, with the new marijuana laws for medical purposes, there is a high potential to reduce opioids prescribing for chronic pain by substituting it with the CBD oil. Naturally derived pain treatment from cannabidiol would offer effective relief for patients without the risk of addiction and overdose, thereby significantly decreasing the level of opioid-related deaths worldwide.

Cannacares CBD transdermal patches (£9.99) are great at treating localised pain. Or if you experience pain if you’re sitting for long periods of time. Equally, people can experience muscle tension pain daily from long-distance driving. Or even in jobs where you’re required to sit or stand — for long periods of time. Tension can occur if you don’t regularly stretch or exercise. Also, bad posture plays a contributing factor. So simply apply a patch to clean the area of your skin to experience the benefits from this powerful plant!

Today, there is an urgent need to find and develop possible alternatives for both chronic and acute pain relief, that go beyond existing opioids. To understand why the CBD has all the chances to reduce the opioid crisis and serve as a powerful painkiller, let’s puzzle out its mechanism of work.

The response of our bodies to pain is regulated by different brain areas, including our internal opioid and endocannabinoid systems (ECS). While being in pain or stress conditions, the human body releases endorphins and endocannabinoids in an attempt to bring our organism back to balance. According to pre-clinical studies, external cannabinoids, such as CBD found in the marijuana plant, can enhance the response of our body to pain by binding with the receptors of our endocannabinoid system.

Give me proof! Studies and research of CBD vs. opioids battle.

None new inventions and innovations will be growing and developing without facts and research proving their effects. The same is for CBD’s role in pain relief and opioid crisis decrease. For the moment, twenty-eight clinical studies were conducted that confirm the fact that cannabinoid agents are the potent analgesics for chronic pain. Basing on the results of the studies, An Expert Review Committee concluded that there is convincing evidence that cannabis can become an effective treatment for chronic pain in adults.

Nevertheless, to date, no clinical trials were conducted to directly compare the effectiveness of opioids vs. cannabis-based products on chronic pain cases. The absence of these studies is mostly related to the federal barriers to conducting research with the use of marijuana. Fortunately, research permitting policy is changing, and the first study, which will be held in 2020, will provide us with the results of how cannabis compares to Oxycodone and placebo in chronic back and neck pain relief.

The High Strength 20% (2000mg) CBD oil from Arima is a natural, potent product that will not only make you feel good; but convince you to believe in the true, healing powers of nature, and help you live a healthier life.

At the same time, in the US, many people suffering from chronic pain have access to cannabis. The most common condition that was reported by patients who use medical cannabis was pain relief. Many of them also indicated they have been substituting their prescribed opiate-based medications with cannabis products. Today, three main patterns of medical cannabis use have been identified:

alternative; complimentary; and tapering-off mechanism to prescribed medications.

Specific reasons to consider medical cannabis as a possible alternative to opioids included the following benefits:

acting more quickly;

reducing potential harm;

better management of symptoms;

fewer side effects.

In an online questionnaire conducted by Corroon et al., 1248 cannabis users were surveyed. 46% of them reported using cannabis as a substitute for their prescription drugs, while the most frequent substitution (35.8%) was opioids. Another online survey performed by Reiman et al. included 2897 cannabis patients. The author examined the use of medical cannabis as a possible substitute for opioid-based medications. Thirty percent of all surveyed patients used opioid-based drugs at that moment or in the past six months. 97% of these patients reported using fewer opioids when using cannabis, while 92% of them experienced more tolerable side effects with CBD than with opioid medications alone. All of the patients reported preferring cannabis to prescribed opioids and said they would consider choosing only cannabis if it was more available.

Cannabidiol has got such high popularity worldwide due to its unique ability to treat almost everything starting from epilepsy to anxiety. Ability to treat depression, anxiety, inflammation, seizures, migraines, nausea, mental and psychosis disorders, and, of course, provide with pain relief — this is not the full list of all the CBD benefits to our health. Due to various possibilities of use, CBD research is continuing, revealing new benefits and confirming or refuting the facts already known.

During the latest studies of cannabis relation to opioids and its role in CBD vs. opioids fight, one more its advantage was revealed. Researchers reported that cannabidiol could help restrain the cravings that usually come with opioid addiction. The study consisted of 42 men and women who have a history of heroin abuse but were not its current users. All the participants of the research received either a placebo or an oral CBD solution and were shown videos containing neutral and drug-related cues. Among neutral cues were different relaxing scenarios such as scenes of nature, while drug-related cues showed scenes of the drug use and heroin-related items, such as syringes, rubber ties, and packets of powder.

At the end of the research, it was discovered that, compared to a placebo, cannabidiol reduced drug cue-induced cravings and anxiety among the participants. Based on these results, it can be stated that CBD is a promising agent for treating patients with heroin abuse.

To date, the United States is in a permanent fight with an opioid epidemic that has claimed more than 300,000 lives since its beginning in the 1990s. A new, clinically approved non-opioid medication will significantly change the existing list of addiction medications. Moreover, it would decrease the growing death losses, reduce enormous health care costs, as well as change treatment limitations imposed by government regulations because of the persistent opioid epidemic problem.

Challenges of CBD research. The other side of the coin.

Despite the favourable results of research and studies held, the development of medical cannabis remains at the doorstep. Mainly, such a position is due to government regulations, although the ethical side also contributes.

For the moment, studying the positive or negative cannabis effects is far from an easy task. The situation becomes even more complicated, considering the number of drug users who have an addiction to different drugs. In case when you’ve got a mix of different medications together with a population already addicted to drugs, it is hard to decrypt the cannabidiol benefits. Cannabis has been part of our society for decades, but it doesn’t simplify the researches flow — its illicit label still hampers the study of this drug.

In Canada, many of the CBD trials are just about to be performed, and the country has the opportunity to get the evidence that will finally answer many of the unknowns. Dr Hance Clarke, director of pain services at Toronto General Hospital, uses cannabis for the treatment of chronic pain patients at the University Health Network Transitional Pain Service Clinic on an individual basis. He said part of his patients has wholly stopped using opioids after the CBD introduction. At the same time, some of them have been able to reduce their daily dose of opioids, while others completely failed. It means that CBD oil introduction for individuals is not a risk-free or a panacea, although, in clinical practice, it can bring benefits for some.

Kanaco CBD gummies bundle deal is a cost-effective way to purchase three packs of fast-acting colourful and tasty gummies and get the 3rd at a half price. Chewing CBD gummies is both delicious and effective: CBD will provide needed relief and unwind while 100% natural snack will supply needed CBD dose.

In the United States, government regulation also remains the biggest obstacle to CBD research. The special license for cannabidiol products research is required because they come from the cannabis plant. CBD gets a classification as a schedule 1 controlled substance, although it is not addictive and doesn’t make people high, unlike THC. This license and other bureaucracy add another half a year to the CBD studies, delaying the whole process of examination.

However, some things have changed in the past year. The US Agriculture Improvement Act, issued in 2018, decided that hemp (cannabis that contains a low THC level) is no longer classified. It means that scientists and researchers studying hemp-derived CBD no longer need a license. That has changed the course of affairs dramatically and noticeably accelerated some research. Nevertheless, the primary problem remained as CBD derived from cannabis is still a schedule 1 drug. Also, to date, there is a considerable shortage of medicinal-quality hemp-derived cannabidiol.

Besides schedule 1 status of medical cannabis, there is another significant challenge for CBD research in the US. There is a requirement that all marijuana used in studies has to be obtained from a single farm at the University of Mississippi. Although the US Drug Enforcement Administration is considering collaboration with other potential growers, today, University is still a monopoly, and it is permitted to grow only one hundred pounds of cannabis for research purposes annually. Another problem is that until recently, the University had permission to cultivate cannabis with a 7% THC content, although more than 70% of medical cannabis consumers choose to use CBD oil and other CBD products with THC content about 90%. Cannabis for research purposes with a higher THC content (13.4%) has become available from the National Institute on Drug Abuse (NIDA) only recently.

Doctors and patients. Moral barrier to medical marijuana usage.

Medical marijuana remains a matter of dispute, and many scientists specializing in this issue voice their concerns. At the same time, other people consider CBD research as a perspective and an exciting field of discovery. They want to use marijuana as a safer option for patients with chronic pain.

Both people supporting and refuting the medical cannabis theory agree that in-depth research is necessary to understand all of its medicinal benefits, correct dosage, and safety to start using it for managing such diseases as chronic pain and opiate addiction. Currently, we have data on how medical marijuana influences opioids use, and this data is positive and perspective. According to the studies recently published in JAMA Internal Medicine, the opioids prescriptions level is lower in states where medical cannabis is allowed by the law.

Not only medical community members disagree about fundamental conceptions about medicinal cannabis use. A certain disconnect between doctor and patient about the approval ratings of medical marijuana has appeared recently. Patients demand more information about all the CBD risks and benefits from their doctors. Regardless of whether the physician has a pro-, neutral, or anti-medical marijuana position, he needs to leave all his prejudices outside the exam room. Doctors should advise and warn patients about all the risks and benefits of cannabis use to limit their worries due to the lack of understanding.

According to the results of the Quinnipiac University poll held in April 2017, 94% of Americans support allowing adults to legally use marijuana for medical purposes if their doctor prescribes it. Today, this number is growing and will continue its growth in some years, with a sufficient amount of research.

Bottom line

Addiction is a severe disorder, and it’s not about morals, only pure statistics. We can’t ignore the fact that almost half a million Americans have died from opioids overdose in the past decade. We have to understand better the addiction, the way how it works and grows. Only this way, we will be able to develop non-addictive treatments. When these medications will be approved and available, a stigma which these treatments are carrying will be decreased and disappear one day. Patients will realize that something can function normally without severe side effects and addiction.

Chronic pain is still a hot button issue. Psychiatrists all over the world need to be aware of non-opioid options, especially for their patients with substance use histories. CBD appeared on the horizon as a new treatment for chronic pain with its benefits and drawbacks. There is an urgent need to continue research and to puzzle out all of its pros and cons to finally decide whether it has chances to replace opioids one day or not.

We are the ones who drive the CBD development, the ones who drive history.

Verified by a Healthcare Professional

Anastasiia Myronenko

Anastasiia Myronenko is a Medical Physicist actively practicing in one of the leading cancer centers in Kyiv, Ukraine. She received her master’s degree in Medical Physics at Karazin Kharkiv National University and completed Biological Physics internship at GSI Helmholtz Centre for Heavy Ion Research, Germany. Anastasiia Myronenko specializes in radiation therapy and is a fellow of Ukrainian Association of Medical Physicists.

This article includes the promotion of products and services sold on Alphagreen and affiliate links to other businesses.

Alphagreen and its materials are not intended to treat, diagnose, cure or prevent any disease. The information and products presented on this site are not intended for medical use nor do they make any medical claims. Always seek the advice of your physician or another qualified healthcare provider for any questions you have regarding a pre-existing medical condition, are pregnant and/or are breastfeeding, and before undertaking any diet, exercise or another health-related program.

References