Can CBD and medical cannabis combat the opioid crisis?
The opioid crisis continues to worsen in the United States and around the world, with high-strength synthetic opioids like fentanyl doing much of the damage. Nigeria and Egypt are two countries that have well-documented issues with Tramadol, an opioid drug used recreationally. However, opioid problems extend beyond recreational abuse to medicine, with powerful, opioid-based painkillers proving particularly problematic.
In 2016 alone, more than 60,000 Americans died from drug overdoses, with around two-thirds of those from opioids. The opioid epidemic was a talking point during the 2016 US presidential election, a sign of how serious it has become for the nation. Several NFL players and MMA fighters have gotten addicted to opioid painkillers such as OxyContin, which can cause nausea, vomiting a loss of appetite, dizziness, constipation and more.
Opioids may be good for pain management, but the side effects and abuse potential make them a risky treatment, especially for patients who need to take them all the time. Therefore, not everybody is prepared to take them, and many who do are constantly on the lookout for substitutes.
Medical cannabis for pain?
Cannabis has always been a popular alternative herbal medicine for chronic pain and related conditions, but we didn’t know why until the endocannabinoid system – in which cannabinoids like cannabidiol (CBD) and tetrahydrocannabinol (THC) – work in was discovered, late in the 20th century.
One of the many variables that the endocannabinoid system regulates is the body’s perception of pain. This has provided researchers with a novel target area for painkiller medication, and encouragingly, CBD is non-psychoactive with no abuse potential. While it has some potent therapeutic properties, THC is psychoactive and subsequently not for everybody, although the bind that the cannabinoid makes with the CB1 receptor is effective at distracting the mind from physical pain.
A lot of chronic pain arises from inflammation, which occurs when the immune system becomes overactive and starts to attack the body. Controlling inflammation can be key to controlling pain, and CBD has shown potential to do this by managing immune system response through the CB2 receptor in the endocannabinoid system. Neuropathic pain which stems from the central nervous system is also treatable with CBD (sometimes, THC is also required).
The puzzling fibromyalgia may just end up giving us a more comprehensive idea of how the endocannabinoid system works in regard to pain and other symptoms. A disease called Clinical Endocannabinoid Deficiency has been put forward, which suggests that fibromyalgia, a condition which causes mental and physical discomfort, is caused by an underproduction of endocannabinoids. One of the symptoms of fibromyalgia is pain – 2009 research demonstrated that CBD and other cannabinoids are effective analgesics.
Full-spectrum CBD oil is normally more effective than a CBD-isolate product at treating pain, since a collection of other compounds – mainly cannabinoids and terpenes – are also present to offer a synergistic boost. Furthermore, as full-spectrum oil is extracted from hemp, a cannabis sativa strain with limited amounts of THC, it cannot be recreationally abused. Interestingly, CBD inhibits a THC high with its anti-psychotic effects – CBD is a negative allosteric modulator (i.e. a suppressant) of the CB1 receptor.
Taking CBD for pain
The plethora of CBD intake methods means the cannabinoid can help with various kinds of pain and different levels of severity. Acute pain is an intense type of pain that comes on suddenly. While orally-consumed painkillers can ultimately help, the slow metabolization and absorption of the necessary compounds makes them far from perfect.
However, CBD can bypass the slow reaction time of conventional painkillers when it’s inhaled. This is one reason why smoking cannabis has remained popular, despite the health risks of smoking. But there’s no logical argument for smoking medicinal cannabis now that vaping is possible.
Vaping CBD e-liquid and vape oil does not clog the lungs with tar or pose a carcinogenic risk, yet the absorption method remains exactly the same – the vapor gets into the alveoli (small air sacs) which CBD penetrates to get into the bloodstream. Once in the bloodstream, CBD can start co-operating with cannabinoid receptors to reduce pain.
If pain is preventing or making sleep more difficult, then the effects of CBD need to last longer than the roughly three hours that they do with vaping. This is where edibles come in. With CBD gummy bears, the cannabinoids take longer to metabolize, but the more controlled release of CBD means the effects can last all night. Moreover, CBD capsules and edibles are better-suited for daytime use for those who work in offices or other places where vaporizing is not accepted or easily possible.
CBD for addiction?
CBD’s uses in tackling the opioid crisis may not stop at relieving pain – a growing body of scientific research and anecdotal evidence indicates that the non-psychoactive cannabinoid could help treat addiction, including that to opioids. While some argue that using CBD or cannabis instead of opioids is just replacing one addiction with another, the reality is that even psychoactive marijuana is safer, for mental and overall health, than opiates. There are no recorded overdoses with cannabis and CBD use, and studies have shown the latter is tolerated well, even in doses of 1000mg and more.
An investigation on rats carried out by researchers at the University of San Diego found that administering CBD offered extended relief from addiction to cocaine and alcohol. The rats treated with CBD were less likely to slip back into old ways and seek out drugs. Furthermore, the indication is that the benefits of CBD remain even after the substance leaves the body. However, there is conflicting research on the usefulness of CBD for addiction – more studies are certainly required.
Final thoughts
For now, the scientific jury remains undecided on how effective cannabis and CBD could be in taking on the opioid crisis, although the safety and novelty of the compound suggests it’s worth a shot. A Brightfield Group and HelloMD survey found that an increasing number of people are cutting down their opioid use, either significantly or completely thanks to CBD.