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cbd oil vs opiates

Cbd oil vs opiates

Yet the finding that products containing only CBD also provided pain relief and were substituted for pain medications is promising and merits future study, noted Boehnke.

“CBD is less harmful than THC, as it is non-intoxicating and has less potential for abuse,” said Kevin Boehnke, Ph.D., a research investigator in the Department of Anesthesiology and the Chronic Pain and Fatigue Research Center. “If people can find the same relief without THC’s side effects, CBD may represent a useful harm reduction strategy.”

For this study, the team focused on 878 people with fibromyalgia who said they used CBD to get more insight into how they used CBD products.

“Fibromyalgia is not easy to treat, often involving several medications with significant side effects and modest benefits,” Boehnke explained. “Further, many alternative therapies, like acupuncture and massage, are not covered by insurance.”

Boehnke stressed the need for more controlled research into how CBD may provide these benefits, as well as whether these benefits may be due to the placebo effect.

Fibromyalgia is one of many chronic pain conditions that remains stubbornly difficult to treat.

The cannabis-derived substance provides fewer side effects, with less potential for abuse.

Boehnke and his team surveyed people with fibromyalgia about their use of CBD for treatment of chronic pain.

The U-M team found that more than 70% of people with fibromyalgia who used CBD substituted CBD for opioids or other pain medications. Of these participants, many reported that they either decreased use or stopped taking opioids and other pain medications as a result.

Cbd oil vs opiates

Given the current opioid epidemic in the USA and medical cannabis’s recognized analgesic properties, MC could serve as a viable option to achieve opioid dosage reduction in managing non-cancer chronic pain. Unfortunately, the evidence from this review cannot be relied upon to promote MC as an adjunct to opioids in treating non-cancer chronic pain. The nine available studies included in this review suggest that cannabis was effective as an adjunct to opioid in reducing the dosage of opioids in study participants. However, the design of included studies provides a limited basis on which to make a rational, evidence-based recommendation. As the USA grapples with the opioid abuse epidemic and searches for less addictive alternatives, experimental studies are urgently needed to assess the effects of cannabis on non-cancer chronic pain as well as its potential to reduce the need for opioids. If cannabis is found to be effective in reducing non-cancer chronic pain, it could serve as a viable substitute for prescription opioids, thus mitigating the opioid epidemic.

Quality assessment of included studies was conducted independently by two reviewers (LK and BO), using the ROBINS-I risk of bias tool for cohort studies and the AXIS tool for cross-sectional studies [17]. Disagreements were resolved by discussion. Cohort studies were assessed for bias related to (1) confounding, (2) selection of participants, (3) classification of interventions, (4) deviations from intended interventions, (5) missing data, (6) measurement of outcomes, and (7) selection of the reported result. Each section of the bias assessment was judged to see if there was a low, moderate, serious, or critical risk of bias. An overall assessment of the risk of bias was made based on the most severe form of risk of bias reported in any of the domains. The cross-sectional studies were assessed for bias in each section of the publication as in Additional file 1: Introduction, Methods, Results, Discussion, and Others. Risk of bias criteria were assessed as “Yes,” “NO,” or “Do not know” (Additional file 1). Given the heterogeneity of included studies, a meta-analysis was not possible. Thus, a qualitative summary of the evidence was conducted.

The pain alleviating effect of MC is conferred by the therapeutic effect of tetrahydrocannabinol-alpha (THC)—the dominant component of the cannabis extract—and cannabidiol (CBD), a lesser (40%) component of the extract of MC [7]. Cannabis is considered an illicit drug by the US Drug Enforcement Agency (DEA), and it is not approved by the Food and Drug Administration (FDA) [8]. Nevertheless, several US states have policies permitting cannabis use to treat certain medical conditions [9]. A meta-analysis of MC for non-cancer chronic pain reported a significant effect on pain reduction, although its effect was marred with high number needed to treat, and a higher likelihood to harm [10]. More so, compared with placebo, while MC may increase the number of people achieving pain relief, it is associated with an increase in nervous system adverse events [11]. These reports cast doubt on the effectiveness of MC for non-cancer chronic pain. Pain, including back pain, migraine, chronic pain, arthritis, and pain from cancer and surgery, is the most common condition for which MC is prescribed by health providers [6, 8]. When MC is used by patients taking opioids, it does not significantly change the area under the curve (AUC) of opioids or their metabolites, and there is a time delay to maximum serum concentration (Cmax) of opioids [12]. In addition, MC has no significant effect on the pharmacokinetics of opioids [12]. In one study, 35.8% of respondents substituted opioids for MC, with greater substitution among those with comorbidities like pain [13]. Consequently, MC is perceived as an effective remedy for non-cancer chronic pain as well as a potential substitute that may help curb the on-going opioid epidemic [13]. This led to an increasing interest in research on MC, though there is a limited focus on the use of MC for opioid dosage reduction or non-cancer chronic pain. For instance, a systematic review by Whiting et al. included patients with chronic cancer pain and studies that compared CBD to a placebo [14]. Another clinical review by Hill discussed the indications for MC and patient eligibility for MC certification, without an appraisal of MC for non-cancer chronic pain [15]. In addition, a review by Campbell et al. summarized literature on MC use for non-cancer chronic pain [16]. Therefore, in this review, our objective was to assess the effectiveness of MC in reducing opioid dosage or substituting opioids for the treatment of non-cancer chronic pain.

This systematic review was not registered.


The strength of the evidence is the adoption of a rigorous standard approach to the review, based on the PRISMA checklist, the inclusion of publications from four databases, and the independent screening of study eligibility. Given the dearth of empirical studies about MC versus opioids for the treatment of non-cancer chronic pain, it is important that readers have information on the full range of currently available evidence. Thus, this review relaxed inclusion criteria allowing for the inclusion of observational studies, including case reports. Though findings from the nine included studies suggest that medical cannabis may be used as an adjunct with opioids to reduce opioid dosage when treating non-cancer chronic pain, it is limited by the fact that it is derived from self-reports of reduction of opioid dosage as well as the fact that most included studies did not report the MC dosage that led to reduction of opioid dosage. More so, a study that reported a 22–30% reduction of opioid medication use, when MC is used as an adjunct, equally stated that 70–78% of participants reported no influence of MC on the use of opioids [20]. The wide range of MC dosage (1.5–2000 mg) reported by two cross-sectional studies suggests the difficulty in arriving at a standardized MC dosage for patients with non-cancer chronic pain. Furthermore, included cohort studies were assessed as having serious or critical risk of bias overall. The lack of measures previously published to assess study outcomes, unclear precision estimates, and insufficiently described methods for these studies underscore the need for caution in interpretation of findings.

Figures from the 2016 National Health Interview Survey estimate that one in five (20.4%; 50 million) Americans suffer from non-cancer chronic pain [2]. The burden of chronic pain among Americans is higher among the following demographics: (1) females (22.1%) versus males (18.6%), (2) non-Hispanic White (23.0%) versus other races/ethnicities, and (3) adults 45 years or older [2]. The magnitude of non-cancer chronic pain has led to the proliferation of opioid prescriptions and addiction which is currently a public health concern in the USA [4]. A meta-analysis of randomized controlled trials (RCTs) of patients with non-cancer chronic pain indicates that opioids had a significant but small improvement in pain and physical function, though more patients vomited when compared with placebo [5]. When used for other reasons than prescribed, opioids can constitute abuse or dependence [6]. Chronic opioid use can lead to opioid tolerance, which leads a reduced response to the same dosage of opioids that once provided the desired effect [6]. Therefore, individuals with opioid tolerance need to use higher dosages to achieve the same effect, which predisposes them to addiction [6].

In states where MC is legal, future research should assess the effects of long-term MC use on opioid addiction and opioid-related deaths. Additionally, there is a need to assess the optimal/standardized MC dosage to achieve a reduction in opioid dosage and what routes of MC administration would most reduce opioid dosage the fastest. Researchers must also assess the long-term health and wellness consequences of reduced gastrointestinal motility reported to be beneficial to reduce opioid dependence and opioid-related mortality.

Type of outcome measures

Four databases—Ovid (Medline), Psyc-INFO, PubMed, Web of Science, and grey literature—were searched to identify original research that assessed the effects of MC on non-cancer chronic pain in humans. Study eligibility included randomized controlled trials, controlled before-and-after studies, cohort studies, cross-sectional studies, and case reports. All databases were searched for articles published from inception to October 31, 2019. Cochrane’s ROBINS-I tool and the AXIS tool were used for risk of bias assessment. PRISMA guidelines were followed in reporting the systematic review.

A Health Sciences Librarian (AN) developed the search strategy (Additional file 1) for the review and searched PubMed, Web of Science, PsycINFO, and Ovid (Medline). All databases were searched for articles published from inception to October 31, 2019. Two reviewers searched the grey literature using Google and Google Scholar.