Medical Marijuana vs Opioids for Chronic Pain Management
By: Dr. Ashok Khanna & Deven Khanna
According to the National Center for Health Statistics, Chronic Pain Syndrome (CPS) affected 76.2 million Americans in 2016, with the number growing daily. CPS is the leading cause of long term disability. It effects more Americans than diabetes, cancer, and heart disease combined. Chronic pain impacts every aspect of a persons life, it deteriorates the family system, creates an inability to work and raises many difficulties when supporting a family. Along with these impacts, CPS also limits quality time to one’s spouse and children, interferes with concentration, sleep and deteriorates the overall wellbeing of the individual.
Treatment strategies have been ineffective in improving a person’s quality of life. Chronic pain has lead to an opioid epidemic that contributed to more than 42,000 deaths in 2016. Many patients and doctors are turning to Medical Marijuana as a viable treatment strategy.
Chronic pain is a complicated medical condition to treat. There are no pain meters to measure a patients level of pain and all medical conditions effect a person’s level of pain differently. Treatment and medications are very individualistic. All patients have different pain thresholds and metabolize medications differently. One dosage of pain medication that works for a patient may not necessarily work for another, as tolerance to the medication increases, the medication becomes less effective.
The origination of a patient’s chronic pain also plays a big role in treatment. Neuropathic pain presents very differently than pain that results from inflammation, soft tissue damage, or structural changes. Medications and medicinal remedies effect these types of pain syndromes differently. Chemical imbalances in the brain play a huge role in the way a patient preserves pain and can dictate the effectiveness of treatment. A patient’s level of physical fitness and perception of life also greatly effects a person’s level of pain and the effectiveness of medications.
Since Marijuana is federally illegal in the United States, it is difficult to research the efficacy of Medical Marijuana as a treatment for chronic pain. Fortunately, states have moved to reverse this trend and through state legalization, science is beginning to look at the viability of Medical Marijuana to treat chronic pain. Countries around the world have already begun to discover the benefits of Cannabinoids, and so far, the research is very promising.
Opioids and Chronic Pain Relief
A study, published in the Journal of Pain in 2009, reviewed non-cancer pain in a total of 14 systematic reviews, 38 randomized trials not included in a previously published systematic review, and 13 other studies. The majority of these studies examined the short term effects of opioid use and did not examine the long term effectiveness of opioid use and it’s inherent risks of prescribing long term. The study determined that there were many gaps in the research related to chronic pain management and opioids. However, many doctors specializing in chronic pain confirm that although opioids are not the ideal treatment model for chronic pain, there have been no other viable treatment modalities that improve patient’s pain levels and quality of life to the extent of opioids.
Cannabis and Chronic Pain Relief
In a review of literature over a 70 year period researchers looked at 28 studies examining the efficacy of cannabinoids to treat chronic pain. The researcher concluded, “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these trials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications” (Hill).
Many doctors such as, Dr. Donald Abrams, a professor and Chief of Hematology/Oncology at San Francisco General Hospital, who supports cannabis to treat chronic pain states “Given the safety profile of cannabis compared to opioids, cannabis appears to be far safer. However, if a patient is already using opioids, I would urge them not to make any drastic changes to their treatment protocol without close supervision by their physician.”
Cannabis vs. Opioids
Although opioids have given many people another chance to have a productive and fulfilling life, while limiting the devastating repercussions of chronic pain and illness, opioids have also left a wave of devastation in its path. Severe long term side effects have created addiction, apathy for life, and increased suicide rates. As of 2018 more than 115 people in the United States die each day after overdosing on opioids. The Centers for Disease Control and Prevention estimated that the total cost of the Opioid epidemic for prescription opioid misuse alone, to be about $78.5 billion a year which includes the costs of healthcare, loss of productivity, addiction treatment, and criminal justice.
We have a chronic pain epidemic that can’t be ignored. We are in need of a better solution to pain management than what opioids have provided. Cannabis could most definitely be apart of the solution. Many patients have found that they can effectively treat their pain symptoms, as well as other medical conditions with Medical Marijuana. Patients that have been on opioids long term, find that they can decrease their opioid use by an average of 64%, while achieving greater pain relief. One of the adverse effects of Opioids is that it depletes neurotransmitters in the brain that leads to depression and suicide. Anxiety and panic attacks also increase in many patients. Many strains of Medical Marijuana have been proven in studies to reduce or even eliminate anxiety and panic attacks, while restoring neurotransmitters to a normal range when combined with caffeine.
Cannabis Not an Exact Science
Science has not concretely established a protocol for the administration of medical marijuana for relief of chronic pain. There are many strains and methods for administration. It is recommended by many doctors to start with low doses of Medical Marijuana and slowly titrate up as needed. Lower doses have been shown to be more effective for treating chronic pain while higher doses can equally increase pain levels and exacerbate illnesses. Find the appropriate strain, dose, and way of administration of Medical Marijuana that is most effective for you and talk to your doctor about possible side effects and concerns. Chronically ill patients are typically on multiple medications and drug interactions must be monitored.