Thursday, May 13, 2021

Transitioning from Opioids to Cannabis for Chronic Pain

Antoine Dautry

-shared by media

In the United States, there are approximately fifty million people who suffer from chronic pain. A debilitating condition that can vary by intensity and duration. In 2016, the CDC reported that 20.4%of adults in the U.S. had chronic pain. And 8.0% had a condition called high-impact chronic pain.

Someone with chronic pain can have good days and bad days. But it is hard to predict what the pain level will be each day. Or prepare and plan for it. Unmanaged chronic pain can impact every aspect of life, from employability to self-care, happiness, and social relationships.

That is why chronic disease is characterized as a qualifying health condition in states with legalized medical cannabis. For some people, cannabis has become a better method of managing pain as-needed. And many people believe that when comparing opioids to cannabis, that medical marijuana may be a safer option.

How Did America’s Opioid Crisis Happen?

Did you know that in many countries with Universal Healthcare, prescription medications’ marketing is minimal? For example, in Canada, you aren’t going to see repeat commercials about new pharmaceuticals, with h ten-minute disclaimers about potential side-effects.

Pharmaceuticals are marketed to physicians, but the laws are strict. For example, a pharmaceutical company may send samples and literature to educate a physician. But they can’t offer an incentive like a “free trip to Hawaii” if the physician prescribes large amounts of the drug annually.

Which makes sense, right? Because we know how that can turn out. With cash and prizes as an incentive for physicians to prescribe certain medications, safety goes out the window. For the less scrupulous kinds of doctors out there, anyhow. And there are many. These issues are the foundation of the opioid crisis now faced in the United States.

But in terms of pain management, we arrived at this crisis because of a lack of safer, accessible, and affordable options. Now that patients are under severe restrictions on how many opioids they are prescribed, millions of Americans live with the pain they cannot resolve. Physicians will not prescribe more opioids, and patients have come to rely on them for pain management.

What Are the Risks of Long-Term Use of Opioid Medications?

Acute withdrawal symptoms from opioid medications can set in as quickly as 4-6 hours after the last dose. And last for more than five days after the cessation. Many patients have to undergo a precipitated withdrawal. That is a step down of opioid medications by lowering doses to make the withdrawal symptoms more manageable.

The most immediate threat for patients who have stopped taking opioids is the withdrawal symptoms. Not only are the symptoms of opioid withdrawal very difficult, but the patient must cope with the chronic returning pain at the same time.

MarijuanaDoctors.com explains that opioids work by binding to opioid receptors that are present in the human body and brain. They block the receptors so that the body cannot ‘feel’ the pain. The cause of the pain symptoms does not resolve; opioids simply make it possible to shut down the pain sensation. And they also produce feelings of relaxation and euphoria.

People who live with moderate to severe chronic pain rely on that relief. The problem is that over time, the body develops a tolerance to opioids. The same amount of prescription doses do not work. And then, since pain is not resolved, the quantity increases.

With higher potency levels, opioids enter into a tug-of-war with the body and brain. The body turns up the dial on pain receptors. Prescriptions for opioids increase in strength. Then the body ‘fights back’ and increases pain receptor sensitivity. More opioids are needed, and they become less effective simultaneously. And overdose risks increase.

Are Opioids Effective for Pain Relief?

Many things have changed in the way that opioid medications are prescribed because of the growing prescription medication addiction and overdose crisis. For instance, patients who undergo surgical procedures are only provided with a limited number of NSAIDs or opioid medications. And then, they are encouraged to use natural pain relief methods (heat and ice application and over-the-counter remedies.

Recovering from surgery is one thing because the pain will improve over time. But for patients who have a chronic pain condition, there is no resolution. They are not going to wake up one day to learn that they have cured their chronic pain. They need an effective, safe and affordable way to manage that pain so that they can live and work.

Opioids were never developed for long-term use. But over time, physicians (lacking a better alternative) started prescribing them monthly. Some of the known side-effects of long-term use of opioids include:

  •     Bone density loss and increased risk of fractures
  •     Breathing problems during sleep (including severe sleep apnea)
  •     Immunosuppression (impairment of the immune system)
  •     Chronic constipation and bowel obstruction
  •     Myocardial infarction
  •     Tooth decay (caused by xerostomia)

Prescription opioid medications cause people to feel relaxed and happy but also sedated. This type of medication is very similar to heroin, according to clinical patient studies. But as a long-term solution to pain, opioids are not the answer. Clinical studies have shown that they can increase nerve sensitivity over time. That means more pain (at ever-increasing doses), not less for people who use prescribed opioids daily or weekly.

How Can Cannabis Provide Relief for Patients with Chronic Pain Symptoms?

One of the most cited clinical studies was published in January 2017. The National Academies of Sciences, Engineering, and Medicine (NASEUM) conducted research and review into 10,000 human studies. The purpose was to determine whether cannabis could provide a real benefit for symptom management.

The results of the study suggested that cannabis could be a highly effective alternative to opioids for pain management. The study also reviewed the combination of cannabinoids and mild opiates for long-term use—a less harmful but equally effective option for chronic pain management.

How does cannabis react in the body to relieve pain? There are many different strains of cannabis to explore. But the most popular types for pain relief have high CBD levels, which helps moderate inflammation within the body.

Contrary to opinion, some of the best strains for pain relief are not sedative. Patients with a medical card can choose from lower dose THC options that have different terpenes understood to provide pain relief—the entourage effect of more than 700 strains of cannabis that may be appropriate for chronic pain symptoms. Cannabinoids and terpenes, and even flavonoids combine to create a more natural approach and an option for symptom management.

Neuropathy and Nociceptive Pain Relief with Medical Cannabis

Nociceptive pain comes from inflammation after an injury or damage to tissue or muscles. That is the slow and throbbing pain some people experience. And when there is an injury, the body turns up the activity of immune cells to repair the problem. But that also increases inflammation and discomfort. The immune system cells release proteins, which trigger pain symptoms.

Medical cannabis that is high in CBD has also been useful for patients that have neuropathic pain. People with diabetes, or Parkinson’s disease, and epilepsy experience neuropathy. It is very difficult to treat because it is not isolated to one area. Cannabinoids and CBD seem to provide positive results for some patients.

Will Physicians in Legalized States Start Transitioning Patients?

One research study has tracked a reduction in opioid overdoses and fatalities in states that have legalized medical cannabis programs. The findings were startling. In states with legalized medical cannabis programs (and authorized use for patients with chronic pain), overdose rates fell.

But not just for patients using (or abusing) opioids. The mortality rates fell across the board for people addicted to other types of prescription or illicit drugs, including heroin and fentanyl. The mortality rates in each state evaluated dropped by 24.8%.

The longer the medical cannabis program was enforced, the more lives were saved. Visits to the hospital for non-fatal but emergency overdose incidents also fell by 23% because there was a safer alternative that patients could try (under doctor supervision) than opioid medications.

Traditionally, drug rehabilitation’s goal has been to ‘quit cold turkey’ with talk-therapy, nutrition, and other support. And critics feel that replacing one addiction (opioids) with another (cannabis) is counterintuitive. However, the lifesaving potential of step-down therapies for prescription medication addicts is promising.

Worldwide, there has yet to be one documented case of a cannabis overdose, where cannabis was the particular drug of use. In the United States in 2018, there were 67,367 deaths from a drug overdose. The CDC states that opioids were the main driver in 69.5% of all drug overdose deaths. And two out of three opioid overdoses involve synthetic opioids. Or lab-made novel psychoactive substances (NPS).

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