Cannabis vs. Opioids for Chronic Pain — Are the Risks the Same?
Key takeaways:
Opioids are not considered a first-choice treatment for chronic pain due to their risk for dependence and misuse.
Cannabis may be an effective alternative to opioid treatment for chronic pain. It seems to have less risk and is much less likely to cause a fatal overdose.
Cannabis may also help people reduce or stop taking opioids for pain. But consult a medical professional before you try this approach.
Table of contents
Adults with chronic pain are often prescribed medications, including opioids, for pain relief. However, opioids are commonly misused, and the opioid epidemic has claimed millions of lives around the world.
As a result, people are looking for alternatives to opioids. And cannabis has emerged as one possible option.
But is cannabis the same as an opioid? And can it treat chronic pain without the same risks?
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What are opioids?
Opioids are a class of medications that attach to opioid receptors in the brain. They can be used to treat different types of pain. But they’re also controlled substances, which means they have a high potential for dependence and misuse.
Some examples of opioids include:
Hydrocodone/acetaminophen (Lorcet, Norco)
Oxycodone/acetaminophen (Percocet, Endocet)
Oxycodone (Oxycontin, Roxicodone)
Tramadol (Ultram)
Opioids are not a first-choice treatment for most people with chronic pain due to their risk for misuse and dependence. The exception to this is chronic pain related to cancer and end-of-life care. If you take opioids for chronic pain, you should take the lowest effective dosage. And your healthcare provider will likely evaluate your treatment frequently to see if you need to keep taking opioids and make sure you aren’t misusing them.
What is cannabis?
Cannabis is the term used to refer to the Cannabis sativa plant. It contains over 100 active ingredients, including cannabinoids, terpenes, and flavonoids. The most well-known cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).
Cannabis isn’t FDA-approved to treat any medical condition. But many U.S. states have legalized cannabis for medical use. And pain is one of the most common reasons people use cannabis in states where it’s legal.
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Is cannabis an opioid?
No, cannabis isn’t considered an opioid. But THC does have an indirect effect on opioid receptors, which may be part of the reason cannabis seems to help reduce pain symptoms.
What research exists on using cannabis for chronic pain?
In 2017, the National Academies of Science, Engineering, and Medicine (NASEM) determined that there’s evidence cannabis can improve chronic pain symptoms in adults. NASEM called for larger studies and long-term safety data to better understand its effects.
For non-cancer chronic pain, two review articles evaluating 2,000 patients found that cannabis had significant pain-relieving effects. It also helped improve other symptoms related to pain, such as:
Problems sleeping
Muscle stiffness
Quality-of-life issues
Patient satisfaction
Clinical trials are ongoing worldwide to look more into the use of cannabis products for chronic pain. One medication, nabiximols, which has a 1:1 ratio of CBD to THC, has shown promise for its use in chronic cancer pain and pain related to multiple sclerosis. The medication is prescribed in more than 20 other countries and is currently in clinical trials in the U.S.
What about CBD for chronic pain?
You’ve probably seen CBD products everywhere, from CBD edibles for pain to CBD lotion for acne. Although more research is needed, CBD may be helpful for chronic pain on its own. It seems to help the most with nerve pain or pain associated with inflammation, such as arthritis.
One benefit of CBD is that it doesn’t cause the psychoactive “high” that THC often does. It may also improve sleep and overall quality of life in people who take it. And even better, it may help people reduce or stop taking opioids.
Keep in mind that CBD products sold over the counter aren’t currently regulated. So they may not always contain what the bottle says. And there may be contaminants in them as well. Look for third-party testing, and be sure to only purchase CBD products from a reputable retailer.
Is cannabis safe for treating chronic pain?
Like all medications, cannabis has some risks and side effects to be aware of. Most cannabis side effects are due to THC. These include symptoms such as:
Drowsiness
Headache
Red eyes
Elevated mood
At high doses, or with prolonged use, more serious THC side effects include:
Breathing problems (with inhaled dosage forms)
Anxiety or paranoia
Hallucinations or delusions
Seizures
CBD doesn’t seem to cause the same side effects as THC. And it may actually help reduce THC side effects when they’re consumed together. But high doses of CBD can lead to diarrhea and drowsiness. There’s also some evidence that large doses of CBD may be harmful to your liver.
Opioids and cannabis differ when it comes to overdose. An opioid overdose can often be fatal. But a cannabis overdose almost never is. However, that doesn’t necessarily mean that cannabis is a safer option to treat chronic pain. We need more research to better understand the risks versus benefits of cannabis use to know for sure.
Can you consume cannabis as an alternative to opioids?
Cannabis may be an alternative to opioids in some situations. Studies have not yet shown cannabis to be helpful for acute pain. However, for chronic pain — and particularly nerve and neuropathic pain — there may be benefits.
What’s more promising is that cannabis can help people take less opioids. One study from 2020 looked at adults who were reliant on opioids for chronic low back pain. When the adults in the study took cannabis, half were able to stop all opioids. And one-third cut back on opioid use.
In surveys, cannabis was preferred over opioids for the following reasons:
Less severe side effects
Lower effects from withdrawal
Easier accessibility
Better outcomes
Can you combine cannabis and opioids?
Possibly. But keep in mind that it’s best to do this with the help of a medical professional. They can guide the process and make sure you do it safely.
In most cases, cannabis is combined with opioids to help people lower their opioid dose. Studies have shown that consuming cannabis allows people to lower their opioid use by 40% to 60%.
Research also shows that when low-dose THC is added to chronic pain treatment with opioids, people have better pain control and there’s less risk of opioid-related harm.
In another study, people taking both cannabis and opioids as a part of a chronic pain therapy plan experienced fewer side effects and a better quality of life than with opioids alone.
As mentioned previously, CBD may also help with opioid abuse. It may help reduce cravings, lessen withdrawal symptoms, and allow you to lower or stop opioid use.
More providers are becoming comfortable with cannabis as an option, so don’t be afraid to talk to yours if you’re considering using cannabis to help you take less opioids or stop them altogether.
Are cannabinoids more or less habit-forming than opioids?
People consuming cannabis regularly can become dependent on it, but it’s less habit-forming than opioids. You can become tolerant to both cannabinoids and/or opioids if you use them regularly.
The overuse of both can lead to substance use disorders. But cannabis use disorder is less common than opioid use disorder. It’s estimated that around 20% to 30% of cannabis users will develop this disorder in their lifetime. Opioid use disorder, on the other hand, can occur in up to 50% of people taking opioids for chronic pain.
If you stop taking opioids, you’re likely to experience diarrhea, vomiting, and muscle aches. But when you stop taking cannabis, the effects aren’t quite as severe. The most common symptoms include insomnia, irritability, and loss of appetite.
The bottom line
Early research shows that cannabis may be effective for chronic pain, and it may be an alternative to opioid medications. Cannabis may have fewer side effects and risks when compared to opioids, but it also has some important risks of its own. Larger studies and more long-term data is needed.
If you’re considering cannabis for chronic pain, be sure to talk through the risks and benefits with your healthcare provider.
Why trust our experts?
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