Cannabis as an Opioid Alternative: What Do We Know So Far?

Cannabis as a pharmacological agent has been used for centuries. It's been described in China, in Asian countries dating back to well before the BC era. Ultimately it made its way to the United States where it actually was made available to patients until it was outlawed in the 1930s and '40s. And now obviously it's making a comeback in the hope that we can use that as an option to opioids. But the jury is still out on that. Because it is still a schedule 1 drug, studies of medical cannabis are very difficult to do. So, we just have a lot of anecdotal evidence and some studies that show that it has some benefit in pain management, specifically in neuropathic pain conditions such as multiple sclerosis. There are also some case reports showing that in specific patients, opioids have either been significantly reduced or completely stopped using medical cannabis.

The two main constituents that are thought to produce most of their pharmacological activity in terms of pain management are cannabidiol and THC, but there are well over 80 other compounds which may or may not have an effect. Unfortunately, we haven't been able to study any of those yet. So, for primary care, what I would say about using cannabinoids as a treatment option is that it may be something to consider before you start putting patients on opioids. Once you start them on opioids, if they've been on it for a couple of months, chances are they're going to be on it for the rest of their lives. And so medical marijuana may be an option to offer to patients and hopefully decrease the use of opioids for chronic non-cancer pain.