There seems little doubt that the United States is in the throes of an opioid epidemic. According to CNN, nearly two million people in the U.S. suffer from opioid painkiller-related ‘substance use disorder.’ In 2017, nearly 48,000 people died from a drug overdose involving opioids. This figure is the equivalent of over 130 fatalities per day, or a death every 11 minutes!
In 2016, health care providers in America wrote an incredible 214 million prescriptions for opioid pain medication. About 11 million people abused opioid prescriptions in the same year.
America comprises less than 5% of the global population but uses 80% of the world’s opioids — 99.7% of the global supply of hydrocodone.
Drug overdose is the #1 cause of death in Americans under the age of 50. As healthcare experts desperately seek an alternative, cannabis could provide an unexpected answer. THC is the most abundant compound in cannabis, and is known to have various analgesic properties. However, not everyone wants the high associated with THC when attempting to ease their chronic pain.
CBD is the most abundant non-intoxicating compound in cannabis. It doesn’t provide a high and it is also linked with a reduction in pain symptoms. In this article, we compare CBD with prescription painkillers to see if the former is a worthy substitute for the latter.
Painkillers: Are They Worth the Risk and Side Effects?
When most people hear the term painkiller, they instinctively think something like morphine or codeine. In other words, high-strength pharmaceutical opioids with addictive characteristics and dangerous side effects.
However, narcotics aren’t the only type of painkillers (aka analgesics) out there. Standard over-the-counter drugs like Tylenol and ibuprofen are also painkillers, as are medications like naproxen and Aleve. Basically, analgesics fall under three main categories:
- Opioid narcotics
- Non-narcotic analgesics
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
The nation’s growing addiction to opioid narcotics is well documented at this point. These pharmaceutical drugs bind to the receptors in the brain and spinal cord and work to disrupt pain signals. Opioids also release dopamine, a hormone that creates a feeling of euphoria. Opioids such as codeine and morphine are naturally derived from the opium poppy plant which grows in South America, Central America, and Asia.
Oxycodone and hydrocodone are semi-synthetic opioids created in labs using a combination of synthetic and natural ingredients. Hydrocodone was the most widely prescribed opioid in America between 2007 and 2016, while oxycodone was second. In 2016, 6.2 million hydrocodone pills were distributed across America, along with 5 million oxycodone pills.
Fentanyl is a synthetic opioid believed to be up to 100 times more powerful than morphine. Its potency is such that a small amount could prove fatal. Misuse of Fentanyl results in a substantial number of deaths annually.
What exactly is opioid addiction?
Opioid addiction is known as ‘opioid use disorder.’ Discontinuing use after an extended period of time can lead to severe withdrawal symptoms. Also, regular users develop a tolerance, which means they must take more to have the same effect. Those who become dependent on opioids may eventually switch to heroin because it is cheaper.
According to 2016 research by the National Institute on Drug Abuse, around 50% of American heroin users turned to the drug after abusing prescription painkillers. Opioid addicts are 40 times more likely to develop a heroin addiction.
Estimates of the economic burden of opioids vary. The CDC claims the epidemic costs around $78.5 billion per annum. The number of opioid prescriptions has increased at least fivefold in the last 20 years. In the late 1990s, The number of addictions and deaths escalated during the early 21st century, and has continued to stay elevated. The number of addictions and deaths escalated during the early 21st century, and things are officially out of control.
From July 2016 to September 2017, for example, the number of opioid deaths increased by 30% in 52 specific areas across 45 states.
Non-narcotic painkillers, on the other hand, include standard over-the-counter (OTC) drugs like Tylenol (acetaminophen), as well as NSAIDs like Motrin and Advil (ibuprofen). These analgesics are generally effective for mild pain but are not strong enough to be effectively used for more severe, chronic pain or post-surgical treatment.
Clearing up a common misconception…
It is often erroneously suggested that NSAIDs and other OTC drugs are not harmful. However, these non-prescription painkillers can cause serious issues. NSAIDs block the creation of prostaglandins by the enzymes Cox-1 and Cox-2. If no prostaglandins are created, the pain message coming from the nerves is muted. Side effects from OTC drugs can include:
- Allergic reactions
- Gastrointestinal problems
- Kidney damage
- High blood pressure
- A higher risk of heart disease
- Liver failure
- Acute hepatitis
It is no surprise to learn that Americans are finally becoming fed up with painkillers. Could CBD be the answer? We take a look at the evidence below.
CBD: What Is It, and How Does It Work?
Cannabis and synthetic painkillers prevent pain in different ways. When a certain part of the body experiences injury or trauma, nerve endings at the site of damage will send signals to the brain, informing it of the injury and ordering it to take responsive action. This results in the onset of the pain sensation pathway.
Functionally, narcotic opioids work by blocking the “receiving” end of this pain sensation pathway; that is, they sever communication between the body’s various tissue systems and the central nervous system.
The pain-mediating effects of cannabis, on the other hand, are not as systematically understood, though it is known that compounds like THC and CBD function by interacting with the body’s endocannabinoid system, which is a central regulatory network that functions in maintaining whole-body homeostasis.
What’s lesser-known, however, is the fact that cannabis also manipulates pathways within the opioid system and performs many of the same pharmacologic functions as high-strength narcotics. For instance, active cannabinoids, just like opioid painkillers, have been shown to reduce pain-inducing inflammation, trigger the release of endorphins, block the nociceptive pain sensation pathway in the central nervous system (CNS), alleviate neuropathic pain, and act as a muscle relaxant.
Cannabinoids: ‘Novel anti-inflammatory drugs?’
A study by Nagarkatti et al., published in the August 2010 edition of Future Medicinal Chemistry, described cannabinoids as ‘novel anti-inflammatory drugs.’ According to the research, cannabinoids “suppress inflammatory response and subsequently attenuate disease symptoms.” It also surmised that cannabinoids could be useful when treating certain types of cancer triggered by chronic inflammation.
CBD (as well as other active cannabis compounds) appears to perform like opioids by blocking pain at the neurological level. However, unlike opioids, it simultaneously promotes whole-body homeostasis by reducing inflammation and relaxing muscles at the site of the trauma.
Of course, this constitutes the centerpiece of the CBD vs. painkillers argument: while cannabis engages the pain management network of the opioid system and manipulates whole-body homeostasis within the endocannabinoid system, prescription painkillers only engage the pain-relieving receptors of the opioid system; they do not play any functional role in whole-body homeostasis.
This is why, even though they’re very effective at minimizing pain, painkillers have a tendency to throw other bodily systems dangerously out of whack.
CBD vs. Painkillers: Drug to Drug Interactions, Potential Side Effects, and Medical Conditions That They Treat
Up to 20% of Americans with chronic pain are believed to be switching to cannabis products over prescription medication. A study by Reiman, Welty, and Solomon published in Cannabis and Cannabinoid Research in June 2017, examined the use of cannabis as a substitute for opioids among almost 2,900 patients with chronic pain.
Thirty-four percent of the group reported using opioids within the previous six months. An incredible 97% of the respondents who used cannabis either agreed or strongly agreed that they were able to reduce the number of opioids they use. 81% of those who used cannabis agreed or strongly agreed that it was more effective at treating their condition than when they used it with opioids.
There is also published research which shows CBD’s potential to deactivate a certain class of cytochrome enzymes at high dosages, which may imply drug to drug interaction problems involving the metabolization of other medications. The enzymes in question, specifically the cytochrome P450 enzymes, are a class of liver enzymes that are active in the metabolization of several pharmaceutical medications.
CBD and THC can potentially increase levels of a number of medications, like warfarin and clobazam, by reducing P450 enzyme activity in the liver. Therefore, if you are one of the thousands of people looking to replace or otherwise reduce opioid medication reliance by switching to cannabis, it’s advised to do so only under the supervision and guidance of a physician.
The wide-ranging benefits of CBD
In terms of chronic pain management and specific medical conditions that CBD may benefit, the number continues to grow. CBD is now used as a treatment for:
- Nociceptive pain stemming from inflammation
- Acute injury/trauma
- Chronic back pain
- Cancer side effects
- Muscle spasticity
Moreover, CBD has also been documented to effectively treat neuropathic pain. This is a type of pain that stems from a malfunction within the central nervous system. It initiates a pain response even when there is no physical tissue damage or injury.
A 2012 study in the Journal of Experimental Medicine claims that cannabinoids suppress inflammatory and neuropathic pain by targeting alpha-3 glycine receptors.
In May 2012, Hurd et al. looked into the use of CBD as a treatment for opioid addicts. The initial results of the clinical trial in November 2016 claim that CBD’s “selective effect on drug-seeking behavior was pronounced after 24 hours.” It also says the effects endure for up to two weeks after the last use of drugs following short-term exposure to CBD.
In May 2019, Hurd et al. followed up with a study published in the American Journal of Psychiatry. According to the research, CBD reduced “cue-induced craving and anxiety in individuals with a history of heroin abuse.” Hurd said that the findings show CBD has significant promise for treating people with heroin use disorder. Since so many people who use heroin began as opioid addicts, perhaps cannabidiol can help them as well?
CBD vs. Painkillers: Which Is Best?
In conclusion, the evidence available to date suggests that CBD at least wins for having fewer side effects and more beneficial adjunct effects. CBD is believed to have an excellent safety profile, but it is also true that CBD affects everyone differently. While your neighbor may enjoy immense pain relief from CBD, you might not experience the same benefits.
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