If you pay any kind of attention to the cannabis industry or cannabis news outlets, you’ve likely heard CBD labeled as a “miracle” pain reliever a million times over — a 100% natural treatment that can (and should) replace prescription painkillers under every possible circumstance.
But how true is this, really? Is cannabis really effective enough to be able to replace any and every painkiller out there, regardless of the medical condition being treated?
In this article, we’ll take a close look at this question in an attempt to get to the bottom of the whole CBD vs painkillers argument. While there’s no denying CBD’s role as a functional and highly efficient analgesic (pain reliever), the discussion begs the question of whether or not high-strength prescription meds should still be the treatment of choice under certain circumstances.
Painkillers: Are they worth the risk and side effects?
When most people hear the term ‘painkiller’, they instinctively think something like morphine or codeine; 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 (NSAID’s)
The narcotic opioids of course include prescription meds like morphine, dilaudid, and codeine, and are the ones we hear about causing severe addiction, dependence, and fatal overdoses. Nearly $80 billion is spent each year on the North American opioid epidemic, and the U.S. Department of Health and Human Services estimates1 that roughly 12.5 million people misuse their opioid medications, resulting in over 33,000 deaths annually, or about 90 people per day.
Moreover, opioid prescriptions have been on an alarming and steady rise since the 1990’s, with a 400% increase seen in the total number of prescriptions written since 1999. And, because of the highly addictive nature of the drugs, many patients end up resorting to heroin use after their pharmaceutical prescription runs out; heroin has the same pharmacological function and is of the same drug class of drugs as narcotic opioids, but it’s far cheaper, more potent, and easier to get.
Non-narcotic painkillers, on the other hand, include standard over-the-counter (OTC) drugs like Tylenol (acetaminophen), as well as NSAID’s like Motrin and Advil (ibuprofen). These analgesics are generally effective for mild nociceptive (tissue damage) pain, but are not strong enough to be effectively used for more severe, chronic pain or for post-surgical treatment.
All in all, the primary issue with synthetic analgesics isn’t that they’re ineffective, it’s that they produce such serious and significant side effects. For instance narcotic painkillers, in addition to posing the obvious problems of abuse and overdose, are known to cause severe gastrointestinal pain/irritation, vomiting, fatigue, insomnia, and constipation. Likewise, even though they’re safer than narcotics, OTC analgesics like ibuprofen work by inhibiting the formation of inflammation-inducing prostaglandin, but in doing say they also induce stomach bleeding by inhibiting digestive prostaglandin. In terms of side effects, there really is no win-win situation with synthetic analgesics.
CBD: What is it, and how does it work?
Cannabis and synthetic painkillers prevent pain in different ways. When a certain part of your body experiences injury or trauma, for instance, 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 an endogenous, central regulatory network that functions in maintaining whole body homeostasis.
What’s lesser known, however, is the fact that cannabis also manipulates pathways2 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 medically proven 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.
In short, CBD (as well as other active cannabis compounds) appears to perform the function of 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 actual site of 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
It’s being estimated that 1 out of every 5 Americans who suffers from chronic pain are turning to cannabis products over prescription meds – and they have good reason for doing so.
A 2016 study out of the University of Michigan, for example, showed that cannabis decreased the side effects brought on by other opioid medications, reduced opioid use by over 60%, and improved the overall quality of life among prescription opioid users.
Moreover, the side effects of CBD itself have been shown to be virtually non-existent. Dr. Donald Abrams, in fact, Chief of Oncology at San Francisco General Hospital, had this to say about the coordinated relationship between cannabis and opioids:
“Given the safety profile of cannabis compared to opioids, cannabis appears to be far safer.”
This, coming from someone who prescribes pain medication to cancer patients and chronic pain sufferers on a daily basis, and who witnesses firsthand the effects on quality of life that opioid medications so often present.
That being said, several studies have been published which showcase CBD’s potential to deactivate a certain class of cytochrome enzymes at high dosages, which may imply drug to drug interaction problems with regard to proper 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. Research has shown3, for example, that both CBD and THC can potentially increase levels of Warfarin and Clobazam under certain doses by reducing P450 enzyme activity in the liver.
If you are one of the many thousands of people looking to replace or otherwise reduce opioid medication reliance by switching to cannabis, it’s advised to make the switch slowly and start off with small doses of CBD, while continuing to take your opioid medications.
“[If a] patient is already using opioids,” Dr. Abrams says, “I would urge them not to make any drastic changes to their treatment protocol, without close supervision by their physician.”
And finally, in terms of chronic pain management and specific medical conditions that CBD treats, there haven’t really been any instances where opioid medications have clearly shown to be effective when cannabis had not.
CBD has been a proven treatment4 for nociceptive pain stemming from inflammation, acute injury/trauma, chronic back pain, cancer side effects, and muscle spasticity.
Moreover, it has also been documented to effectively treat neuropathic pain, which stems from a malfunction within the central nervous system and initiates a pain response even when there is no physical tissue damage or injury.
Medical research and CBD
As we’ve shown with a few examples in this article, there have already been numerous studies carried out showcasing the pain management effects of CBD, as well as its potential to act as a replacement therapy for prescription opioid medications.
Additionally, there is a current active clinical trial5 being carried out right now which aims to study the short term effects of cannabidiol (CBD) on opiate cravings among heroin addicts. Depending on the results of the trial, which is titled “Acute and Short-term Effects of CBD on Cue-induced Craving in Drug-abstinent Heroin-dependent Humans”, a definitive position could be reached which effectively showcases the ability of CBD to alter the addictive pathways of not only heroin, but other prescription opioids as well.
The implications of this, if accurate, would be nothing short of immense, taking into consideration that the current opioid epidemic is costing taxpayers upwards of $80 billion per year, not to mention taking the lives of nearly 40,000 people per year from opioid overdose.
CBD vs. Painkillers: Which is best?
It really would be inaccurate and irresponsible to claim any one “victor” in the CBD vs painkillers argument; there are far too many variables at play, and far too many medical factors to consider in order to make any kind of claim that “CBD is better than painkillers”, or vice-versa.
These “medical factors” could include any countless number of things, from genetic considerations to extenuating health conditions to overall medical history – not to mention the actual nature of the condition being treated.
And, what’s more, CBD as an effective pain-relief medication certainly doesn’t have the same results for every patient; some, in fact, have claimed that their opioid medications are superior in terms of overall pain management.
Also, dosing and administration is another thing to take into consideration, as the method of cannabis intake can prove to be vital in terms of its physiological effectiveness.
Kevin Ameling, for example, is a daily cannabis user who was able to replace a vast assortment of high-strength opioids after a serious accident more than a decade ago, with medical marijuana. However, he nearly gave up on the alternative treatment after only a couple weeks, until he was able to find a dose and “intake method” that suited him and his specific condition: “I found [that] smoking [actually worsened] my symptoms, while low dose edibles [worked] the best.”
The Bottom Line: CBD vs. Painkillers
All in all, it would be naive for anyone to claim that painkillers shouldn’t hold a proper place in modern medicine; as stringent as we are in terms of advocating for CBD use, these drugs can be incredibly effective, and many millions of people rely on them each and every day in order to lead a more enjoyable, manageable life.
That being said, the incredibly dangerous side effects of most synthetic analgesics cannot – and should not – be ignored. If any one individual has the opportunity to decrease their reliance on painkillers, they should take full advantage.
While it’s not recommended to cease taking prescription painkiller medications right off the bat, try CBD out in small doses and see if it’s effective for you, either in terms of direct pain management or in terms of its ability to decrease your reliance on prescription analgesics. The potential benefits of achieving a healthier lifestyle – and better quality of life – with reduced side effects, are far worth it.
1: Department of Health and Human Services
2: “Advances in the field of cannabinoid–opioid cross-talk”
3: Department of Health: Medical Cannabis – Adverse Effects and Drug Interactions
4: “Cannabinoids in the management of difficult to treat pain”
5: National Institute of Health Clinical Trials
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