There seems little doubt that the United States is in the throes of an opioid epidemic. According to CNN, 1.7 million individuals in the U.S. suffered from a ‘substance use disorder’ related to prescription opioid pain relievers in 2017. During the same year, 47,600 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. An estimated 11 million people abused opioid prescriptions in the same year.
If you still don’t think there is a problem, consider this: America comprises less than 5% of the global population but uses 80% of the world’s opioids, and 99.7% of the global supply of hydrocodone!
Drug overdose is the #1 cause of death of Americans under the age of 50! Big Pharma in the United States has pushed these pills like nowhere else on Earth, and it is clear that opioids do FAR more harm than good.
As healthcare experts desperately seek an alternative, cannabis and its cannabinoids could provide an unexpected answer. THC is the most abundant intoxicating compound in marijuana and is linked with various analgesic properties. However, not everyone wants to get high to ease their chronic pain.
CBD is the most abundant non-intoxicating compound in weed and is also extracted from industrial hemp. It doesn’t provide a ‘high’ and 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; 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 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 completely synthetic opioid believed to be up to 100 times more powerful than morphine. Its potency is such that a small amount could prove fatal, and misuse of Fentanyl has resulted in a substantial number of deaths annually.
Opioid addiction is known as ‘opioid use disorder.’ Once you stop using these drugs, you are likely to experience hellish 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 switch to heroin because it is cheaper.
According to 2016 research by the National Institute on Drug Abuse, around 50% of young Americans who inject heroin turned to the drug after abusing prescription painkillers. If you are an opioid addict, you 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. However, a study by Sheryl Ryan, published in the April 2018 edition of Pediatrics, suggests the true cost to society is an incredible $504 billion; almost 3% of the nation’s GDP!
The number of opioid prescriptions has increased at least fivefold in the last 20 years. In the late 1990s, Big Pharma told the medical community that patients wouldn’t become addicted to opioids. As a result, physicians were happy to dole out these potentially deadly drugs as if they were candy.
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 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 post-surgical treatment.
It is often erroneously suggested that NSAIDs and other OTC drugs are not harmful. However, the truth could be darker than believed. Medscape claims that Americans use over 30 billion doses of NSAIDs each year and 25 million doses of acetaminophen. The latter is believed to cause up to 1,000 deaths each year according to the FDA, but this figure is probably way below the real mark.
These non-prescription painkillers can cause serious issues. NSAIDs block the creation of prostaglandins by special enzymes Cox-1 and Cox-2. If no prostaglandins are created, your tissue doesn’t swell, and the pain message coming from the nerves is muted. Side effects from OTC drugs can happen if you abuse them, and include:
- Extreme allergic reactions
- Gastrointestinal problems
- Kidney damage
- High blood pressure
- A higher risk of heart disease
- Liver failure
- Acute hepatitis
The issue with painkillers isn’t the lack of efficacy; it is the potential for addiction and serious side effects. You are solving one problem by creating an even worse one! It is a prime example of the ‘cure’ being worse than the disease. It is no surprise to learn that Americans are finally becoming fed up with painkillers and are seeking a safer alternative. CBD is potentially the answer.
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 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 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.
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 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
Up to 20% of Americans with chronic pain are believed to be switching to marijuana products over prescription medication. A study by Reiman, Welty, and Solomon, published in Cannabis and Cannabinoid Research in June 2017, examined the use of weed as a substitute for opioids among almost 2,900 patients with chronic pain.
34% of the group reported using opioids within the previous six months. An incredible 97% of respondents who used marijuana either agreed or strongly agreed that they were able to reduce the number of opioids they use. 81% of those who used marijuana agreed or strongly agreed that the herb 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 concerning 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.
It seems as if 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 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 with small doses of CBD, while continuing to take your opioid medications.
And finally, in terms of chronic pain management and specific medical conditions that CBD may benefit, there haven’t been many instances where opioid medications had clearly shown to be effective when cannabis had not. CBD is now used as a treatment for nociceptive pain stemming from inflammation, acute injury/trauma, chronic back pain, cancer side effects, and muscle spasticity.
Moreover, CBD 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.
A study by Xiong et al., published in the Journal of Experimental Medicine in June 2012, discovered that cannabinoids such as CBD suppressed inflammatory and neuropathic pain by targeting alpha-3 glycine receptors.
Back in May 2012, Hurd et al. looked into the use of CBD as a treatment for opioid addicts. When she posted the results of the initial clinical trial in November 2016, Hurd wrote that CBD’s “selective effect on drug-seeking behavior was pronounced after 24 hours” and endured 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 wins this particular ‘battle’ hands down; but we need more research into cannabidiol before stating this as ‘fact.’ CBD is believed to have an excellent safety profile, but it could cause side effects in some users. 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.
Most studies that have looked into CBD for pain relief show that you need a relatively high dose.
The cannabinoid isn’t cheap by any means, but it probably works out cheaper than prescription medication, even though your health insurance doesn’t cover it.
While we can’t conclusively declare CBD as the ‘victor,’ it is clear that painkillers, especially opioids, are extremely dangerous. It is patently ironic that according to the Controlled Substances Act, marijuana has a ‘high risk for addition’ when it is significantly less addictive than opioids. Unlike weed, addiction to opioids carries with it a substantial risk of overdose, and ultimately, death.
When you use an opioid, the substance goes into your bloodstream and then the brain. At this stage, it acts on mu-opioid receptors, and once it binds and activates them, it sets off an array of physical and psychological actions. Aside from the desired euphoria one feels, it is also likely that you’ll feel respiratory depressing effects.
Ultimately, the majority of opioid users who die from an overdose choke to death because they can’t get enough oxygen to meet the demands of the brain and the body’s other organs. After the drug binds to the mu-opioid receptors, it often has a sedating effect which suppresses the brain activity charged with handling your breathing rate. Opioids also decrease your brain’s ability to monitor and respond to CO2 when it reaches dangerous levels in the blood.
You may ultimately discover that CBD doesn’t provide the painkilling relief you seek. In that case, you have the option to try marijuana and its THC. If nothing else, opioid users MUST get control over their usage of these drugs, before it is too late. Whatever you may think of CBD and its cannabinoids, and there is a lot of research to go through, there is a far greater chance of dying from the usage of opioids.
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