Marijuana for Chronic Pain — an alternative to opioids?

Millions of people in the United Kingdom are affected by chronic pain and remain one of the hardest conditions to treat successfully. Arthritis and neuropathic pain, along with back injuries and post-operative discomfort are among the many types of chronic pain that need long-term treatment.

Opioids were traditionally used for the most extreme cases of chronic pain, however concerns regarding dependency, tolerance, and adverse reactions have motivated both patients and healthcare providers to seek out alternative, less dangerous ways of managing their pain. Medical marijuana is becoming an increasingly popular subject of conversation as an alternative to opioids.

There are two major cannabinoids within the Cannabis plant: Tetrahydrocannabinol (THC) and Cannabidiol (CBD), that act upon the human body’s Endocannabinoid System (ECS). The ECS is involved in the regulation of pain perception, inflammation, mood and sleep. Both THC and CBD affect pain pathways in the body; centrally and peripherally.

Opioids are known to cause dose escalation due to tolerance developing. With cannabis-based treatments, some individuals may find they are able to keep their dose level stable, or even reduce it. Studies conducted in areas where medical marijuana has been more readily available indicate there is an association with lower opioid use and fewer opioid-related problems when access to cannabis has been made available. Although the UK still has strict controls in place for prescribing cannabis, the data collected from these studies will continue to help guide future research and policy decisions.

Cannabis may be considered as a treatment for chronic pain due to the potential benefits listed below:

Reduced risk of physical dependence compared to opioids
Anti-inflammatory properties that treat the root cause of pain
Potential improvements in sleep quality and general well-being
Multiple methods of administration: oils, capsules, and vaporization
Ability to combine THC and CBD for better balance in pain relief

Although cannabis does have its limitations, there are side effects that can result from taking THC-dominant cannabis products, including dizziness, fatigue, and impaired cognition. Additionally, the effectiveness of cannabis will vary based on the type of pain experienced, the amount taken, and how the individual responds to it. Therefore, UK guidelines recommend that cannabis-based medications should only be prescribed by specialists once all other treatments have been unsuccessful.

The issue is not whether marijuana can completely replace opioids, but rather whether it can provide additional or alternative solutions for patients experiencing chronic pain. As further research develops, cannabis is being seen as a tool to complement a broader, more personalized approach to treating chronic pain.