CBD as an Alternative for Pain Management & Opioid Addiction

According to data compiled by the American Academy of Pain Medicine, more than 100 million Americans suffer from chronic pain daily. The most common conditions involve experiencing unrelenting pain in the lower back or neck and debilitating migraines or headaches. These types of chronic pain negatively impact the suffer’s lives by diminishing their mental health, limiting their physical actives and overall decreasing their quality of life.

In an attempt to easy pain and enhance quality of life, in 1991 many physicians began prescribing opioids. The increase in opioid prescriptions was mainly influenced by reassurances from pharmaceutical companies and medical societies that claimed addiction risk to prescription opioids was very low. Pharmaceutical companies also began to promote the use of opioids in patients with non-cancer related pain even though there was a lack of data regarding the risks and benefits.

In response to increased opioid related overdoses, physicians severely decreased opioid prescribing, which then led to another rapid increase in deaths from heroin abuse. Heroin related overdoses increased by 286% from 2002 to 2013, with 80% of heron users admitting to misusing prescription opioids before turning to heroin.

2013 marked the third wave of the opioid epidemic as an increase in deaths were now being linked to synthetics, like fentanyl. In 2016 over 20,000 Americans died from illicitly manufactured fentanyl. According to a report on preventable deaths from the National Safety Council, Americans are more likely to die from an accidental opioid overdose than a motor vehicle accident.

Poorly managed and unresolved chronic pain remain an important catalyst for opioid misuse, leading to tolerance, dependency and finally addiction or overdose. A study published at McMaster University in Ontario discovered that opioids do not work well for many types of non-cancer pain. The study concluded that other drugs and non-non-invasive treatments such as physical therapy and ice, may be more effective for pain relief. With the high risk of addiction and overdose along with the plethora of side effects associated with extended opioid use, it is imperative safe and effective alternative or adjunct therapeutic modalities are examined, one such being CBD.

CBD may offer an option for addressing many different types of chronic pain. An animal model study from the European Journal of Pain showed CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study conducted demonstrated the mechanism by which CBD is able to inhibit inflammatory and neuropathic pain, both which prove to be the most difficult, and resistant types of chronic pain to treat. CBD has also been shown effective in addressing anxiety and insomnia which are common in patients suffering from chronic pain.

CBD aids in pain relief without causing numbing the mind or triggering the reward pathway that leads to addiction. While CBD is one of many constituents of the cannabis sativa plant, by itself it does not cause a “high” like that of THC. According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential.... To date, there is no evidence of public health related problems associated with the use of pure CBD.”

CBD has also been suggested to aid in soothing withdrawal symptoms and cravings associated with opioid addiction. An article published in Addiction Biology concluded that CBD interferes with brain reward mechanisms that reinforce the properties of opioids, suggesting that it can be clinically useful in attenuating cravings. CBD’s ability to regulate opioid reward stems from its ability to enhance serotonin signaling in the brain. Serotonin is a mood- regulating brain chemical that is a common target of anxiety and anti-depressant medications. It’s not surprising that the compound also relieves anxiety, a prominent symptom of withdrawal. CBD may also help patients avoid relapsing after a period of abstinence. A study conducted with rats trained to push a lever for heroin showed that when given CBD, they were less likely push the lever depicting reduced cravings that lasted for two weeks after CBD treatment.

While further research is always necessary to definitively determine conclusive results, the findings from various studies are promising in suggesting CBD as a safe and effective treatment option for chronic pain and symptoms related to opioid misuse/addiction.

Resources:

Busse JW, Wang L, Kamaleldin M, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA. 2018;320(23):2448–2460. doi:10.1001/jama.2018.18472

Grinsppon, Peter. (2018) Cannabidiol (CBD)-what we know and what we don’t. Harvard Health Publishing.

Katsidoni V, Anagnostou I, Panagis G. Cannabidiol inhibits the reward-facilitating effect of morphine: involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addict Biol. 2013 Mar;18(2):286-96. doi: 10.1111/j.1369-1600.2012.00483.x. Epub 2012 Aug 2. PubMed PMID: 22862835.