The opioid crisis continues to be in the news. Besides the frequent reporting about opioid addiction and overdose and the shortage of addiction treatment, a new Netflix series, Painkiller, has just been released. The series portrays the role of Purdue Pharma in instigating the opioid crisis and how the company’s owners, the Sackler family, literally got away with murder. In addition, the Supreme Court just agreed to hear a federal appeal of the Purdue Pharma bankruptcy settlement, which let the Sacklers walk away with billions and granted them immunity from any further civil or criminal liability. In other news, a widely reported recent study found that Opioids work no better than a placebo when prescribed for acute and subacute back and neck Pain. But what is glaringly missing from all of these reports is any discussion of the many alternatives to opioids that are available for pain relief.

This article will review the dangers of opioids and the reasons why Marijuana is a good opioid alternative.

Opioids are more dangerous than most patients and doctors believe

Most people believe that the most powerful weapons we have against severe pain are opioids like Vicodin, Percocet, Hydrocodone and Oxycodone.  But is this really true?  It’s an important question because opioids are highly addictive and taking too much can be fatal.  Millions of Americans have become addicted to prescription opioids and about 80% have been medical patients taking them as directed. The Nation Institute on Drug Abuse (NIDA) reports that 10-12% of those prescribed opioids develop an addiction.

Even worse, more than one million Americans have died of accidental overdoses of these drugs since 1999 and the number of deaths per year continues to escalate.  Yet opioids are still widely prescribed for pain because most patients and doctors believe they are the most effective treatment.

Studies reviewed by the National Safety Council, however, found that for acute pain, only one out of every four or five people who were prescribed 15 mg. Oxycodone achieved at least 50% relief. Ibuprofen, Naproxen, and a combination of ibuprofen and acetaminophen all performed much better. (These drugs, known as NSAIDs, however, pose serious risks with long term use). The National Safety Council also reports that there is no evidence for long term effectiveness of opioids for chronic pain.

Marijuana is more effective and safer than opioids for pain relief

Mounting evidence indicates that marijuana may be more effective at treating pain than any other available drug, including opioids.  Marijuana is certainly safer—it is not physically addictive and in over 5000 years of known medical use there has never been any documented case of death due to marijuana overdose.  

Marijuana users do not build up tolerance to the drug, (i.e. needing higher doses to achieve the same effect) the way that opioid users do.  In fact, marijuana, when used together with opioids, can prevent the development of tolerance and can help opioid users wean off their drugs.  States with medical marijuana laws have reduced opioid overdose deaths by an average of 25%.

 

How marijuana works to relieve chronic pain

Marijuana is the only known plant that contains compounds called cannabinoids.  Our bodies naturally make cannabinoids (known as endocannabinoids when our body produces them) to help relieve pain.  Dr. Ethan Russo, a neurologist and pharmacologist, who has done research on endocannabinoids, has even proposed that fibromyalgia, an increasingly commonly diagnosed pain disorder that is characterized by widespread pain and fatigue, is caused by endocannabinoid deficiency.


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Marijuana has a long history of medicinal use

Marijuana grows wild in all but the coldest climates all around the world and has been used medicinally for treatment of pain and many other disorders for thousands of years.  The first written reference to marijuana, also known as cannabis, for treatment of pain was by Chinese Emperor Shen Nung in 2737 BCE.  Marijuana was in widespread use in the United States as a medicine until 1941, when anti-marijuana crusader Harry Anslinger, then the commissioner of the Federal Bureau of Narcotics, insisted that it be outlawed.

The research on marijuana for pain relief

A 2011 review of randomized controlled studies of cannabinoids for treatment of chronic, noncancer pain found significant effects on pain relief as well as significant improvements in sleep. Most of the studies were of neuropathic pain, but one study each of fibromyalgia and rheumatoid arthritis also reported positive results.  No serious adverse effects were reported.

A 2014 survey by the National Pain Foundation of fibromyalgia patients found that 62% of those who tried marijuana said it was very effective at treating their symptoms, 33% said it helped a little and only 5% said it didn’t help at all.

In a 2015 review of controlled studies of cannabinoids in the treatment of chronic neuropathic pain the authors concluded that cannabinoids provide significant pain relief in chronic neuropathic pain in conditions where other treatments do not work. They found that reported side effects in the reviewed studies were minor.

A survey of 100 consecutive medical marijuana patients who were returning for their annual recertification in Hawaii found that 97% used marijuana primarily for relief of chronic pain. They reported an average 64% decrease in pain—a decrease on a 10-point pain scale from 7.8 to 2.8. Half also reported relief from stress and anxiety; 45% reported insomnia relief; and 71% reported no negative side effects. No serious adverse effects were reported. Some of the patients reported they were able to reduce or eliminate their use of opioids for chronic pain.

A 2019 study found that 80% of patients who were using marijuana for chronic pain found it very or tremendously helpful and 88% were able to stop taking opioids. 

There’s been a recent explosion of research on cannabis as an opioid alternative or to reduce opioid dosage. Here are a few more studies from 2023 alone:

A 2023 study at the University of Florida of middle-aged and older chronic pain patients found that the majority of patients found medical cannabis to be effective for chronic pain management. Benefits included reduced pain and anxiety, improved physical and mental functioning, better sleep quality and mood and reduced use of prescription medications, including opioids and benzodiazepines.

A federally funded study published in 2023 investigated outcomes of intentional use of marijuana to manage opioid cravings in people who were using illicit opioids. The study found that cannabis use in this group “is associated with self-assessed reductions in opioid use.” The study authors wrote, “Increasing the accessibility of cannabis products for therapeutic use may be a useful supplementary strategy to mitigate exposure to unregulated opioids and associated harm during the ongoing drug toxicity crisis.”

A 2023 study of patients undergoing cervical spinal fusion surgery found that patients who were using cannabis prior to their surgery found that cannabis users filled fewer opioid prescriptions post-operatively and required lower doses at 60 days postoperatively than non-cannabis users.

Yet another study published in 2023 found marijuana to be a viable alternative to opioids. This study examined individuals with chronic pain who enrolled in the state of Illinois’ opioid diversion program, the Opioid Alternative Pilot Program (OAPP), which offers individuals aged 21 and older a separate pathway to access medical cannabis if they have or could receive a prescription for opioids as certified by a licensed physician.  The study found that marijuana “May Provide an Off-Ramp from Undesired Prescription Opioid Use”.

Conclusion: 

Marijuana is a safer and more effective alternative to opioids for pain relief
 

Given that marijuana is considerably safer than opioids and can provide significant pain relief, the current preference by medical professionals and regulators for use of opioids not only makes no sense, it’s also causing unnecessary harm and death.

The U.S. Drug Enforcement Agency (DEA) continues to classify marijuana as a Schedule I drug, a drug with a high potential for abuse and no accepted medical use. Considering the weight of evidence, the DEA should immediately unschedule marijuana. This action would make this opioid alternative legally available to all Americans, more acceptable to prescribers, and open the doorway to insurance coverage.

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The author, Cindy Perlin, is a Licensed Clinical Social Worker, certified biofeedback practitioner and chronic pain survivor. She is the founder and CEO of the Alternative Pain Treatment Directory and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. She's located in the Albany, NY area, where she has been helping people improve their health and emotional well-being for over 30 years. See her provider profile HERE. She is available for both in-office and virtual consultations.