Cannabis Could Replace Opioids to Treat Insomnia and Pain, Says Study

Anecdotally, medical cannabis patients consistently tell of how they use cannabis as a preferential alternative to prescription medications. In the past few years, these claims have been backed up by scientific studies which have linked cannabis consumption to a noticeable fall in the use of other prescription medication, especially opioid medications.

But very little is known about individuals who are using cannabis from the recreational adult-use market to treat their ailments. 

Medical cannabis access often requires individuals to obtain a prescription from a physician and be registered in a state database of medicinal users; but because of poor healthcare access or patchy state employment protections for medical cannabis patients, this is not a feasible option for many people. Normally, adult-use legal cannabis markets do not have these same sort of barriers to access, and so individuals who are unable or unwilling to register with a state medical cannabis program may choose to use cannabis bought from a recreational cannabis retail outlet to treat their symptoms instead. 

Previous surveys have turned up evidence of individuals choosing to substitute cannabis for prescription opioids, benzodiazepines, and antidepressants, but these questionnaires did not exclusively survey adult-use only dispensary customers. Now, thanks to a new study published in the Journal of Psychoactive Drugs, scientific study is beginning to address this gap in knowledge.

Adult-use cannabis commonly used as pain relief and sleep aid

Researchers surveyed 1,000 adult-use only customers from two cannabis retail stores in Colorado between August and October 2016 using an electronic questionnaire, screening to make sure that the participants were not also registered medical cannabis patients. 

Of the 1,000 people surveyed, 65 percent reported using cannabis in order to relieve pain, with 80 percent of those users finding cannabis to be “very or extremely helpful.” Additionally, a majority of those who found cannabis helpful and who were previously taking over-the-counter pain medications or opioid analgesics, began reducing or even completely stopping their use of those drugs. Eighty-two percent of people taking over-the-counter pain relief reported a reduction or stoppage in their use of the medication, with this number rising to 88 percent of the individuals using opioid analgesics. 

Even more common than taking cannabis to reduce pain, 74 percent of survey respondents reported using the drug to improve their sleeping, with 84 percent of those who did saying that cannabis was very or extremely helpful. Again, a pattern was observed in which the people who found cannabis to be helpful also reduced or stopped their use of other medications, in this case over-the-counter (87 percent) or prescription (83 percent) sleep aids.

The dangers of opioids

While all the results of this survey are interesting in a given light, arguably the most significant result is the observation that cannabis use could be reducing opioid use. 

Opioids are extremely effective at treating moderate-to-severe pain, and so they are often prescribed following surgery, serious injury, or to treat severe chronic pain; but opioids are far from a miracle drug — they can be highly addictive narcotics, and use of the medications for an extended period of time is known to result in dependency and the development of an opioid use disorder. 

The opioid overdose epidemic in the United States is so severe that in 2017 the Acting Secretary of Health and Human Services declared the opioid crisis a nationwide public health emergency. 

In 2016, drug overdose deaths rose to roughly 64,000, a higher count than the number killed in the entire 20-year-long Vietnam War. In 2017 this figure rose further to 72,000 deaths. For context, that’s around 200 deaths a day, and at least 17,000 more deaths than car crashes, HIV/AIDS, or guns have ever caused in a single year. Opioids are estimated to be responsible for at least two-thirds of these drug-related deaths. 

“People develop tolerance to opioids, which means that they require higher doses to achieve the same effect,” says Dr. Julia Arnsten, professor of medicine at Albert Einstein College of Medicine, and one of the authors of the new study. “This means that chronic pain patients often increase their dose of opioid medications over time, which in turn increases their risk of overdose.”

Cannabis as an alternative to opioid medications

“Approximately 20 percent of American adults suffer from chronic pain, and one in three adults do not get enough sleep,” notes fellow study author and assistant professor of clinical pediatrics at the University of Miami Miller School of Medicine, Dr Gwen Wurm. 

That’s a lot of people who might be eligible to take opioids. And over-the-counter drugs aren’t exactly risk-free either. 

“Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use,” explains Wurm. “Paracetamol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the US.”

“In states where adult use of cannabis is legal,” Wurm continues, “our research suggests that many individuals bypass the medical cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary.”

Cannabis isn’t necessarily squeaky-clean itself — high THC (tetrahydrocannabinol) cannabis products have been shown linked to dependency and the development of cannabis use disorder. But unlike opioid use disorder, cannabis dependency is non-fatal; in fact, there are no known cases of fatal overdose from cannabis use in the medical literature. If cannabis is indeed lowering opioid use, as suggested by this study, it could realistically be saving lives in the process.

But researcher caution that further research is needed to understand any potential health risks that might come with long-term cannabis use, and to properly assess the health benefits and side effects of cannabis as a therapeutic.

“The challenge is that health providers are far behind in knowing which cannabis products work and which do not,” says Wurm. “Until there is more research into which cannabis products work for which symptoms, patients will do their own ‘trial and error,’ experiments, getting advice from friends, social media and dispensary employees.”