Opioids vs. Cannabis

Earlier this year, we shared the results from our Tilray Observational Patient Study (TOPS), a multi-site examination taking place in over 20 medical clinics in 5 provinces, designed to track the impact of medical cannabis on opioid use and other prescription drug use, and quality of life among 1,700 patients across Canada.

“While cannabis itself will not put an end to the current opioid overdose crisis” says Tilray VP of Global Patient Research and Access, “a growing amount of evidence from Canada and the US suggests that it can reduce the therapeutic use of opioids and associated morbidity and mortality by providing patients and physicians with a potentially safer alternative in the treatment of chronic pain.

Learn more about medical cannabis as a potential treatment option:

The analgesic effects of opioids and cannabis are both well documented1,2. However, opioids continue to be prescribed more frequently than cannabis and opioid dependence and misuse has spiked in recent years3,4. Like all medications, cannabis won’t work for everyone, but given the facts below, many are questioning if cannabis offers a safer alternative to certain chronic-pain scenarios.


Pain Relief

OPIOIDS

Effectiveness in relieving pain is well-documented5.

Over time, patients can develop tolerance to opioids and require increased doses to address their pain6.

CANNABIS

Effectiveness in relieving pain is well-documented7

Patients do not develop a tolerance to the benefits of cannabis. They can maintain the same daily dose for years, in stark contrast to opioids8.

Additionally, cannabis is a multimodal therapy and can provide additional positive benefits like improved sleep and reduced anxiety for some patients9.

Deaths

Opioids are the cause of almost twice as many deaths than car crashes in Canada every year10. Nearly 4,000 people died from opioid-related causes last year in Canada11. People in Canada die every day due to opioid-related causes.

There is not one recorded death due to cannabis overdose in Canada or any country13.

Side Effects

Opioids are highly addictive and have led to a public health crisis in Canada14.

Common side-effects include: sedation, dizziness, nausea, vomiting, constipation, tolerance, respiratory depression and physical dependence15.

Physical dependence and addiction are most concerning16.

Cannabis has a superior safety profile compared to most other medications17.

THC-related side effects, including fatigue and dizziness, are most common. Most can be reduced or avoided by a ‘start low and go slow’ approach18.

CBD has no intoxicating side-effects. The World Health Organization said that there is no evidence of any public health-related problems related to the use of pure CBD19.

Addiction

Highly addictive. Over-prescribing has led to an international opioid epidemic and a record-breaking number of associated deaths20, 21.

U.S. life expectancy has declined for the second year in a row as a result22, 23.

Like most medications, dependence can occur with heavy use. 

Marijuana dependence can generally be reversed through cognitive behavioral therapy and abstinence without debilitating withdrawal symptoms, such as vomiting, diarrhea, insomnia and anxiety24.

Unlike opioids, however, there has been no recorded deaths due to cannabis addiction25, 26.

References:

1 Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: Controversies, current status, and future directions. Experimental and Clinical Psychopharmacology. 2008;16(5):405-416. doi:10.1037/a0013628. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/. Accessed July 23, 2018.

2 Hill KP. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems. Jama. 2015;313(24):2474-2483. doi:10.1001/jama.2015.6199.

https://jamanetwork.com/journals/jama/article-abstract/2338266?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2015.6199. Accessed July 23, 2018.

3 World Health Organization. Bulletin of the World Health Organization. Curbing prescription opioid dependency.  http://www.who.int/bulletin/volumes/95/5/17-020517/en/. Accessed July 23, 2018.

4 United Nations Office on Drugs and Crime. Global overview of drug demand and supply.

https://www.unodc.org/wdr2017/field/Booklet_2_HEALTH.pdf. Published May 2017. Accessed July 23, 2018.

5 Rosenblum et al. Opioids and the treatment of chronic pain: Controversies, current status, and future directions.

6 Dumas EO, Pollack GM. Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective. The AAPS Journal. 2008;10(4):537-551. doi:10.1208/s12248-008-9056-1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628209/. Accessed July 23, 2018.

7 Hill KP. Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems.

8 MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine. 2018;49:12-19. doi:10.1016/j.ejim.2018.01.004. https://www.ejinme.com/article/S0953-6205(18)30004-9/pdfAccessed July 23, 2018.

The National Academies of Science, Engineering and Medicine. The Health Effects of Cannabis and Cannabinoids: The Committee’s Conclusions. January 2017, http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-conclusions.pdf. Accessed July 23, 2018.

10 Bronskill, James. Canada breaks record for annual opioid deaths as crisis worsens. Global News, March 2018. https://globalnews.ca/news/4110583/opioid-deaths-canada-2017/. Accessed July 23, 2018.

11 Government of Canada. Infographic: Opioid-related harms in Canada. June 2018. https://www.canada.ca/en/health-canada/services/publications/healthy-living/infographic-opioid-related-harms-june-2018. Accessed July 23, 2018.

12 Government of Canada. Infographic: Opioid-related harms in Canada.

13 U.S. Department of Justice, Drug Enforcement Administration. Drugs of Abuse. A DEA Resource Guide 2017 Edition. https://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf. (Page 75) Accessed July 23, 2018.

MacCallum et al. Practical considerations in medical cannabis administration and dosing, 15. Accessed July 23, 2018.

14 Government of Canada. Responding to Canada’s Opioid Crisis. https://www.canada.ca/en/health-canada/services/substance-abuse/prescription-drug-abuse/opioids/responding-canada-opioid-crisis.html. Modified June 28, 2018. Accessed July 23.2018

15 Benyamin R, Trescot A, Datta S. Opioid Complications and Side Effects. Pain Physician. 2008;11:S105-S120. http://www.painphysicianjournal.com/current/pdf?article=OTg1&journal=42. Accessed July 23, 2018.

16 Benyamin et al. Opioid Complications and Side Effects.

17 MacCallum et al. Practical Considerations in Medical Cannabis Administration and Dosing, 15.

18 MacCallum et al. Practical Considerations in Medical Cannabis Administration and Dosing, 15.

19 World Health Organization. WHO Pre-Review Report. http://www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf. Published November 2017. Accessed July 23, 2018.

20 World Health Organization. Bulletin of the World Health Organization. Curbing prescription opioid dependency.

21 United Nations Office on Drugs and Crime. Global overview of drug demand and supply.

22 Stein, Rob. Life Expectancy drops again as opioid deaths surge in U.S. NPR. December 21, 2017. https://www.npr.org/sections/health-shots/2017/12/21/572080314/life-expectancy-drops-again-as-opioid-deaths-surge-in-u-s. Accessed July 23, 2018.

23 Arias E, Kochanek K, Murphy S, Xu J. Mortality in the United States 2016. National Center for Health Statistics. Dec 2017. https://www.cdc.gov/nchs/data/databriefs/db293.pdf. Accessed July 23, 2018.

24 Kogan NM, Mechoulam R. Cannabinoids in Health and Disease. Dialogues Clinical Neuroscience. 2007;9(4):413-430. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202504/. Accessed July 23, 2018.

25 U.S. Department of Justice, Drug Enforcement Administration. Drugs of Abuse. A DEA Resource Guide 2017 Edition. https://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf (page 75)

26 MacCallum et al. Practical Considerations in Medical Cannabis Administration and Dosing, 15.