Opiates, the compounds like morphine and codeine found in poppies, are the most effective naturally occurring substances for reducing pain. Humans have known about the medical power of poppy sap for millennia — Sumerians referred to it as the “joy plant,” and it appears in Ancient Egyptian medicals texts as a treatment to stop babies from crying. Modern medicine has now given us synthetic versions of this natural medicine: drugs like hydrocodone, oxycodone, and fentanyl were all created to mimic the action of natural opiates.
But as ancient doctors and shamans probably understood, the sheer power of these substances can make make for a hazy distinction between medical therapy and outright abuse. Opioids bring about emotional euphoria alongside physical pain relief. The body also builds a quick tolerance for opioids, calling for greater and greater doses in order for them to be effective. Worldwide, an estimated 26 to 36 million are physically and psychologically addicted to opioids. The U.S. has been hit particularly hard by this public health epidemic — more than 165,000 Americans have fatally overdosed on opioids in the last 15 years.
Although physicians prescribe dangerous opioids with seeming abandon — especially in cases of relatively minor oral surgery — there are huge cultural and legal biases against investigating the benefits of cannabis for pain relief.
How Do Opioids Work?
Opioids relieve pain in a few different ways. Whether a patient has acute pain from injury or surgery, or more chronic, nerve-based pain caused by diseases like cancer and HIV/AIDS, opioids can interrupt communication between pain receptors all over the body that signal the brain to feel pain.
Opioids can also work from the brain downwards, changing the degree to which that pain is felt
Although the short-term effectiveness of opioids for pain relief is well-established, their tendency to mandate increased use and to provoke addiction have led many to believe that they do more harm than good in the long run.
Cannabis — in particular, the cannabinoid CBD — also has some proven mechanisms of pain relief. Although not as drastic in action as opioids, CBD can work on pain receptors to lessen pain and inflammation throughout the body. When smoked, high-CBD strains have a generalized effect, but if applied via topical solutions, CBD concentrations can provide more localized relief for inflammation and injuries. Notably, CBD has none of the psychoactive effects of its fellow cannabinoid THC — and in fact, it can counteract the high that THC induces, creating no euphoric effects and leaving no room for psychological dependence.
Although opioids tackle pain much harder than cannabis, there’s a growing body of evidence to show that high-grade medical cannabis may be enough to complement or even replace opioid treatment in certain cases. One study at NYC’s Montefiore Medical Center showed that between 1999 and 2014,
States where medical cannabis is legal had 25% fewer opioid overdose deaths than states where it remains illegal
Another recent study at the University of Michigan showed that patients using opioids cut their opioid use in half after adding cannabis to their treatment. Most strikingly, a study out of Israel (a country at the forefront of cannabis research) indicated that among a group of chronic pain patients, 44% stopped using opioids altogether less than a year after beginning their pain with cannabis as well. Of course, these studies are more broadly demographic than specific and clinical — restrictions on medical cannabis research in the U.S. means that we still don’t know exactly which conditions and which groups of patients are best suited to treatment with CBD. But these preliminary numbers suggest that physicians have fallen into the bad habit of over-prescribing the pharmaceutical equivalent of a power drill when a screwdriver might be more than enough to do the trick.
Can Cannabis Help with Opiate Addiction?
Cannabis may also be able to weaken the physiological hold of opioid addiction itself. High-CBD strains or concentrations can act on the body’s TRPV-1 receptors and alter patterns of addiction to opioids, methamphetamine, cocaine and alcohol (although to date, studies of this effect have only been conducted on rats).
Professional football is one high-profile industry that may help bring about some change in the replacement of opioids with medical cannabis. Chronic traumatic encephalopathy, or CTE, is a degenerative brain condition caused by constant blows to the head. Depending on the severity, it can lead to anything from dizziness and memory loss to dementia, deafness, and suicidality.
Although the condition we now call CTE has manifested in athletes as long as contact sports have been around, it’s only started to be accurately diagnosed in the last 10 years, especially in football players. CTE symptoms don’t begin until eight to ten years after the injuries occur, causing severe health problems for players after retirement (which is to say nothing of the many other injuries they might have suffered).
Washington University interview-based study of 644 former NFL players has revealed that 52% of them used opioids in their playing days — with 71% of that group admitting to having abused opioids during their careers, and 15% acknowledging misuse of opioids within the last month. As a group, retired NFL player abuse opioids four times as much as the general population.
Eugene Monroe is the only athlete who’s trying to change that by speaking publicly about the pain-relieving benefits of medical cannabis (his advocacy may even have led to his being cut). In his retirement, Monroe has begun petitioning the NFL to remove cannabis from its list of banned substances and to stop freely prescribing opioids for injured players.
Monroe is joined by retired athletes in several other sports who are aggressively calling for the allowance of medical cannabis in professional leagues
It’s hard not to be cynical about the role that drug companies play in all of this. Fentanyl, oxycodone, oxymorphone, and many other brand-name synthetic opioids are listed by the DEA as Schedule II substances because of their “currently accepted medical use.” Cannabis is still listed as a Schedule I substance that can’t be studied because it has “no currently accepted medical use.” No wonder the makers of Fentanyl just spend $500k against weed legalization in Arizona.
Brownstein, M.J. “A brief history of opiates, opioid peptides, and opioid receptors.” Proceedings of the National Academy of Sciences, USA. June 1993, Vol. 90.