How Does Cannabis Compare to Opioids for Treating Nerve Pain?

Matt Weeks March 24, 2018 6 comments

When it comes to treating nerve pain, is cannabis really better than opioids? The answer may be surprising.

The number of people suffering from chronic pain has skyrocketed in recent years. Today,  more than 1.5 billion people across the globe help treating nerve pain, according to the American Academy of Pain Medicine.

Yet, despite its upward trend, modern medicine has not created an effective way to deal with the problem. The most popular treatments for chronic pain often leave sufferers addicted to new drugs, in a foggy mental haze, and still living in agony.

The result is a rapidly rising number of people with a poor quality of life and few options.

Hence, the rise of cannabis. Because it’s non-addictive and natural, cannabis has become the treatment of choice for many chronic pain sufferers lucky enough to live where it’s legal.

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But is it really better than the competition? In a one-on-one match, could cannabis overtake opioids when it comes to treating nerve pain?

Cannabis vs. Opioids

Despite the reputations, there are more similarities than differences between these two pain-killing powerhouses.

First, they’re both plant-based medicines. But while cannabis remains largely botanical in its medicinal forms, synthetic opioids are common. Synthetic opioids just don’t look like their mother plant – opium – anymore.

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Second, both substances work in similar ways in the brain. Although they interact with different receptors, both substances tend to work same kinds of tissue, and send their anti-pain signals down similar neural pathways.

Cannabis and opioids can function because they’re similar in structure to naturally occurring substances in the brain. But, because they’re not exactly the same as the body’s natural chemicals, they produce different results in the brain. This means they can limit the body’s ability to feel pain.

And, of course, cannabis and opioids have their differences. While those differences may not mean a lot in terms of handling regular pain, when it comes to treating nerve pain, the differences seem stark.

But can the differences work together?

Cannabis Combined with Opioids

Scientists who tested how the two substances function in conjunction with each other have found results that are equal parts promising and scary. A 2018 study[1]Cooper, Ziva D. et al. (2018). Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology. 43, 2046–2055. … Continue reading published in Neuropsychopharmacology investigated how patients treated participants with either cannabis, Oxycodone, a mixture of the two, or a placebo, would respond when they were forced to put their hands in freezing cold water.

The researchers noted how long the participants were able keep their hands submerged and recorded how painful the subjects said the experience was.

The ideal dosage of opioids only turned out to be 5 mg of Oxycodone. Participants who received that dose held their hands under water for the longest amount of time and felt the least amount of pain.

But participants who received half that amount of Oxycodone and smoked cannabis showed the same results.

The researchers concluded that cannabis can bolster the pain-relieving effects of opioids, and may help opioid users cut down on their dosages.

However, not all studies promote such good news. If patients want to mix both substances, they should be careful not to take too much of either one, according a study in the Journal of Addiction Medicine (2019).

That study found that adults who combined both substances on their own reported higher levels of anxiety, depression, and other drug use than chronic pain sufferers who only stuck to one or the other. While these results were survey-based and do not imply causation, they signal that caution should applied when taking opioids. The first study shows that cannabis should decrease the number of opioids a person takes — not simply augment it.

treating nerve pain represented by THC chemical structure over cannabis leaf, pain treatment

The Best Medicine for Treating Nerve Pain

Cannabis and opioids have a complicated relationship. They’re similar but different. They can work together in certain dosages but not as well in large ones. And they’re both well-documented pain relievers.

But despite all those things, only one is capable of sufficiently treating nerve pain — cannabis.

Nerve pain, also known as neuropathic pain, is a different beast than other kinds of pain. Most normal pain involves stress to a tissue or organ. Stubbing a toe, stomach aches, picking up a hot plate — all of these are examples of normal (nociceptive) pain.

Conversely, nerve pain involves damage directly to the nervous system. It is caused by nerves sending mixed-up signals through the brain, signals that cause the body to produce a deep and shooting sensations. Examples include pain from cancer, phantom limbs, multiple sclerosis, and chemotherapy.

In these instances, opioids simply don’t work very well. Luckily, cannabis does.

The endocannabinoid system is responsible for managing this type of pain, so the naturally occurring substances within cannabis have a direct route to heading it off.

Opioids soothe tissue pain by dampening the pain sense the brain picks up. Cannabinoids work by “numbing” the pain senses coming into the brain. It makes the brain unable to register the pain signals from nerves, leading to better feelings.

That’s why cannabis is drug of choice for so many cancer sufferers. It can calm the agonizing sensations from both the disease and the treatment.


Rogers, Andrew H. et al. (2019). Opioid and Cannabis Co-Use among Adults With Chronic Pain. Journal of Addiction Medicine, 13 (4): 287


Author avatar

Matt Weeks

A writer living and working in Athens, GA, Matt's work has appeared in various newspapers, books, magazines and online publications over the last 15 years. When he's not writing, he hosts bar trivia, plays in local bands, and makes a mean guacamole. He holds an undergraduate degree in journalism and a master's degree in organizational theory. His favorite movie is "Fletch."

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  1. Paul Boehme

    I appreciate Good Science, Written Understandably.
    Same Entourage Effects noted between THC & CBD.
    Ccannabis use helpedme WANT TO GET OUT OF BED, Something Opioids NEVER DID!
    Opioids in fact, made me want to Cocoon.
    Cannabinoids made me Curious, made meWant to Grt Up!
    Regain Balance, Relearn to Walk, relearn to Swallow, Regain Will to Live!

    • Jennifer Grant

      That’s really great, Paul! Cannabis is amazing for managing chronic pain and still allowing one to “live”. We are happy you have found that balance. Thank you for sharing!

    • Jim Grayson

      Hi, Paul. I thank God you are better than you were. I am awaiting the legislators in Kentucky to finally get around to making medicinal cannabis legal. I’ve had four failed spinal fusions and have been in constant nerve pain since February 3, 1989. I’m not able to say what my pain management doctor prescribes but it has made a mess of me and my colon. I’m sure you know what I mean. Apart from the back pain, I have had congestive heart failure following a heart attack in 1993 (I’ve had three separate heart bypass surgeries since the heart attack), numerous joint problems on which I’ve had arthroscopic surgeries. I have hypothyroidism, which started as hyper but I had to have mt thyroid removed to help get it under control. I have other problems as well which I won’t go into.
      I know the feeling of not wanting to get up any more. Part of it is my heart but a great deal of it is not wanting to face the pain which ramps up as soon as I get out f my recliner. That’s where I have to sleep.
      Anyway, my friend, I’m so happy for you, truly, for finding what I know would help me. I used it illegally for six years in the 1990’s and those were the happiest years I’ve had since my back pain started. Medical cannabis works. I wish the big pharma companies which are paying off the lawmakers to keep cannabis illegal would burn down. Truly. I hate to say that but my life is a wreck as it is now. I was able to get out ONCE this year on an outing unrelated to doctors, not counting two brief trips to the library where I used a wheel chair to get around.
      Paulo, may the Lord bless and keep you and your loved ones, and may you continue to feel better and better, in the Name of Jesus.

  2. Brad Garner

    I’m using combination of both at moment to control extreme pain .I find it as effective & less stress on the body in general

  3. Randy

    So I’m curious about one thing, does all cannabis contain some amount of CBD?

    • Jennifer Grant

      Hi Randy, each cannabis strain will have its unique CBD concentration. You can purchase or grow high CBD strains (such as AviDenkel and Charlotte’s Web) that have very low THC; you can have a 1:1 ratio of THC to CBD (like Sour Tsunami and Cannatonic; and then there are the high THC strains (Blue Dream and Ghost OG).