Cannabis and opioids do have similarities. And occasionally, they can work in tandem at killing pain.
Cannabis and Opioids: They both come from plants, they are both psychoactive, and they are both commonly consumed for killing pain. Beyond that though, they both interact with receptors in the body, and those receptors are often found in the same tissue.
But at the same time, cannabis has a far lower toxicity profile, and addiction to cannabis is not nearly as prevalent as opioids. According to the National Institute on Drug Abuse, in 2018, over 46,000 people in the United States died from opioid overdose.
But, by working together, cannabis could potentially help patients lower their dependency on opioids – while still killing pain. To understand how cannabis and opioids could work together at killing pain, we need to understand how they each work, period.
How Cannabis and Opioids Work at Killing Pain in the Body
Cannabinoid and opioid molecules both work in similar ways. They bind to G-protein coupled receptors, and these receptors are primarily located in the synapses of neurons. Some of them are also located in regions of the brain that are well-known for regulating pain.
From there, these cannabinoid and opioid receptors begin to work down similar pathways, like the MAP kinase pathway. In fact, a study published in Pharmacology Biochemistry and Behavior (2004) theorized that cannabinoids and opioids could possibly interact at the receptor level.[1]Daniela, et al. “Molecular and Cellular Basis of Cannabinoid and Opioid Interactions, Pharmacology Biochemistry and Behavior.” DeepDyve, Elsevier, 1 June 2005, … Continue reading
Opioids reduce pain by interacting with three receptors in the body: the mu, delta and kappa receptors. Endogenous molecules called peptides work to activate these opioid receptors to regulate feelings of pain and reward. They flood the brain with dopamine, which creates the feeling of euphoria that makes opioids so addicting.
Through neuroimaging, scientists have begun to understand more about how cannabis can reduce pain. They found that THC relieved pain by activating CB1 receptors in the anterior cingulate cortex region of the brain.
Further study in regard to how cannabinoids and opioids interact are still needed, but science is beginning to find out more. A study published in Frontiers in Pharmacology (2015) found evidence to suggest that delta or mu opioid receptors can interact with cannabinoid CB1 receptors.[2]Befort, Katia. “Interactions of the Opioid and Cannabinoid Systems in Reward: Insights from Knockout Studies.” Frontiers in Pharmacology, Frontiers Media S.A., 5 Feb. 2015, … Continue reading
Findings like this one are shedding more light on the mechanics of these interactions and how they can be used therapeutically.
How Cannabis and Opioids Affect the Perception of Pain
Put simply, opioids wipe away the body’s ability to feel pain. This is what makes them so crucial for pain management. But unlike opioids, cannabis does not altogether get rid of pain. Instead, cannabis changes the brain’s perception of it. This may be beneficial in some regards, since eliminating pain is one of the reasons why opioids are so addictive.
However, both cannabinoids and opioids are similar in that they interfere with pain signaling by preventing the release of a specific kind of neurotransmitter. But the side effects are drastically different. Opioids are overwhelmingly more addictive than cannabis, and overdose of opioids can result in death.
Many of the opioid receptors are located in the brain stem, which affects the body’s heart rate and respiration. And respiratory depression is usually the cause of death in cases of opioid overdose. As cannabis legalization gains traction in the United States, more and more patients are actually choosing cannabis over opioids for chronic pain management. Not only because the side effects are much milder, but the possibility of a deadly overdose is virtually nonexistent.
Cannabis Reducing Opioid Dependency
Another similarity between cannabis and opioids is the tendency for patients to develop a tolerance over time. This requires an increase in dosage, which is where opioids can become dangerous. Increasing levels of opioid intake often leads to abuse, which can lead to death. Increasing cannabis dosage can lead to dependency, but again, it won’t lead to death.
Scientists are finding that there is actually potential for cannabis to help reduce opioid withdrawal symptoms. This means that, through interaction with the body’s CB1 receptors, cannabinoids could help curb the opioid epidemic.
It’s possible that this unlikely pair could also help patients reduce their dosage of opioids. Case in point: A 2014 study published in the Journal of Health Economics found that states with legalized cannabis showed lower opioid mortality rates.I[3]Powell, David, et al. “Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?” Journal of Health Economics, North-Holland, 3 Feb. 2018, … Continue reading
Changing Pain Management
Researchers are still working to understand the mechanics at play between cannabinoids and opioids. Hopefully soon they’ll have definitive data on whether lower opioid mortality rates really tie to the legal availability of cannabis. However, if cannabinoids and opioids can work together in the central nervous system to relieve pain, with fewer overdose deaths, this could change the way physicians prescribe these drugs for pain management.
If cannabis can indeed lower dosage levels of opioids, this understanding could curb overdose rates in the United States. And, if using cannabis to target CB1 receptors can ease opioid withdrawal, it could offer important possibilities in treating addiction. In other words, the future is bright for research into these fascinating medical possibilities for killing pain.
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