Cannabis vs. opioids: What’s best for treating pain?

Both cannabis and opioids are commonly considered to help relieve pain. They work in your body in different ways to reduce pain signals, and their effects can vary based on dosage and individual health conditions.

Combining them can increase the risk of certain side effects, including sedation and slow or shallow breathing, which can be dangerous. Mixing them may also make an opioid’s effects last longer than intended.

Before using cannabis and opioids together, speak with your doctor or a Leafwell pharmacist. It’s important to understand how they may interact with each other in order to treat pain safely.

Cannabis vs. opioids for pain

Cannabis and opioids help ease pain in different ways.

Cannabis compounds, known as cannabinoids, help regulate pain tolerance and inflammation in the body. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are cannabinoids that may be especially helpful for relieving pain.

Opioids are a class of prescription medications used to treat pain. They work by attaching to nerve receptors in the body to block pain signals from reaching your brain. This helps lower your perception of pain.

Common opioids include:

• Hydrocodone (Vicodin)
• Hydromorphone (Dilaudid)
• Oxycodone (Oxycontin)
• Oxymorphone (Opana)

Opioids are federally classified as Schedule II controlled substances according to the Drug Enforcement Administration (DEA). This means that even though they have a medical purpose, they have a high potential for dependence or misuse.

Cannabis is currently classified as a Schedule I controlled substance according to federal law. This means that, according to the DEA, it has no medical purpose and a high risk of misuse. However, attempts are underway to change cannabis to a Schedule III controlled substance, which means that it has medical use and a lower risk of misuse.

Research on cannabis vs. opioids for pain

Studies show that both cannabis and opioids can help ease pain.

One report suggests that cannabis can be used to help relieve different kinds of pain, including neuropathic (nerve) pain and musculoskeletal pain.

In another review of studies, cannabis was found to help lower pain intensity. Still, researchers note that more studies are needed to confirm the long-term safety and effects of cannabis for pain relief.

According to a review of studies, opioids are considered to be an effective option for pain relief. However, another review notes that they may not be a good option for long-term use due to a combination of factors, such as side effects, risk of misuse or addiction, and a lowered effectiveness over time.

Can CBD help with chronic pain?

CBD is a nonintoxicating compound in cannabis. Early research suggests that it may be helpful for chronic pain, but more high-quality, large-scale studies are needed.

In one study, CBD was found to help manage arthritis symptoms like joint pain. Another study suggests CBD may be an effective tool to help lower opioid use and ease chronic pain.

Safety of cannabis vs. opioids for chronic pain

It’s important to weigh the risks and benefits of both cannabis and opioids as options to treat chronic pain.

Cannabis, while generally well-tolerated, can cause some side effects, such as:

• Dry mouth
• Dry eyes
• Dizziness
• Drowsiness
• Confusion
• Impairment
• Paranoia
• Headache
• Nausea

In rare cases, heavy cannabis use can lead to a condition called cannabis hyperemesis syndrome, which may cause severe vomiting.

Smoking cannabis also carries respiratory risks, so alternative products like edibles or oils may be a better option.

Opioids can also cause side effects, including:

• Dry mouth
• Headache
• Stomach ache
• Dizziness
• Drowsiness
• Flushing
• Constipation

Opioids can also come with more serious side effects that warrant emergency medical attention, including:

• Nausea, vomiting, or loss of appetite
• Difficulty breathing, or slow, shallow breathing
• Difficulty swallowing or swelling in the mouth or throat
• Swelling in the hands, feet, lower legs, and ankles
• Skin changes like rash, itching, or hives
• Hallucinations
• Chest pain or changes in heartbeat
• Seizures
• Sedation or loss of consciousness
• Dependency
• Fatal overdose

If you are taking an opioid medication, consider speaking with your doctor or pharmacist about having naloxone (Narcan) on hand. Naloxone is a lifesaving medication that can reverse opioid overdose.

Addiction risk

Opioids can be highly addictive and can lead to a condition called opioid use disorder. About 8.6 million people in the United States have reported misusing prescription opioids.

By comparison, cannabis dependency, commonly known as cannabis use disorder, affects up to 30% of users. But unlike opioids, it carries no risk of fatal overdose.

Risks of using cannabis and opioids together

Some people consider taking cannabis and opioids together to help ease pain. However, this should only be done under strict medical supervision due to the risk of potentially dangerous combined side effects.

Mixing cannabis and opioids may increase your risk of:

• Dry mouth
• Confusion
• Drowsiness
• Sedation
• Low blood pressure
• Slow or shallow breathing

Cannabis can also inhibit liver enzymes that help your body break down and metabolize opioids. This means that combining them may make the effects of opioids stronger and longer-lasting than intended.

In some cases, doctors may recommend cannabis as an alternative to opioids to help treat pain and potentially lower opioid dosage. However, more studies are needed to confirm that cannabis is a safe and effective option for different types of pain.

If you want to reduce your opioid intake, ask your doctor for guidance.

Adding cannabis to your treatment plan is not without risks. Speak with your healthcare provider or Leafwell pharmacist for personalized guidance, and if you use opioid medications, ask them about carrying Narcan to prevent overdose.

The bottom line: Consider the risks and benefits of cannabis vs. opioids for pain relief

Taking cannabis and opioids together can increase the risk of certain side effect risks. It can also cause the effects of opioids to last longer than intended, potentially increasing the risk of overdose.

While some people find that cannabis helps them with pain and lowers their reliance on opioids, taking them together should only be done under the supervision of your healthcare provider.

If you’re prescribed opioids, consult your doctor or a Leafwell pharmacist before combining them with cannabis.

Always talk with a licensed healthcare provider before starting or stopping any medication or cannabis product.

Resources

• About prescription opioids. https://www.cdc.gov/overdose-prevention/about/prescription-opioids.html
• Cannabidiol as a treatment for arthritis and joint pain: An exploratory cross-sectional study. https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-022-00154-9
• Cannabinoid interactions with cytochrome P450 drug metabolism: A full-spectrum characterization. https://pubmed.ncbi.nlm.nih.gov/34181150/
• Cannabinoids and pain: New insights from old molecules. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2018.01259/full
• Cytochrome P450-mediated changes in oxycodone pharmacokinetics/pharmacodynamics and their clinical implications. https://pubmed.ncbi.nlm.nih.gov/23605691/
• Drug scheduling. https://www.dea.gov/drug-information/drug-scheduling
• Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: A prospective cohort study. https://www.tandfonline.com/doi/full/10.1080/00325481.2019.1685298#abstract
• Long-term opioid therapy for chronic noncancer pain: A systematic review and meta-analysis of efficacy and safety. https://www.sciencedirect.com/science/article/pii/S0885392407006720
• Medical cannabis use is associated with decreased opiate medication use in retrospective cross-sectional survey in patients with chronic pain. https://pubmed.ncbi.nlm.nih.gov/27001005/
• Opioids and opioid use disorder. https://medlineplus.gov/opioidsandopioidusedisorderoud.html
• Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. https://www.sciencedirect.com/science/article/abs/pii/S0304395904004476
• Oxycodone. https://medlineplus.gov/druginfo/meds/a682132.html
• Prescription of controlled substances: Benefits and risks. https://www.ncbi.nlm.nih.gov/books/NBK537318/
• “Smoking weed it gets you over the hump”: Cannabis co-use as a facilitator of decreased opioid use among people who inject drugs in Los Angeles, California. https://www.sciencedirect.com/science/article/pii/S2772724624000416
• The health effects of cannabis and cannabinoids. https://nap.nationalacademies.org/read/24625/chapter/1
• Understanding your risk for cannabis use disorder. https://www.cdc.gov/cannabis/health-effects/cannabis-use-disorder.html

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