Friday March 20, 2020
By Erin Hiatt
Cannabis has been used for thousands of years as a medicine for pain. However, a more methodical approach to providing medical cannabis to patients is a relatively recent development. Prop 215, passed by California voters in 1996, was considered a significant victory for patients seeking legal access to cannabis medicines, and carved a major path forward for all the states that followed with legal cannabis programs of their own.
Since that landmark passage, a super majority of states have medical cannabis programs in one form or another. But despite the growing availability of cannabis, Americans are still in pain. A lot of it. In fact, the Centers for Disease Control estimates that 50 million people, or about 20 percent of adults, have chronic pain, and that 20 million of those have “high-impact chronic pain,” defined as pain that frequently interferes with daily activities.
Yet to be taken into account statistically is how cannabis may interact with nociceptive pain - inflammatory in nature and as a response to tissue damage that may follow an injury or surgery. Similarly, research on how cannabis interacts with pharmaceutical drugs lags behind, often leaving doctors and patients guessing about how best to address post-surgical pain. Which begs the question, does cannabis reduce tolerance to pain killers?
Cannabis vs. Pain Killers
The independent medicine information website Drugs.com has compiled a comprehensive list of how cannabis may interact with some pharmaceuticals. Twenty-four drug/cannabis combos are considered “major,” meaning they are clinically significant and should be avoided because the risk of interaction outweighs the benefit.
The site also lists some 313 drug/cannabis duos considered a moderate risk, counseling patients to avoid combining the substances unless there are special circumstances. Of the 24 listed substance interactions considered clinically significant, the majority are pain killing opioids frequently used post-surgery in hospitals, including hydrocodone, oxycodone, and fentanyl. For some, consuming opioids even not in combination with cannabis (or any other substance for that matter) is very risky.
Opioids can be highly addictive for anyone, especially if there is a family or personal history of substance abuse. And it is well-known that opioid abuse can kill: in 2017, 130 Americans died every day from opioid overdose.
Addictive potential aside, the research laying out the specific mechanisms for how opioids and cannabis may interact is mixed. One study suggested that patients who consumed cannabis in combination with oxycodone were able to withstand higher levels of pain. Still another study found that cannabis could affect pain tolerance in a bell-shaped curve, and that THC may actually reduce a patient’s ability to tolerate pain.
Difficulties in Definitive Generalization
Conducting definitive studies on how opioid/cannabis combos may affect tolerance to pain killers is challenging because cannabis is not just one compound that can be tested side-by-side. How the plant interacts with other substances (and consumers individually) will vary by strain, dosage, and cannabinoid ratios. Unless studies are undertaken one by one – which could take a lifetime – how to proceed with opioid/cannabis combinations is really up to the patient and their caregiver.
Drugs.com says this about the opioid/cannabis combination and the potential worst-case scenario. “Using narcotic or pain cough medications together with other medications that also cause central nervous system depression can lead to serious side effects including respiratory distress, coma, and even death. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications.”
Something to keep in mind is that opioids are not the only pain killers out there. NSAIDs (ibuprofen), aspirin, and anti-inflammatory pain killing combos are really common. And how they interact with cannabis, especially post-surgery, is under-studied. Be sure to always share with your doctor your cannabis consumption – regardless of how often you do so – so together you can make the best decision for your health.
Your health is a serious matter. Always consult a medical professional or doctor before you combine cannabis with pain killers or any other substances. Be safe out there everyone!