opiod

Pain: According to Merriam-Webster dictionary pain is described as “usually localized physical suffering associated with a bodily disorder (such as a disease or an injury)”. Acute pain activates our fight or flight mechanism in order to preserve our well-being. Acute pain is not a bad thing when it helps us identify possible morbidity and even mortality. It helps us seek alternative plans for self-preservation, helps us seek medical care when acute pain does not subside, and it can be alleviated when the noxious event is taken away. It’s a basic feeling which has helped evolution to take place. Pain can also become dysfunctional though. Pain that is produced by a noxious event which is not withdrawn or pain which produces morbid conditions can lead to chronic pain syndromes. These chronic pain syndromes can manifest in any organ or organ system and result in a loss of quality of life, lower life expectancy and worst case scenario increase mortality.

As humans evolved, we discovered many substances in nature which can alleviate acute pain and chronic pain. Many of these substances allowed scientists to create semi-synthetic and synthetic pain medications. Opiate based chemicals lead to 100’s of formulations and dosages. Non-narcotic medications also have been proven to help with acute and chronic pain. But what scientists and physicians did not realize is that there is a great price that is paid by the patient in the form of side effects. Non-narcotic medications such as NSAIDS can lead to gastric bleeding, acute kidney injury, and even increased risk of strokes and heart attacks. Opiate based medications are equally as dangerous if not more since they can lead to addiction, loss of quality of life and most importantly increase loss of life. Opiates, even though they are good at controlling pain, are highly addictive and can lead to respiratory depression. Respiratory depression can lead to respiratory arrest and ultimately death.

According to the NIH, “the total number of U.S. overdose deaths involving prescribed opioid pain relievers increased 1.9 fold from 2002 to 2011”. This increase in overdoses does not include the tremendous use of underground fentanyl abuse where the numbers are even more extreme. In this time period, physicians were mandated to treat pain according to pain scales and ultimately graded with patient satisfaction scores. Yes, doctors were graded on treating pain. This led to increased use of opioid based medications, increase in addiction rates and ultimately increase in mortality due to overdoses. This unfortunate cycle of events needed to be stopped and the government is finally realizing that. Pain scales are being re-evaluated, patient satisfaction scores do not include pain treatment evaluations, and now other modalities for treating pain are being explored.

One modality that is aggressively being researched for medicinal properties to control pain (acute and chronic) is cannabis. Cannabis includes marijuana and hemp. The use of cannabis is not a new modality, but rather an ancient remedy which was ostracized into the “harmful” and “no medical use” area of medications and illicit drugs. Let’s look at the medical history of cannabis and see why it has become an illicit drug. Ancient Chinese physicians recommended using cannabis to prevent malaria, treat rheumatic pains, constipation and female disorders. As early the second century AD, cannabis resin was used as an anesthetic and given to patients to reduce pain during surgery. In early America, marijuana extract was used to treat migraines and a host of other diseases. Hemp was used in textile industries. In 1937, the marijuana tax act was passed and stone walled any chance of cannabis being used in the textile industry or as a potential medicine.

In the last 2 decades, cannabis and its different phytochemicals have finally found their way into laboratories and into people’s hands legally. We have discovered that the different chemicals, mainly THC and CBD, have properties that may promote wellness and mitigate diseased state. Marijuana is now grown for its THC and CBD constituents while hemp is grown for its industrial value and high CBD content. In fact, CBD oil from hemp is legal in 50 states and does not require a script from a physician as long as its THC content is less than .3%.

CBD oil has been found to have quite a few properties according to current research. Research has now shown that CBD can regulate pain perception, act as an anxiolytic, promotes restful sleep, and has neuro-protective properties against oxidation. All these properties of CBD make it a viable option for people who suffer from these symptoms and who do not want to use opioids. Case in point, I saw a patient in my ER several days ago who suffered from arthritic pain but refused to take opioid medications. Instead he was using CBD oil to mitigate his symptoms. He is doing this without risk of respiratory depression or risk of developing an addiction.

People now have a choice to either use NSAID’s and opioid medications riddled with side effects, which can increase morbidity and mortality, or use a phytochemical called CBD to mitigate symptoms of pain and the anxiety that usually go along with it. No risk of respiratory depression, no risk of addiction, no risk of GI bleeds and most importantly, no risk of increased mortality.

And here is another promising area for CBD. People who take opioid medications who may have now become addicted to them, may be able to use CBD to counter the effects of addiction while mitigating pain. As a person detoxifies from opioids, CBD has been shown to reduce the cravings for opioids. This is an amazing finding for addiction medicine and may reduce the opioid epidemic even further.

Sources:

Merriam-Webster Dictionary

Dr. Matt’s Plan, Living Longer and Healthier 2014

Overdose Death Rates: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Cannabinoids in the management of difficult to treat pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/

Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center Stage. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604178/