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An Alternative Solution to the Opioid Crisis

Topic: Canada's Opioid Overdose Crisis

Chronic pain is rarely isolated; it is frequently linked with sleep disturbances and emotional distress, forming the well-known “Pain Triad”. These three interconnected ailments can affect a person’s quality of life. For example, a high level of pain can lower your mood and reduce your quality of sleep.

Medications typically used to treat the Pain Triad

The drug classes that correlate to the three pillars of the pain triangle are listed below1. Medical cannabis is a promising alternative for all, and it is likely to avoid the negative side effects associated with these drugs, particularly opioids.

Medical cannabis as an alternative solution to the opioid crisis

Medical cannabis is a promising alternative to opioids for the treatment of chronic non-cancer pain2, which is the most common indication for its use. Other areas where cannabis has showed promise to date are in fact covered by drug classes overwhelmingly used to the three pillars of the pain triad. Moreover, cannabis may well spare patients many of the side effects associated with opioid use3.

For those interested in using medical cannabis as an adjunct therapy option to opioid, Starseed offers several product options that maybe helpful for patients. Starseed’s clinic partner ‘North Star Wellness’ is also available for medical cannabis consultations free of charge. With 9 clinics across Ontario and a team of expert health care professionals, North Star Wellness offers in-person and telemedicine consultations for patients in need of education and medical authorization for cannabis.

Register and book your appointment today.

References:
[1] National Pain Centre (2017). The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Hamilton, ON: McMaster University. Retrieved from http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf
[2] Benedict, G., Sabbagh, A., & Conermann. (2022). Medical cannabis used as an alternative treatment for chronic pain demonstrates reduction in chronic opioid use – a prospective study. Pain Physician Journal, 25, E113-E119. Retrieved from https://www.painphysicianjournal.com/current/pdf?article=NzQwOA%3D%3D.
[3] Ergisi, M., Erridge, S., Harris, M., Kawka, M., Nimalan, D., et al. (2022). An updated analysis of clinical outcome measures across patients from the UK medical cannabis registry. Cannabis and Cannabinoid Research, X(X), 1-10. Retrieved from https://www.liebertpub.com/doi/epdf/10.1089/can.2021.0145.
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Medical Cannabis and Mental Health
Cannabis and mental health have a complicated relationship because studies have yet to prove a causal association — does cannabis cause mental illness or do persons who suffer from mental illness 'self-medicate' with it? Cannabis is frequently used to self-medicate and to replace or avoid potentially dangerous substances such as benzodiazepines and alcohol. The concern is that people frequently turn to recreational, unregulated cannabis with extremely high THC levels, which could also be contaminated. As a result, they are more likely to be exposed to hazardous compounds, as well as acquire THC tolerance and dependence. This emphasizes the need for discussing cannabis usage with a healthcare professional who can advise and monitor cannabis use, as well as provide guidance and access to CBD-dominant cannabis products that can help manage anxiety symptoms by reducing THC side effects.1,2 References:  [1] Shannon, S. Opila-Lehman, J. Cannabidiol Oil for Decreasing Addictive Use of Marijuana: A Case Report. IMCJ Integrative Medicine: A Clinician’s Journal. 14(6):31-35, (2015). [2] Zuardi AW, Rodrigues NP, Silva AL, Bernardo SA, Hallak JEC, Guimarães FS, et al. . Inverted U-shaped dose-response curve of the anxiolytic effect of cannabidiol during public speaking in real life. Front Pharmacol. (2017) 8:259. 10.3389/fphar.2017.00259
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Ways to cope with Chronic Pain
Chronic pain is best treated through multi-modal therapies including physical therapies, psychotherapy, spiritual care, lifestyle management, and interventional therapies. Start by setting goals that are SMART (specific, measurable, action oriented, realistic, and time-based). For example, “I want to reduce my pain from an 8/10 to a 6/10 so I can walk the dog around the block within 4 weeks after starting treatment”. The drug classes that correlate to the three pillars of the pain triangle – Chronic Pain, Insomnia and Stress are listed below. Medical cannabis is a promising alternative for all, and it is likely to avoid the negative side effects associated with these drugs, particularly opioids. Retrieved from: http://nationalpaincentre.mcmaster.ca/documents/Opioid%20GL%20for%20CMAJ_01may2017.pdf   Medical Cannabis as an Alternative Therapy for Chronic Pain Alternative pain treatment options are necessary to address the opioid crisis and the high prevalence of chronic pain. There is an increasing number of chronic pain patients not achieving their pain management goals, and there is a lack safe options to address chronic pain1. Cannabis has better safety profile than opioids, with no reported deaths directly due to overdose. In the U.S, in the states with legalized cannabis, there was a reduction in opioid-related mortality and opioid prescriptions2. Furthermore, our body’s own endocannabinoid system and opioid system interact synergistically with major pain pathways. Cannabinoids have several mechanisms of action to produce pain relief, whereby cannabinoid receptors are present in the peripheral and central nervous system, and in immune cells. References: [1] Stucke, A. G. et al. Opioid Receptors on Bulbospinal Respiratory Neurons Are Not Activated During Neuronal Depression by Clinically Relevant Opioid Concentrations. J Neurophysiol 100, 2878–2888 (2008). [2] Bradford, A. C., Bradford, W. D., Abraham, A. & Adams, G. B. Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population. JAMA Intern Med (2018) [3] Wen, H. & Hockenberry, J. M. Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Intern Med (2018).

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