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Managing Opioid Withdrawal with Cannabis

Opioids, like fentanyl, morphine, and oxycodone, are commonly taken to treat pain. But, opioids can be addictive and lead to a fatal overdose when taken in toxic amounts or combined with other substances such as alcohol, cocaine and methamphetamines.

Between 2018 and 2020, construction workers accounted for 1 in 13 opioid toxicity deaths. Unregulated opioids (mainly fentanyl) and unregulated stimulants (cocaine and methamphetamines) directly contributed to the majority of these. Alcohol also contributed to 1 in 5 opioid toxicity deaths among construction workers.

Given the risk of opioid toxicity, a common goal for many people is to lower the amount they take or eliminate them altogether.  This goal can be difficult to achieve due to ongoing chronic pain, work and life demands, and symptoms of opioid withdrawal. Support and ongoing follow-up with a medical provider can help.

What is opioid withdrawal?

Opioid withdrawal can happen when a person whose body is physiologically dependent on opioids slowly or suddenly lowers the amount taken leading to uncomfortable or distressing symptoms. Without an alternative treatment, this may lead to relapse – returning to opioids to find relief.

What are the symptoms of opioid withdrawal?

Symptoms of opioid withdrawal can include:

·       Drug craving
·       Restlessness
·       Tremors
·       Nausea and vomiting
·       Insomnia
·       Increased heart rate
·       Sweating

How to manage opioid withdrawal?

Rather than managing withdrawal alone, appropriate clinical management of opioid withdrawal with a medical professional is important to prevent overdose and relapse. The goal of medical withdrawal management includes relieving sufferings associated with withdrawal, providing appropriate diagnosis and screening, engaging in Opioid Use Disorder treatment and using harm reduction strategies. Medically supervised withdrawal, or detoxification, involves giving medications such as methadone or suboxone to manage the side effects of stopping opioids. Transitioning to follow-up treatment is important to prevent relapse and returning to opioids.

Can cannabis help to manage opioid withdrawal?

Cannabis is commonly used to treat pain, anxiety, nausea and insomnia. Unlike opioids, it does not depress respiratory function and there have been no documented cases of death due to overdose.  As part of harm reduction strategy, cannabis may help in three ways:

1. Cannabis has the potential to prevent opioid misuse as an analgesic alternative
2. Cannabis may alleviate opioid withdrawal symptoms
3. Cannabis may decrease the likelihood of relapse or returning to opioids

A 2021 Ontario study with a group of 2315 individuals receiving pharmacological treatment for Opioid Use Disorder found that taking cannabis daily in the past month was associated with lower odds of opioid use compared to occasional use. Further research is needed to understand the impact of cannabis and cannabis use patterns on opioid withdrawal and opioid use disorder treatment to inform tailored recommendations.

For more information and resources contact your primary care provider or your local helpline. In Ontario call Connex Ontario at 1-866-531-2600.

How should I take cannabis to help manage opioid withdrawal?

Book an appointment with a medical cannabis prescriber for personalized recommendations.

Book An Appointment

Gomes T, Iacono A, Kolla G, Nunez E, Leece P, Wang T, Campbell T, Auger C, Boyce N, Doolittle M, Eswaran A, Kitchen S, Murray R, Shearer D, Singh S, Watford J. on behalf of the Ontario Drug Policy Research Network, Office of the Chief Coroner for Ontario and Ontario Agency for Health Protection and Promotion (Public Health Ontario). Lives lost to opioid toxicity among Ontarians who worked in construction. Toronto, ON: Ontario Drug Policy Research Network; 2022.
Rosic T, Kapoor R, Panesar B, Naji L, Chai DB, Sanger N, Marsh DC, Worster A, Thabane L, Samaan Z. The association between cannabis use and outcome in pharmacological treatment for opioid use disorder. Harm Reduct J. 2021 Feb 23;18(1):24. doi: 10.1186/s12954-021-00468-6. PMID: 33622351; PMCID: PMC7903683.
Wiese B, Wilson-Poe AR. Emerging Evidence for Cannabis’ Role in Opioid Use Disorder. Cannabis Cannabinoid Res. 2018 Sep 1;3(1):179-189. doi: 10.1089/can.2018.0022. PMID: 30221197; PMCID: PMC6135562.

Previous Article
Managing Side Effects of Cannabis
People who are looking to use medical cannabis frequently ask: “what are the side effects, and is it addictive?” It is important to break down the answer depending on the patient's unique circumstances and characteristics because there are many different factors at play in this complex question. Is cannabis addictive? Addiction, commonly known as substance use disorder, is possible with cannabis use. However, this is almost always only seen when large amounts of THC-dominant cannabis are taken recreationally rather than medicinally. In fact, a recent report from Health Canada on CBD found that it has a very low risk of abuse and is not habit-forming.1 This is consistent with the 2018 drug dependence WHO report.2 What are cannabis’ side effects? The severity of any adverse effects associated with cannabis use—whether they are negative, unwanted, or unpleasant—must be considered. For instance, while cannabis can cause feelings of relaxation and well-being, some people may find these sensations unsettling. The more severe chronic side effects of cannabis use, however, result from chronic, excessive use. These include  problems with the lungs (caused by smoking), risk of worsening of mental health disorders in some individuals, and infrequently cannabinoid hyperemesis syndrome. To avoid such side effects, healthcare practitioners advise: ·       Use the lowest amount of THC possible for daytime symptom management ·       Co-administer CBD ·       Micro-dose THC using vaporizer, avoid smoking cannabis ·       Take a 1–2 week cannabis holiday as needed Common adverse events of CBD and THC Cannabinoids like CBD and THC are well known for their analgesic, anti-anxiety, muscle relaxant, anti-inflammatory, and antiepileptic properties, among others. However, some individuals may experience unwanted and negative side effects, which typically depend on the dose and route of administration. See below for a summary of common adverse events.3 Health effects during pregnancy and breastfeeding Just like many other substances and medications, a pregnant woman or new mother’s use of cannabis can affect her fetus or newborn child.4 Cannabinoids are carried through the mother’s blood to her fetus during pregnancy. They are also passed into the breast milk following birth. This can lead to health problems for the child including: ·       Lower birth weight of the baby ·       Decrease in memory function, ability to pay attention, and reasoning and problem-solving skills ·       Increase risk for future substance use Recommendations to avoid and limit unwanted health effects of cannabis 5 ·       Carefully follow your treatment plan and dosing instructions by your healthcare practitioner. ·       Delaying cannabis use, at least until after adolescence, will lessen the likelihood or severity of adverse health outcomes. ·       Use products with low THC content and high CBD. ·       Synthetic cannabis products, such as K2 and Spice, should be avoided. ·       Avoid smoking cannabis and choose safer inhalation methods including vaporizers. ·       Do not drive or operate other machinery for at least 6 hours after using cannabis. Combining alcohol and cannabis increases impairment and should be avoided. ·       Women who are pregnant or breastfeeding should not consume cannabis at all. ·       People with a personal or family history of psychosis or substance use disorder have a higher risk for cannabis-related health problems and should consult with their healthcare practitioner about this. What to do if you take too much THC If you’ve mistakenly taken too much THC you might experience a sudden feeling of heightened sensations, panic, and uncomfortable “high”, which is also known as acute cannabis toxicity. There has been an increase in first-time cannabis users across Canada who may not be aware of the many effects of cannabis, their physiological tolerance, and the delayed onset of symptoms seen with some routes of ingestion6. Although you cannot die from a cannabis overdose, the following supportive care practices should be kept in mind: ·       Completely avoid any dangerous behaviour, such as driving, operating machinery, being around children, or consuming other substances like alcohol. ·       Call a trusted family member or friend who will be there for you and offer comfort. ·       Visit your local emergency department if you have severe intoxication symptoms including chest pain, mental health crisis, or extreme nausea and vomiting. ·       For cannabis hyperemesis syndrome (i.e., cannabis-induced nausea and vomiting), limited evidence suggests that applying topical Capsaicin cream to the abdomen may help alleviate symptoms within 30 to 45 minutes.7 ·       The effects of cannabis typically last longer at higher THC concentrations. ·       Effects from inhaled cannabis usually last 2-4 hours, and ingested cannabis usually lasts 8-12 hours. ·       Keep calm. Most symptoms will dissipate within minutes to hours. ·       Keep hydrated with water and eat healthy snacks like fruits, nuts, or cheese. ·       Although there is no medical literature to support it, some cannabis connoisseurs recommend chewing a black peppercorn. ·       Find a quiet place without a lot of stimuli where you can keep calm, breathe deeply, and rest. ·       Take a shower to relax the mind and body. Some research indicates that cold showers can help you feel more alert and grounded. ·       Distract yourself by engaging in calming activities like colouring, talking to trustworthy friends, or listening to your favourite music. Reporting adverse events Please let us know if you have experienced an adverse event. As a licensed producer under the Cannabis Act, we have procedures in place to appropriately report adverse reactions to Health Canada. Call or email Starseed Client Care Team at 1-844-756-7333 or [1] [2],abuse%20potential%20or%20cause%20harm. [3] Adapted from, Cannabinoids and Pain by Samer N. Narouze & Caroline A. MacCallum. 2021. Springer. [4] [5] [6] [7]
Next Article
The Potential Effects of Terpenes in Medical Cannabis
Terpenes are aromatic organic chemicals found in all plants. They determine the scent of many flowers and herbs and are responsible for the taste and flavours of cannabis. Terpenes created in unique combinations are what give plants their fragrance, taste, and appearance. A plant’s terpenes are also a way to protect itself from predators or to attract insects for pollination. Because terpenes produce vibrant smells, they form the basis of many essential oils and are an integral part of many alternative therapies, such as aromatherapy. Inhaling the scents from some plants and essential oils may affect a person’s mood and stress levels. Terpenes in Cannabis With hundreds of fully characterized terpenes, terpenes are the largest group of plant chemicals. While many of these occur in concentrations too low to detect, some have a more robust presence. Emerging evidence suggests that all plant compounds in cannabis work together synergistically—this is known as the entourage effect and can be thought of as: The whole of all compounds present in cannabis are more together than the sum of its parts. In other words, a special whole-plant synergy occurs when cannabinoids and terpenes are consumed together, as opposed to by themselves. According to a published article from the National Center for Biotechnology Information, well-respected cannabis researcher, Dr. Ethan Russo asserts that terpenes are more effective when consumed along with the main active cannabinoids, THC, and CBD. The assertion from the scientific community is that THC, CBD, and now terpenes work better consumed collectively as a full dose, rather than in isolates. Together, the cannabinoids add up to greater than the sum of their parts, but alone, their full potential isn’t fully harnessed. Some examples of well-known cannabis terpenoids include limonene, myrcene, α-pinene, linalool, β-caryophyllene, caryophyllene oxide, nerolidol and phytol. The top 5 terpenes While there are many terpenes in the natural world, scientists have only studied a handful. Examples of better-known terpenes include: Myrcene Most cannabis cultivars are dominant in either myrcene or caryophyllene. Myrcene, a terpene that’s also predominant in hops and lemongrass, has been described as delivering scent notes that are herbaceous, spicy, earthy, and musky. Myrcene gives cannabis a mildly sweet flavor profile—it’s also found in mangoes. Caryophyllene Caryophyllene, also known as beta-caryophyllene or β-caryophyllene, lends a spicy, peppery bite to some cannabis strains. Caryophyllene is also found in other plants such as cloves, rosemary, oregano, and black pepper. Caryophyllene is the only known terpene found in cannabis that is believed to bind to the CB2 receptor in the endocannabinoid system, which is found in the body’s immune system. Thanks to this unique action, caryophyllene is sometimes also classed as an atypical cannabinoid. Limonene Limonene is a common terpene that most people can recognize by its scent. As the name suggests, limonene gives the rinds of fruits such as lemons and oranges their citrusy smell. Limonene is found in the rinds of citrus fruits and ginger, and the terpene is also predominant in many cannabis cultivars that have a fruity, fresh bouquet aroma. Pinene Pinene is another naturally abundant terpene. There are two forms of pinene: a-pinene and b-pinene. Pinene provides the fresh, bright scent of many plants, including pine needles, rosemary, and basil. Linalool Linalool is most abundant in the lavender plant and gives the flower its rich scent. Linalool is one of the more important compounds in aromatherapy and is responsible for the calming effect many people get when smelling lavender or its essential oil. Linalool does appear to act on the body, but researchers must study its effects further to understand how people can use it to benefit their health. The growing clinical interest in these aromatic compounds is yielding some fascinating findings. It’s likely that the coming years will see a more sophisticated understanding of terpenes develop, and how they behave both individually and synergistically. If you have questions about our products or services, please reach out to our Client Care Team at 1-844-756-7333 of