Pain Management: CBD vs Opioids

Date Posted: 27th November 2018 | Category: Uncategorized

For more than 5000 years, cannabis and opioids have been used for pain management. While cannabis is derived from a plant of the same name— the cannabis plant— opioids come from opium, a gummy substance found in the opium poppy. Today synthetic forms of opioids are found commonly in the market and are used for both acute and chronic pain management.

The use of opioids is legal. Until recently, however, the use of marijuana for medicinal purposes was declared illegal. However, with more light being shed on the effectiveness of cannabis as a form of pain medication, the usage of opioids has come into question. The fatal consequences of opioid overuse have also contributed toward the search of an alternative. In 2016 alone, a majority of deaths caused by drug overdose was attributed to the use of prescription painkillers (20,101 people). As a result, the abuse of opioids has now been declared a public health emergency.

While marijuana is still considered illegal on the federal level, a better understanding of the chemistry and components of the plant has propelled several states to legalize its use for medicinal purposes. Possibly the most prominent discovery is that of the Cannabidiol and Tetrahydrocannabinol compounds and their role in the pain relieving effects of marijuana.

Both Tetrahydrocannabinol (THC) and Cannabidiol (CBD) can be used for pain management purposes. THC is also a psychoactive cannabinoid that causes the mind-altering effects that are associated with marijuana.  Cannabidiol, on the other hand, is not psychoactive. Therefore, cannabidiol is a more attractive option for people who are looking to treat their pain but do not want to get “high”.

How do they differ though and which is a better form of treatment? Let’s take a look.  


Our nerve cells carry proteins called opioid receptors. Opioids will attach to these proteins and block pain messages that the body sends to your brain via the spinal cord. However, the use of opioids is not without side-effects. The mechanism for how the human body responds to CBD is yet to be fully understood. What we know so far is that the human body produces certain types of cannabinoids on its own. There are also two cannabinoid receptors present, namely CB1 and CB2. CB1 receptors are involved in many primary functions such as coordination, movement, pain, mood management, memories and appetite. THC will attach to these receptors.

CB2 receptors, on the other hand, affect inflammation and pain and are found to be more common in the immune system. Previously, it was believed that CBD attaches to CB2 receptors, but it doesn’t. Something interesting happens instead. Taking CBD actually induces the body to use more of its own cannabinoids.



Perhaps the most significant difference between CBD and Opioids is the side-effects involved.

Opioids can be dangerous especially when their use isn’t medically supervised. Minor side-effects include sleepiness, constipation and nausea. In case of an overdose, however, opioids can result in shallow breathing, slow heart rate, unconsciousness. The shallow breathing is attributed to opioids slowing down the part of your brain that controls breathing. In case of an opioid overdose, death occurs because breathing stops. If help is given in time, the overdose can be treated with drugs that block the effect of opioids on breathing.

Prolonged use of opioids also results in a tolerance buildup that can cause people to increase the dosage, thus escalating the chances of an overdose.  In 2018, it was reported that the overuse of prescribed opioid painkillers causes as many as 115 deaths per day in the United States.

The use of CBD is comparatively risk-free. For starters, there is no known dose of cannabis that can prove to be lethal. According to a study, medical cannabis has a reasonable safety profile over a period of one year use. For states that legalized marijuana, there has also been a significant drop (25%) in opioid-related deaths. There are no significant side effects to the use of CBD on the central nervous system, even in the case of high dosage. Some people reported changes in appetite and diarrhea.  Fatigue was the only prevalent side effect.




Another advantage of CBD is that it does not cause addiction, which opioid use causes. Withdrawal from opioids can cause patients to suffer from anxiety, drug cravings, insomnia, abdominal pain, vomiting, diarrhea and tremors.

Therefore, CBD can be considered as a viable and effective alternative to opioids. It poses almost no risk. It is not associated with deaths. It has no serious side-effects and can help improve overall quality of life.


Opioids have a long history of being powerful painkillers. Some of them were considered as the strongest and most effective drugs for pain management. While CBD is clearly safer and has the potential to prevent deaths caused by opioid overuse, the question still stands:

When it comes to chronic pain, can CBD provide effective treatment compared to opioids? With more and more states legalizing the use of medical cannabis, research has poured in regarding the use and potential of CBD and medical cannabis for chronic pain management. There has also been new research examining the potency of opioids and its superiority over other types of pain medication. Let’s take a look at that first.

Examining 240 veterans that suffered from chronic back pain or osteoarthritis of the knee or hip, over a period of 12 months, this new study carried the following conclusions.

  • Half of the group was treated with opioid medication, while the other was treated with non-opioids. After a period of 6 months, the non-opioid group reported their pain intensity to be less severe than the assessment obtained from the opioid group.
  • By the end of the year, while the non-opioid group had less pain intensity, the opioid group was found to be suffering from more side-effects
  • The lack of effective pain management in the opioid group was attributed to opioid tolerance. According to Dr. Erin Krebs, the lead researcher on the study, after a few weeks or months of taking opioids, your body becomes used to a certain level of the drug and requires higher dosages to achieve the same effect. The higher the dose, the stronger the side-effects and the less effective your pain management.

The use of medical cannabis, on the other hand, tells a different story. A study published in June 2017 involved a group of 2,897 patients using medical cannabis. It had the following findings:

  • Of the 34% that reported to have opioid medication in the last six months, a majority reported medical cannabis to be just as effective (or in some cases, even more effective) as opioids but without the side-effects.
  • 97% reported that they were able to reduce or eliminate the use of opioids by switching to medical cannabis.
  • 81% that used cannabis alone declared it to be more effective than opioids.

Therefore, the study concluded cannabis to be an effective form of treatment for pain. It also highlighted that it helped patients avoid the risks and side-effects that were attached to opioid use.

Another Harvard-led review that analyzed 28 studies to determine the efficacy of medical cannabis in treating chronic pain, neuropathic pain and spasticity due to multiple sclerosis drew similar conclusions.



Although testing on humans is needed for more conclusive results, the benefits of CBD may potentially surpass that of its use in pain management. For starters, CBD has shown promise in treating depression and anxiety. This may be due to CBD’s ability to act on the brain’s receptors for serotonin and to regulate mood and social behavior.

CBD has also been shown to reduce the side-effects of chemotherapy, such as nausea and vomiting. Its inflammatory properties may help treat acne. In studies involving the treatment of Epilepsy and Parkinson’s disease, CBD was shown to effectively treat symptoms. It was also shown to reduce the progression of Alzheimer’s in animal studies.

Other studies suggested that CBD improved heart health in various ways by reducing blood pressure and preventing heart damage. It may also prove to be an effective form of treatment for substance abuse, mental disorders, diabetes and certain types of cancers.



Further research needs to be undertaken to determine the volume of CBD that is required for effective pain management to be possible. Balancing the CBD:THC ratio also requires some trial and error before patients can figure out the right cannabinoid ratio that suits them best. In chronic pain conditions, for example, doctors will prescribe higher amounts of THC to patients but will also increase the amount of CBD to offset the psychoactive side-effects. In some cases, when the patient does not respond to increasing levels of THC, the opposite may be done and higher levels of CBD may be administered. It’s an iterative process. It can only be perfected with the help of constant feedback from the patient to get the most optimal results with the fewest side-effects.

A national education program also needs to be developed regarding dosage and delivery methods for medicinal cannabis. This program will allow healthcare companies as well as dispensaries to acquire a more in-depth understanding of how medicinal cannabis works and the amount of dosage required to effectively treat chronic pain versus acute pain.  

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