Pain is often considered a fifth vital sign. It is subjective data that only the patient can describe. In order to provide quality patient care, health care providers must not only treat the underlying cause of illness, but also the pain associated with it. Opioids are now the predominant treatment in providing pain management. Although these medications are excellent in reducing pain, they produce an array of issues when treating chronic pain.
Because chronic pain requires around the clock medication, patients often build a tolerance to these drugs and become addicted which can cause financial burdens, legal issues, and overdoses. There are many alternative, less invasive treatments to pain such as the use of cannabinoids. Cannabinoids have been used as a form of medicine for thousands of years and have been noted to reduce or lighten many chronic pain conditions such as Fibromyalgia, Post Traumatic Stress Disorder, sleep disorders, seizure disorders, Multiple Sclerosis, etc. This paper explains in detail the benefits of the use of cannabinoids in pain management by using various sources and studies. Cannabinoids provide an alternative for managing chronic pain, and a possible solution to America’s rising opioid epidemic.
Keywords: Cannabinoids, chronic pain, pain management, health care, opioids
The treatment of chronic pain challenges health professionals to not only treat the underlying cause of the pain but also to provide adequate pain management. In the past, the use of opioids has been the number one source in controlling symptoms of pain. Although opioids are excellent in alleviating acute pain, they come with an array of complications when dealing with the treatment of chronic pain. This has brought on a variety of issues including a high risk for addiction and a financial burden. Solutions to the opioid epidemic include the use of alternative therapies such as the use of cannabinoids.
Chronic pain is becoming more and more prevalent as a result of the aging population and advancements in medicine and technology. This is because the evolution of medicine and treatments are now saving more lives. A disease that was once deadly, is now manageable. Although these are amazing advancements, survivors of diseases such as cancer or HIV are now left to deal with the chronic pain associated with surviving the illness.
The article, “Cannabinoids in the management of chronic pain” stated, “Chronic pain is an escalating public health problem currently affecting approx. 1 in 5 people. This is estimated to increase to 1 in 3 over the next decade” (Lynch, 2015, p. 1). The escalation in the incidence of chronic pain underscores the need for health care provider awareness about various methods of pain management, including alternative therapies such as cannabinoids. In patients with chronic pain, is treatment with cannabinoids compared to opioid therapy an effective alternative in managing pain?
Many health care administrators were once reluctant to delve into the benefits of cannabinoids because of lack of research. While the use of cannabis is still illegal in certain states in the US, many people feel morally guilty using cannabinoids to treat pain. The use of cannabinoids is often overlooked because it deviates from standard treatment. However, there is now increasing evidence to explain the advantages of using cannabinoids in treating chronic pain. Cannabinoids either treat or reduce the symptoms of various diseases such as seizure control in epilepsy, treatment of neuropathic pain in cancer and HIV survivors, controlling symptoms of multiple sclerosis, the treatment of chronic migraines, treating mental illnesses such as anxiety and depression, and sleep disorders.
The Health Care System
The use of cannabinoids in treating chronic pain will affect the health care system by decreasing the number of overdoses as a result of becoming addicted to opioids. Doctors will be able to legally prescribe cannabinoids as an effective use of pain management without feeling guilty that their patient may become addicted to the medication. According to Lubeck, “approximately 64,000 drug overdose-related deaths in the United States in 2016.
Of those, the most significant increase was associated with fentanyl and synthetic prescription opioids” (Lubeck, 2018, p. 1). Physicians, nurses, and first responders are utilizing all of their time, energy, and resources on reviving patients who have become addicted to opioids. There is evidence to show that overdoses due to opioids drop by 25% in states that have legalized medical cannabis. (Wilson-Poe, 2018). This demonstrates the fact that those who use medical cannabis in treating their pain will have a decrease in dependence on opioids because of the success of other therapies.
The use of cannabinoids in medicine is dated back to ancient times. In fact, the Ebers Papyrus is one of the oldest medical textbooks in existence which talks about the use of cannabinoids in treating chronic pain. Additionally, cannabinoids were said to have been used in the Victorian era during the early 19th century. Irish physician O’Shaughnessy explains using cannabinoids to treat tetanus, cholera, and infantile seizures. He states that the 40-day old baby developed nocturnal convulsive episodes and no typical treatment worked. It was then that he decided to trial cannabinoids.
O’Shaughnessy states, “ the child was treated repeatedly with various cannabis tinctures for the next few weeks until convulsions stopped. The child is now in the enjoyment of robust health and has regained her natural plump and happy appearance”(Friedman & Sirven, 2016, p. 1). By the mid-19th century, cannabinoids were being used in Europe and North America to treat migraines, tremors associated with Parkinson’s disease, and convulsive disorders. Neurologist Sir William Gowers noted that cannabinoids were the only known anticonvulsant at the time (Friedman & Sirven, 2016, p. 1). In the past, there were no man-made drugs used to relieve chronic pain. All these professionals had to treat their patients with were herbal remedies and plants such as cannabis.
With the use of cannabinoids in treating chronic pain rather than opioids, fewer patients will become addicted. Most opioid addictions start when a patient has undergone some sort of surgery or procedure involving the need for pain medication. In fact, “ In 2015, the number of overdose deaths attributable to prescribed painkillers was over 15,000, a 3-fold rise since 2001.2 Even more unsettling, many of these deaths occur in people who receive their prescriptions from one doctor, meaning they were not doctor shopping to obtain the drugs, or taking or buying them from others’ (Coady, 2017).
Doctors are overprescribing medications. This causes patients to first build a tolerance towards these opioids requiring higher doses and then patients eventually develop an addiction. As explained by Coady,” When patients remain on these medications chronically, most develop tolerance, and need higher and higher doses to obtain the same effects. Even worse, most become physiologically dependent, and live in an uncomfortable state of almost constant withdrawal symptoms, as opioid blood levels fluctuate up and down over the course of the day. An estimated 25% become non-medical users, and 10% develop opioid use disorder”(Coady, 2017). When the supply of these pain medications starts to run low, patients try to seek other forms of cheaper and harsher opioids such as heroin, fentanyl, or morphine.
As explained by Fogger and McGuinness, “ Faced with a decreasing availability of pills and wanting to prevent withdrawal symptoms, the transition from prescription pills to heroin becomes an alternative due to the substance’s availability”( Fogger & McGuiness 2014). Not only does this begin a lifetime of addiction but these patients then start to run into problems with the law because they are obtaining these drugs illegally. This issue occurs in every day, working people who started having a toothache or back pain requiring medication and are now hooked on heavy, illegal opioids.
The use of cannabinoids in chronic pain permits a better quality of life in patients than the use of opioids. Patients that take cannabinoids will be able to enjoy a more valuable social life because the side effects of cannabinoids are a lot less invasive than the side effects of opioids. In a study performed by Boehnke, Litinas, and Clauw, patients in Michigan who are medical cannabis cardholders were interviewed.
They were asked how the use of cannabis reduced their chronic pain in contrast to opioids. The results are as followed, “Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n=118), decreased number and side effects of medications, and an improved quality of life (45%)( Boehnke, Litinas & Clauw, 2016, p. 3). Although opioids are excellent in relieving pain, they stop the patient from being able to participate in normal day to day activities. Opioids often cause drowsiness, lethargy, depression, and a decreased desire to perform social activities.
With the use of cannabinoids, according to Doctor Abrams, “ I’ve had patients with cancer who’ve been put on high doses of opiates, and they find they can’t communicate with their family. Once they have effectively weaned themselves off their opiates onto cannabis, they find it much easier to communicate with their loved ones, while also achieving relief of their pain”(Weisberger, 2018, p. 1). Making the switch from opioids to cannabinoids can improve a patient’s social life and self-esteem.
The use of opioids in treating chronic pain has caused an epidemic. In fact, “ The Trump Administration has undertaken a series of actions, including creating the President’s Commission on Combatting Drug Addiction and the Opioid Crisis and declaring a public health emergency under the Public Health Services Act”(The Council of Economic Advisors, 2017, p.2).
This issue has become a national crisis and it is time to look into alternative therapies to treat pain. Furthermore, the cost of prescription opioid overdose, abuse, and dependence in the United States alone is estimated to be $78.5 billion. In addition to this, 73% of the $78.5 billion was used for healthcare spending, criminal justice costs, and lost work rate due to addiction and imprisonment. The costs remaining were as a result of fatality (The Council of Economic Advisors, 2017, p.3). This is an issue that is not only affecting individuals with chronic pain, but it is affecting the country as a whole and is considered a national crisis.
The use of cannabinoids in treating chronic pain can be a solution to the current opioid epidemic. With evidence that cannabinoids can treat or lighten symptoms of several chronic diseases such as fibromyalgia, multiple sclerosis, migraines, Post-Traumatic Stress Disorder, epilepsy, and many more diseases, it can be used as an alternative method of treating patients with these illnesses. There is a need for more research and clinical trials to evaluate if cannabinoids can compete with opioids in terms of pain, however, there is increasing research that states cannabinoids are in fact chronic pain relievers. With the replacement of cannabinoids instead of opioids, there will be fewer overdoses, a better quality of life, and a decreased financial burden.