Fighting the battle with chronic pain Is cannabis a viable alternative to opioids?

by Kyle Dijon Hill MS
The beginning of 2010 marked a time of significant increase in the availability, usage, and abuse of prescribed opioid medications, sparking an unprecedented drug overdose epidemic in America.  With over ninety Americans dying each day, it is time to generate viable solutions to curtail the destruction.
The descent into opioid addiction and overdose typically begins with the use of prescribed pharmaceutical opioids for the treatment of chronic pain.  Despite being a mainstay approach for pain management, opioid therapy remains controversial due to side effects, efficacy, outcomes, and a high potential for abuse and addiction.  One important element in curtailing the opioid crisis is finding an alternative first line treatment option for chronic pain; one that does not progress to dependence or overdose.  Medical cannabis needs to be acknowledged as such an alternative.  Current research suggest that cannabis, when used as adjunct therapy or as a substitute, may result in a greater cumulative relief of pain, better quality of life, and a reduction in the morbidity and mortality associated with pharmaceutical opiates.
There are documented uses of cannabis as a medicine as far back as 5,000 years ago, with its earliest usage in China and Egypt. It was listed in the U.S. Pharmacopoeia until 1941, where it was recommended to treat various ailments, including fatigue, rheumatism, asthma, delirium tremens, migraine headaches, cramp and depression associated with menstruation, and even coughing. Because of its influence on the endocannabinoid system (ECS), it has the potential to treat an array of symptoms and ailments.
Discovered by Israeli researcher Dr. Raphael Mechoulam, the endocannabinoid system is a complex biological system in all humans that regulates functions of brain, endocrine, and immune tissues. It is perhaps the most important physiological system, being a key component in homeostasis, the tendency of the body to seek and maintain internal balance, even in the presence of external stressors.
The endocannabinoid system is a collection of cell receptors and molecules which can be illustrated through the analogy of a lock and key, cell receptors being locks and the molecules acting as a keys.  Once these molecules (ie. keys) come in contact with the receptors (ie. locks) a message is relayed, causing a response from the cell. The  molecules of the endocannabinoid system can either be an “endogenous endocannabinoid”, produced in the body by the body; a “phytocannabinoid”, coming from cannabis; or a  syntethic version, produced in a lab.
Cannabis supplements the endocannabinoid system.  It triggers responses that regulate bodily functions such as sleep, appetite, digestion, mood, immune function, movement, reproduction, fertility, pleasure, reward, pain, memory, and body temperature.  Importantly, ECS receptors in the central nervous system mediate the perception of pain.  Because of this, a growing body of clinical research suggests cannabis is a relatively safe and effective treatment for chronic pain management.
Comparing and contrasting side effects and safety profile of opioids to cannabis, cannabis reigns supreme while opioid usage is associated with an alarmingly strong addiction potential and the possibility of overdose via respiratory depression.  Unlike the receptors of opioid pain treatment, cannabinoid receptors are absent from the brainstem, and so lack opioids’ fatal side effect of respiratory depression with overdose.  Since no cannabinoid receptors are on the brainstem where breathing is controlled, no possible lethal dosage can occur.