Science & Health
Marijuana And Opioids Are ‘Equally Efficacious’ In Reducing Pain, With Cannabis Offering Additional ‘Holistic’ Benefits, Study Shows
Medical marijuana and opioids are “equally efficacious” at mitigating pain intensity in patients with chronic pain, according to a new study in the Journal of Cannabis Research—but cannabis also provided more “holistic” relief, such as by improving sleep, focus and emotional wellbeing.
Researchers said their findings support the hypothesis that medical cannabis (MC) “alleviates pain through holistically altering the pain experience” rather than “only targeting pain intensity.”
“The results of the present study support the hypothesis that the effects of MC on pain experience are more holistic than those of opioids,” their report says. “MC may alleviate pain through affecting a broad range of pain-related experience experiential factors such as relaxation, improved sleep and mood, being able not to react to the pain, as well as a sense of control.”
The nine-person Finnish team, led by Åbo Akademi University psychology professor Jussi Jylkkä, looked at a sample of 201 chronic pain patients, 40 of whom used medical marijuana and 161 of whom used opioids to treat pain. There was some crossover, with about 45 percent of medical marijuana patients reporting also using opioids for their pain and about 4.3 percent of opioid users having used medical cannabis.
Subjects completed retrospective surveys on the “positive and negative phenomenological effects of the medicine,” and researchers then compared scores from the two groups.
“Neither MC nor opioids are first-line treatments for chronic pain, but both are commonly used when other treatments fail to provide sufficient pain relief,” authors note, adding that recreational users of cannabis or opioids, along with people who used the substances to treat conditions other than chronic pain, “were explicitly asked not to partake in the study.”
The researchers concluded from the self-reported data that medical marijuana and opioids “were perceived to be equally efficacious in reducing pain intensity, but MC additionally positively affected broader pain-related factors such as emotion, functionality, and overall sense of wellbeing.”
“Both MC and opioids were perceived to reduce pain intensity equally well,” the study says. Participants said the two treatments “did not differ” in terms of side effects, but they rated the overall effects of medical cannabis as more positive.
The strongest differences between the two groups, the study says, were deeper relaxation, better sleep, improved mood and being able to feel pain without reacting to it, which were more commonly reported in the medical marijuana group.
“In sum, the results lend support to the notion that the psychoactive effects of MC are relevant to its therapeutic effect on pain, in line with suggestions in previous literature,” authors said. “However, by ‘psychoactive’ in this case we do not mean something that produces an altered state of consciousness in the sense of distorting one’s perception of reality and cognitive processes, but instead something that holistically alters consciousness to a more positive direction, or towards ‘normality.'”
Further, they noted, there were “no indications that MC, despite its holistic effects on consciousness, was experienced to distort cognitive processes, but instead was perceived to improve memory, focus, and clarity of thought.”
Researchers said their findings align with past research showing additional benefits for medical cannabis patients using marijuana to treat chronic pain, for example a 2017 study that found medical marijuana users “experienced substantially less depression and anxiety than opioid users.” A separate 2018 study, meanwhile, found that “cannabis did not affect perceived pain intensity, but instead made the pain feel less unpleasant and more tolerable.”
“The use of MC in chronic pain has also been associated with improved physical and social functioning and overall quality of life,” the study says, pointing to research from 2016, 2017 and 2022.
“This previous research thus supports the hypothesis that MC may exert its therapeutic effect on pain through altering the pain experience in a more holistic way than traditional analgesics,” it says. “That is, in addition to having an antinociceptive effect (i.e., removing pain or lessening its intensity), MC may affect the pain experience more broadly, influencing factors such as mood and emotion, pain tolerance, functionality, and overall well-being.”
Notably, authors said the outcomes appeared to be more positive in past studies for patients who consumed whole cannabis flower rather than synthetic THC or isolated cannabinoids. Looking at literature reviews from 2021 and 2022, for example, they noted that “only six of the 20 studies that were included in the review dealt with whole plant-based products, all superior to placebo. By contrast, in both studies, the results concerning isolated and synthetic cannabinoids were mixed.”
“Thus,” they conclude, “the present results contribute to the cumulating evidence that whole-plant cannabis flower may be an effective analgesic.”
A separate study recently found that the so-called “entourage effect” of whole-plant marijuana produces a stronger and longer-lasting psychoactive effect than pure THC.
The Finnish team acknowledged that the narrow availability of marijuana in the country was an obstacle to the research.
“A central limitation of the present survey study pertains to the special status of MC in Finland. Although legal in principle, prescription for MC is very difficult to attain,” the study explains, citing recent research that illustrates the trend: “Medical cannabis prescription rates have decreased in Finland from about 370 in 2017 to 240 in 2020 and to around 160 in 2021.”
The new study, “The holistic effects of medical cannabis compared to opioids on pain experience in Finnish patients with chronic pain,” comes as more research examines the possibility of using cannabis, or specific derivatives of the plant, as safer alternatives to opioids in some settings.
For example, another study published this month in the Journal of Dental Research, found that pure CBD could alleviate acute dental pain about as well as an opioid formula commonly used in dentistry.
“Our results indicate that a single dose of CBD is as potent as current analgesic regimens and can manage emergency dental pain effectively,” the authors wrote in that study, adding that their work appears to be “the first randomized clinical trial testing CBD for managing emergency dental pain” and could eventually lead to FDA approval of CBD for dental pain.
A separate study last month found that letting people buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 percent to 8.1 percent fewer opioid prescriptions.
Another study, published this summer in the journal Cannabis, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other prescription medications. Participants reported reduced pain and anxiety, improved physical and mental functioning, better sleep quality and mood and less reliance on prescription medications, including opioids and benzodiazepines.
