Chronic pain is a significant contributor to human suffering – about 20% of the adult population suffers from some form of chronic pain. Many disorders lead to chronic pain, ranging from musculoskeletal disorders to irritable bowel syndrome to fibromyalgia. Although the cause varies, the treatment is often the same: opioid pain medication. I know several people who have at one point or another had to rely on opiates for pain relief for an extended period – and I’m certain that you know someone too.
The Opioid Crisis
If you’ve ever had a script for them you’ll know opiates are incredibly effective in relieving pain, but they are known to be over-prescribed by doctors. The pain-relieving and pleasurable effects of these molecules also make them highly addictive, often leading to abuse after a doctor prescribed course. According to the National Institute on Drug Abuse, 21 to 25 percent of patients prescribed opiates eventually abuse them and 8 to 12 percent develop an opiate abuse disorder.
Addiction to opiates can lead to a transition to illicit drugs and 4-6 percent of abusers switch to heroin. Opiates are also dangerous in themselves. High doses affect breathing and heart rate, and overdoses cause more than 130 deaths per day in the United States alone. All of these factors have led to what is known as the “opiate crisis”.
Opiate addiction is a chronic disease. Conventional treatments for the problem include psychotherapy sessions and the prescription of other addictive substances.
Alternative treatment options are needed and, in this area, the CBD is involved in its multifaceted effects on the body. Let’s look at the precise mode of action of opiates and then examine how the CBD might be able to help.
What are Opioids and how do they work?
Opiates are a broad class of substances used to target acute and chronic pain. The use of opiates is nothing new – Egyptian papyrus documents suggest that mankind has been using them to relieve pain for thousands of years.
The opium poppy (Papaver somniferous) is a natural source of opiates such as morphine and codeine. Morphine is the plant’s main alkaloid and is ten times more potent than raw opium. Although it is very effective against pain, morphine is associated with severe withdrawal and addiction symptoms. Chemists use the molecule as a precursor in the laboratory synthesis of synthetic opiates such as fentanyl.
The human body also creates a supply of endogenous opiates – endorphins and enkephalins – which are released and bind to opioid receptors when pain signals are detected. Such receptor binding occurs across both the central and peripheral nervous systems in opioid-responsive neurons. External opiates, such as morphine and fentanyl, are also opioid receptor agonists, meaning that they bind to the same sites.
Opioid receptor agonists relieve pain by reducing the activity of nerve signals. This binding also leads to sedation, euphoria and respiratory depression. Opioids activate the brain’s reward system, which releases the neurotransmitter dopamine – a “wellness” hormone.
An increase in dopamine is associated with feelings of pleasure. Because the brain tends to enjoy what makes it happy, it records a long-term memory of what it felt. This phenomenon is known as classical conditioning, which perpetuates the desire to consume more of the substance.
Chronic opiate use and activation of the reward system eventually leads to abnormalities in the brain that reinforce the addiction. Some of these alterations disappear after detoxification, but others may persist for years.
Addiction to opiates is mainly treated by using other opiates. The synthetic opioid methadone is given in order to provide stabilization and to reduce withdrawal effects. It does this by binding to opioid receptors. However, methadone also has addictive characteristics and is implicated in one-third of opioid overdose deaths.
While these substances work in some cases, in others they can lead to a new addiction. So, what can be done? Attention is now turning to cannabis, specifically CBD, as a potential treatment for opiate addiction.
Can CBD help treat opioid addiction?
So, what makes CBD so interesting as a potential treatment for opiate addiction? Well, research is still in its infancy, but results suggest that CBD has the potential to impact drug-related cravings. Research published in the journal Substance Abuse states that CBD is associated with different brain circuits involved in drug addiction and drug-seeking behavior. The authors of the report state that this mechanism of action makes CBD an interesting candidate for the treatment of addiction disorders.
A double-blind, randomized, placebo-controlled study published in The American Journal of Psychiatry explored the effects of CBD on people suffering from heroin addiction. The researchers explained that despite the importance of the opiate epidemic, there is a lack of non-opiate drug treatments.
The study explored the immediate, short-term and long-term effects of different amounts of CBD (400 or 800 mg). Researchers monitored participants for cravings, anxiety, cognition and physiological status. They found that the immediate administration of CBD significantly reduced cravings and anxiety. The cannabinoid also reduced physical measures of heart rate and cortisol levels. No serious side effects were detected. The research team concluded that these results were a strong basis for further investigation of CBD as a treatment option for opiate addiction.
CBD as an alternative pain reliever
Beyond the potential of CBD in the field of opiate addiction, could it also serve as an alternative for chronic pain? It may not be medically accepted yet – but in my experience, and the experiences of those around me – CBD has been an effective way to manage pain. A friend has cut his use of prescription opiates in half – with little change in his discomfort level. I’ve also written about giving CBD to my Pets, with a big improvement to quality of life for Old Man Nicholas (who’s still here at time of writing – he made it to 15!)
It’s not just my own experiments on animals that lead me to believe this – an animal study published in the European Journal of Pain explored the effects of CBD on pain and inflammation in mice. The researchers found that CBD was able to reduce arthritic pain-related behaviors.
A human trial published in the journal Transplantation Proceedings explored the effects of CBD on chronic pain in kidney transplant patients. Of seven participants, two reported a total improvement in pain and four reported a partial response.
Could CBD play an important role against Opioid Crisis?
Preliminary research has generated exciting results for the potential role of CBD in opiate addiction. The cannabinoid appears to change addictive circuits in the brain and reduce cravings and anxiety. The molecule is still under investigation as a potential alternative to opioid drugs – but the results are promising. It reduces inflammation and can calm or dull aches. It can reduce anxiety in many people – the combination of those alone are often enough to help ease symptoms to manageable levels. The fact that CBD doesn’t get you high, coupled with the fact you don’t build a tolerance to it are two MAJOR advantages that are often not considered.