Pain Crisis and Opioid Crisis: The need to break a vicious cycle
Thousands of people die from opioid overdoses every year, and recent evidence suggests that the opioid crisis is still growing in Canada. The widespread use of prescription opioids for pain relief is one of the drivers. At the same time, the chronic pain crisis is equally real. For many patients, opioids are the only way to achieve an improved quality of life, or even just ensure daily functioning.
New, less addictive therapeutics are desperately needed to replace opioids for those who currently use them for pain relief – or for whom that was the gateway leading to illegal use of prescription opioids.
The ethics of prescribing
We’ve come to learn a lot about narcotics and addiction, and how a short-term prescription for surgery recovery or a sports injury may for some result in long-term dependence on opioids. Almost one in five Canadians live with some form of chronic pain, and they are among the most vulnerable in turning to opioids to help. With what we know about how the body responds to opioids—increased tolerance requiring ever-increasing doses to feel the same relief—the ethical repercussions for prescribers are obvious.
Those who treat patients in pain have long ago started to look for alternative, non-addictive ways to relieve pain, with medical cannabis being an option for select patients in Canada since 2001. The recent legalization of recreational cannabis in Canada offers an excellent starting point for broader access and for obtaining better data supporting long-term safety claims.
Where can cannabis help?
A growing body of research suggests cannabis has proven helpful in pain relief and that its addictive properties are low. Several recent and rigorous reviews of studies available to date (including one by a team of researchers from Queens University) drew the conclusion that patients taking cannabis were likely to experience a significant reduction in pain symptoms and suggest that cannabis appears to be an appropriate alternative therapy option to opioids in pain management.
In the parts of the brain and spinal cord that signal pain, there are receptors for both opioids and cannabinoids, and their signaling pathways appear to interact with each other. It has been suggested that it is safe to use cannabinoids and opioids together and that the synergistic effect means progressively smaller opioid doses are needed. Studies are already underway in this area.
However, at this point there is no clear consensus when it comes to cannabis as a way to reduce opioid abuse, addiction and the many fatal overdoses.
In a landmark study in the United States, researchers found states with legalized medical cannabis saw 25% fewer opioid-related deaths compared to non-legalized states, but given that there wasn’t regulation around cannabis use in those states, there is still a need for consistent, replicable data.
Canada has become the first G-20 country to have a legal framework for regulating legalized recreational adult cannabis use, opening doorways to understanding the clinical and public health impact of cannabis use on a much larger (and better documented) scale than previously done.
Therefore, Canadian researchers now have a unique opportunity to help determine if cannabis is the answer to help control and reduce dependence on opioid use for pain relief.
Making an impact
All Canadian physicians who do not have a restricted license, as well as nurse practitioners in some provinces, are currently eligible to authorize medical cannabis. Are they prepared?
Along with new research, evidence and protocols comes a need for customized solutions for health care practitioner education, expert consultations, clinical assessments and data dissemination; to ensure that Canadian patients receive treatment based on the latest insights in this rapidly changing area of medicine.