Opioids

Further Evidence for Cannabis as an Adjunctive Therapy to Opioids

Effects of cannabinoid administration for pain- A meta-analysis and meta-regression

In Summary

A recent meta-analysis provided further evidence that cannabis can be used as a replacement and adjunctive therapy option for opioids. Across all of the studies, it was found that cannabis had a medium-to-large effect on the subjective pain felt. The included studies included a range of given doses, all reported in milligrams and were conducted in various pain models, including Human Immunodeficiency Virus, Cancer, Neuropathic Pain, Diabetes, and more. Further research is needed to standardize an appropriate dose for each condition and ensure the validity of such medications. 

The authors take care to emphasize the need for alternative pain therapies for opioids that are safer and more economically responsible. Currently, pain-related costs from patients, caretakers, and healthcare facilities continue to grow beyond $600-billion annually, as more people grow dependent on opioids. Cannabis is much more cost-effective, and even if it does not entirely replace opioid therapies and is simply an adjunct therapy, it has the potential to greatly reduce the amount of opioid prescribed and lower the necessary dose. Opioids are highly addictive whereas cannabis has a much better safety profile, yet cannabis is still deemed medically irrelevant by the federal government. More research needs to be conducted to reduce the chance of addiction, the opioid crisis in general, and reduce the economic burden of pain-related costs in the United States. 

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Benjamin Caplan, MDFurther Evidence for Cannabis as an Adjunctive Therapy to Opioids
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Cannabinoids have Opioid-Sparing Effects on Morphine Analgesia

Opioid-Sparing Effects of Cannabinoids on Morphine Analgesia- Participation of CB1 and CB2 Receptors

In Summary

Researchers have recently provided evidence that synthetic cannabinoids are able to work synergistically with morphine to provide maximum pain relief while limiting opioid doses. In an effort to control the current opioid epidemic researchers have been looking into the possible benefits of cannabinoids due to the interaction of the opioid and endocannabinoid systems. The results of this study showed that various synthetic cannabinoids (WIN and GP1a) were able to work synergistically with morphine in two separate pain models to maximize analgesic effects. Further evidence is still needed to validate these claims before patient use but this paper provides further evidence that medical cannabis may help put an end to the opioid crisis. 

Highlighted in this paper is the lingering uncertainty of exact mechanisms within the endocannabinoid system. The authors of this article are left without definite answers as to whether or not the analgesic effect is mediated completely through cannabinoid receptor 1 (CB1) or if cannabinoid receptor 2 (CB2) is also involved. Research into cannabinoids is slow within the United States as there are currently only privately funded studies which is severely hindering the medical community from taking full advantage of all it has to offer. The better a system is understood the more definite answers can be found. Critics may never support the rescheduling of cannabis but without moving cannabis to Schedule II or III it remains impossible to back even their claims. 

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Benjamin Caplan, MDCannabinoids have Opioid-Sparing Effects on Morphine Analgesia
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How Opioids Act as Immunosuppressants

Opioid Drug Abuse and Modulation of Immune Function.

In Summary:

 A recent review article has pieced together part the mechanism behind the fact that opioids have immune system suppression properties. Morphine, a popular opioid, and one of the main actors in the modern opiate epidemic of dependence and addiction interacts with factors within the immune system that break down the coordination of the two main cells involved in innate and adaptive immunity. A disruption in one of the primary immune defense operators, this action may leave users susceptible to a multitude of illnesses. This review highlights the importance of understanding the mechanism of opioid-related immunosuppression so that physicians can better treat patients and the public is more aware of the risks. Addicts, especially, should be made aware of the risks posed by illicit intravenous drug use.

Morphine modulates IL-2 promoter activity
morphine skews the lineage bias of CD4 T-cells
schematic outline showing modulation of innate and adaptive immunity following morphine treatment

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Benjamin Caplan, MDHow Opioids Act as Immunosuppressants
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Another Look Into Opioid and Cannabinoid Interactions

In Summary:

A recent study has revealed that the co-activation of mu-opioid receptors and cannabinoid receptor 1 (CB1) results in the attenuation of the response seen when each receptor type is activated on its own. The decreased response of the two receptor types during co-activation has been implicated in negatively modulating neuritogenesis (the process of generating new brain nerve cells). Neuritogenesis is important for the cells’ ability to receive and project signals leading the researchers to call for more research in order to elucidate the effect this may have on addiction.

The fact that there is co-interaction between opioid receptors and cannabinoid receptors is also interesting to inform the discussion of the place that cannabinoid actors may have in supporting the healing of those who are dependent or addicted to opiate medications.

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This paper is also stored here:  http://bit.ly/2X93OVs      inside the CED Foundation Archive

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Benjamin Caplan, MDAnother Look Into Opioid and Cannabinoid Interactions
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