The US has seen an explosion in the overuse and abuse of opioids over the past few years, as tens of thousands of Americans continue to die every year from opioid-related overdoses. According to the National Institute on Drug Abuse, approximately 21% to 29% of patients who are prescribed opioids for pain misuse them, and between 8% and 12% develop an opioid use disorder.
To tackle the ongoing issue of opioid addiction, many patients and healthcare practitioners are increasingly turning to medical cannabis to help curb the use of opioids while reducing chronic pain. However, there currently exist no guidelines on how to properly transition patients off of opioids or use cannabinoids in an effective manner to properly relieve pain.
In a paper recently published in the International Journal of Clinical Practice, researchers used a five-step Delphi process to develop recommendations on how and when to use cannabinoids in the presence of opioids to curb chronic pain and eventually taper the use of opioids using cannabinoid titration. The Delphi process is a technique used used to review and summarize opinions from different experts to develop a consensus guide.
Regardless of physical or psychological interventions, the researchers agreed that cannabinoids might be a viable option for patients with chronic pain who are not experiencing adequate pain relief through the use of opioids, particularly among those who experience complications related to using opioids. There were no age restrictions outlined regarding eligibility.
Guidance on cannabinoid use:
- Cannabinoids should be avoided in people who are pregnant/breastfeeding or have experienced an adverse reactions to cannabinoids
- During the day, an oral extract consisting predominantly of cannabidiol (CBD) should be used
- Patients can potentially add tetrahydrocannabinol (THC) as required with a starting dose of 0.5mg to 3mg; the dose can be increased to 1mg to 2mg once or twice a week to no more than 30 to 40 mg per day
- Smoking was advised against and instead vaporization was recommended for breakthrough pain
Guidance on opioid tapering:
- Upon any improvement in function and reduced need for medication to control pain, opioid tapering can be initiated by 5-10% every 1 to 4 weeks
- The goal is to reduce pain intensity by at least 30% and lower opioid dose by at least 25%, and see a marked improvement in function and quality of life
Healthcare providers should monitor patient progress once or twice monthly and every 3 months after stabilization. They should also evaluate other medications or recreational substances the patient is taking to minimize any side effects or interactions.
This review may help healthcare providers and patients optimize their outcomes by providing guidance on how to properly administer cannabinoids and taper opioids to safely alleviate pain.
Image Credit: Brent Barnett
- Sihota A, et al. Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control. Int J Clin Pract. 2020;e13871.