Could cannabis help minimize post-surgery opioid addiction?

The current widely accepted treatment for acute pain involves a mix between highly-addictive opioids and other pain relief drugs.

An employee checks cannabis plants at a medical marijuana plantation in northern Israel March 21, 2017 (photo credit: REUTERS/NIR ELIAS)
An employee checks cannabis plants at a medical marijuana plantation in northern Israel March 21, 2017
(photo credit: REUTERS/NIR ELIAS)
Two potentially groundbreaking new Israeli studies, both scheduled to start in the coming days, aim to explore whether the use of cannabis oil could lower the amount of opioids that are prescribed for people suffering from trauma and acute pain.
The studies are a joint effort between one of Israel’s leading medical cannabis companies, Bazelet, and the Pain Relief Unit, the Intensive Care Unit and the Orthopedic Unit at Hadassah-University Medical Center in Jerusalem, where the study will take place.
While there have been several clinical studies that have shown cannabis to be an effective treatment for patients who experience chronic, long-lasting pain, very few such studies have so far been done on the effects medical cannabis and its derivative components can have on acute pain and trauma.
The current accepted treatment for acute pain involves a mix between highly-addictive opioids – a term which includes drugs from organic opium derivatives such as morphine and codeine to synthetic derivatives such as tramadol and fentanyl – and other pain relief drugs, though the overlapping effects of cannabis on different anesthetic and pain relief medications have not been thoroughly examined.
During the first study, doctors will prescribe post-surgery patients and those suffering from severe radicular pain (orthopedic pain which radiates from the spine to the back and hip into the limbs) with a pain-relief drug regimen that includes a single dose of cannabis oil, along with opioids, to see whether the change in regimen could ease patients’ dependence on opioids.
During the second study, patients will be given a single dose of cannabis oil before surgery, and during their recoveries a machine that automatically adds to their morphine drip will register the amount of doses, to see what effect the cannabis has on the amount of morphine requested by each patient.
Veteran chemistry professor and head of the scientific research department at Bazelet, Ari Eyal, spoke with The Jerusalem Post on the importance of the studies, saying that the current situation is “absurd.”
The studies come as part of an effort by the worldwide medical community to lower opioid dependence due to their intensely addictive nature and its other harmful side effects such as constipation, nausea and death.
Since the introduction of synthetic opioids in 2013, the US in particular has seen an explosion in opioid addiction, with two of every three overdose deaths in the US in 2018 a result of opioids, according to the CDC.
“Doctors don’t currently ask people before surgery whether they smoke cannabis, despite indications that experienced cannabis users may have a higher tolerance for certain anesthetic drugs than non-smokers or casual smokers,” he told the Post.
He explained that there is a hypothesis in the scientific community that claims regular cannabis users may see changes to their endocannabinoid receptors (that are also in charge of anesthesia intake), which result in a higher tolerance for anesthetic drugs.
In addition to the two studies, Bazelet is also planning a future study with Prof. Eliad Davidson, who heads the Pain Relief Unit at Hadassah, on examining the effect of cannabis terpenes on chronic pain. The study is set to start in the coming months, according to Eyal.
Terpenes are certain components that are responsible mainly for the taste and smell of the cannabis plant, unlike cannabinoids like THC or CBD, which are responsible for more tangible physical and psychoactive effects, and have been the main focus of studies on the matter.
“Unlike most other plants used in pharmaceuticals, which usually have one main active ingredient, the cannabis plant is made of dozens of different active components, each of which affects the patient in different ways when combined with others,” Eyal said.
He explained that the indica/sativa differentiation, which is often accredited to differences in certain cannabinoid quantities, is actually a direct result of differences in terpenes, some of which can cause higher levels of either alertness or drowsiness.
“It doesn’t matter if they tell you it’s “white widow” and post the THC percentage,” Eyal said. “If the terpenes of the plant are completely different, you’ll see a different physical and mental effect.”