The nation’s opioid epidemic has become more and more worrisome as opioid use, misuse (or use disorder), and overdose has vastly increased in the past several years. Every day, more than 130 people in the United States die after overdosing on opioids and projections find that this number will only increase over the next several years. [1, 2, 3, 4, 5]
Opioids are a class of drugs that include illegal narcotics like heroin as well as prescription medications like fentanyl, oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Opioids are typically prescribed because of their effectiveness at reducing physical pain. Due to these analgesic properties, as well as their ability to induce feelings of euphoria, opioids are highly physically and psychologically addictive. 
As a result, pain sufferers and prescribing physicians are turning to medical marijuana as a potentially safer alternative. But is using medical marijuana for pain management safe? Is it even effective at managing pain?
Marijuana Safety and Effectiveness
Marijuana, or cannabis, is known to be psychologically addictive; however, no deaths have been reported due to an overdose.
Some known adverse effects of marijuana use include: 
- Acute memory impairment
- Acute impairment of coordination and judgment
- Chronic cognitive impairment
- Chronic bronchitis
- Increased possibility of motor vehicle accidents
- Social dysfunction such as struggling at work and or in school
- The development of cannabis use disorder
The exact mechanisms showing how marijuana relieves pain are not fully understood. Based on current research, it is thought that marijuana reduces pain by interacting with the natural cannabinoid receptors in our body that likely play a role in pain control. 
In a review conducted by the National Academies of Sciences, Engineering, and Medicine, it was found that the conclusions of five good-to-fair-quality studies on the effectiveness of cannabinoids (the chemicals found in marijuana) for pain management were largely consistent in suggesting that cannabinoids demonstrate a modest effect on pain. 
Another review by a team of researchers found that marijuana or cannabinoids are not universally effective for pain, as routes of use and their effects on types of pain differ. More specifically, they discovered that inhaled (smoked or vaporized) cannabis is consistently effective in reducing chronic non-cancer pain. 
Oral cannabinoids seem to improve some aspects of chronic pain (sleep and general quality of life), or chronic cancer pain, but they do not appear effective in acute postoperative pain, chronic abdominal pain, or rheumatoid pain. Additionally, the researchers found that the available literature shows that inhaled cannabis seems to be more tolerable and predictable than oral cannabinoids. 
Some studies have suggested that medical marijuana legalization might be associated with reduced opioid prescribing rates, decreased prescription opioid use, and opiate-related overdose deaths, but researchers don’t have enough evidence yet to confirm this finding. [6, 8]
There are two U.S. Food and Drug Administration (FDA) approved medications that contain cannabinoid chemicals in pill form; however, the FDA has not recognized or approved the marijuana plant as medicinal. 
While there seems to be a valid argument that marijuana may be a safer alternative to opioids for pain management, overall, researchers note that there is very little known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available marijuana products in the United States.
Given that marijuana products are readily available in much of the nation, more research is needed on the various forms, routes of administration, and combinations of cannabinoids to determine their effects on pain. 
1. Substance Abuse Center for Behavioral Health Statistics and Quality. (2017, Sept 7). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. SAMHSA. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.htm. on 2019, Feb 19.
2. Chen Q, Larochelle MR, Weaver DT, et al. (2019). Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Netw Open, 2(2):e187621. doi:10.1001/jamanetworkopen.2018.7621
3. Rudd, R.A., Seth, P., David, F., Scholl, L. (2016). Increases in Drug and Opioid-Involved Overdose Deaths – United States, 2010-2015. MMWR Morb Mortal Wkly Report; 65 (50-51) : 1445-1452. doi:10.15585/mmwr.mm655051e1.
4. National Institute on Drug Abuse. (2010, Feb 19). Opioid Overdose Crisis. Retrieved fromhttps://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis on 2019, Feb 19.
5. NIDA. Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids on 2019, Feb 19.
6. NIDA. (2018, May 1). Marijuana as Medicine. Retrieved from https://www.drugabuse.gov/publications/drugfacts/marijuana-medicine on 2018, June 22.
7. Schrot, R.J. & Hubbard, J, R. (2016). Cannabinoids: Medical Implications. Annals of Medicine, 48(3), 128-141, DOI: 10.3109/07853890.2016.1145794
8. National Academies of Sciences, Engineering, and Medicine. (2017) The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. https://doi.org/10.17226/24625.
9. Romero-Sandoval, E.A., Kolano, A.L. & Alvarado-Vázquez, P.A. (2017). Cannabis and Cannabinoids for Chronic Pain. Current Rheumatology Reports, 19(11): 67, doi: 10.1007/s11926-017-0693-1.
About the Author:
Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.
She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.
The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.
Published on April 12, 2019
Reviewed by Jacquelyn Ekern, MS, LPC on April 12, 2019
Published on AddictionHope.com