Jason Busse, DC, PhD: Do Cannabis, Opioids have a Role in Chronic Pain Management?

In the late 1990s, opioid prescribing for chronic pain peaked in North America alongside increased awareness of associated adverse events like overdoses, including fatal and non-fatal ones, and the emergence of opioid use disorder among chronic pain patients. This led to a quest for alternatives, notably therapeutic cannabis. The transition from opioids to therapeutic cannabis has become noticeable, particularly in the US, where therapeutic cannabis has become a prevalent alternative.

In an interview with HCPLive, Jason Busse, DC, PhD, professor in the Departments of Anesthesia and Health Research Methods, Evidence and Impact at McMaster University, discusses his upcoming 2024 CCR East presentation on the role of cannabis and opioids in managing chronic pain.

Research demonstrates modest benefits from both opioids and therapeutic cannabis, with about 1 in 10 patients experiencing a significant pain reduction with either treatment. Physical functioning and sleep quality also show improvement, although to a lesser extent. However, the impact on emotional, role, and social functioning remains negligible.

Concerning harms, opioids carry risks of fatal and non-fatal overdoses, with about 1 in 1000 experiencing a fatal overdose and 2 in 1000 a non-fatal one. Additionally, opioids pose a higher risk of developing opioid use disorder, affecting approximately 1 in 20 patients. In contrast, therapeutic cannabis risks include cognitive impairment, sedation, and gastrointestinal adverse events.

Busse explained that understanding the specific patient factors that influence benefits and harms is crucial. For instance, patients with a history of opioid overdose, alcohol use disorder, or mental health disorders are at increased risk of experiencing harm. However, identifying patients more likely to benefit from either treatment remains a challenge.

“They're not first line therapy, [although] they might be a reasonable option for people that have not found success with other approaches,” Busse said. “Shared decision-making is going to be critical to ensure that the decision whether or not to look at a trial of these interventions, is consistent with that patient's values and preferences.”

Disclosures: Busse has no disclosures to report.