Can Marijuana Replace Opioids to Manage Pain?

By Temma Ehrenfeld  @temmaehrenfeld
September 19, 2023
Can Marijuana Replace Opioids to Manage Pain?

The legalization of pot around the country gave people in pain another treatment option. But does marijuana really help pain? Does it decrease painkiller use?

The nation’s growing acceptance of using marijuana as medicine is, like all big changes, an experiment. Pot is widely seen as a remedy for anxiety, although the results vary. Among older people, the biggest unaddressed medical problem is chronic pain.

Placebo-controlled research indicates that cannabis, the technical name, relieves pain mildly with few bad effects. But it’s not a strong case, according to the Centers for Disease Control and Prevention (CDC), which calls for more research. The best use of pot is for nerve pain.

In the meantime, some 68 million Americans are suffering and in need of a solution for their pain, according to a study of a survey of more than 10,400 U.S. adults. More than 20 percent reported that they had pain most days during the previous three months. Another 7 percent said they had pain that limits their life or work.


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Doctors have become more conservative when handing out opioid prescriptions to treat pain. In one study, orthopedic surgeons wrote 20 percent fewer opioid prescriptions under Medicare after states launched medical marijuana laws.

Yet it’s not clear that those laws — or laws that legalized recreational use — helped limit the opioid crisis. The CDC cites evidence that legalizing medical marijuana is not linked to fewer opioid-related deaths. It also states that using marijuana increases your chance of an opioid addiction.      

Chronic pain in America

Back in the 1990s, when millions of people in pain saw a primary care doctor, it was easy to get a prescription for an opioid painkiller like OxyContin. It wasn’t until 2016 that the CDC issued a guideline for primary care doctors, stating that there was insufficient evidence to back the usefulness of opioids long-term for chronic conditions like unexplained back pain. Along the way, some 3 million Americans became addicted to opioids.

That number may be underestimated. Other evidence suggests that as many as one in four chronic pain patients who take opioids develop a problem.

News about opioid use got scary. People who used opioids for pain became addicted. Recreational use of opioids increased. Doctors stopped prescribing the painkillers, as an opioid epidemic became apparent. Users turned to heroin and products poisoned with fentanyl, leading to more overdoses. Meanwhile, some people with pain who didn’t abuse opioids became scared of them, living without an effective treatment.

At the same time, legal marijuana became more available. About half of the nation’s adults can now legally use marijuana recreationally. Other states made it legal with a prescription.

(You can see details about your state’s laws here. For details on medical use by state, check here.)

But marijuana isn’t danger-free. Some 20 percent of regular users can develop signs of a disorder (for example, if marijuana interferes with your marriage or job performance). But research suggests that a moderate to severe problem occurs in just 1 percent of people who use it only for medical reasons. That number jumps to 7.5 if you use marijuana both for medical and recreational reasons.

Have states in which marijuana is legal avoided opioid overdoses and saved lives?

One study indicated that might be the case, but several others since then have said there is probably no relationship between marijuana laws and the number of opioid deaths. The CDC agrees.

It's true that prescription painkiller and marijuana use overlaps. Many people who found their painkiller wasn’t working started using marijuana, looking for relief. Combining the two does seem to help make pain more tolerable. These days, however, your doctor may not keep renewing a painkiller prescription for chronic pain.

If you have an opioid option, you might want to know whether people who use marijuana have less chance of an opioid disorder. The CDC reports that using marijuana combined with opioids may increase the risk of opioid misuse and won’t help you quit.

There’s also counter evidence. For example, pot smokers were less likely to encounter fentanyl, the dangerous synthetic that drug dealers dump into other products, in one study in Vancouver.

The researchers analyzed urine samples in 2016 and 2018, when Vancouver was hit hard by fentanyl overdoses. The samples came from 819 volunteers who participated in medicated opioid use disorder programs, a high-risk group. Some 47 percent of the volunteers who tested positive for marijuana were also positive for fentanyl, compared to 56 percent of those who didn’t.

Fentanyl in the volunteers’ urine probably meant they were using opioids on the side. The data suggests that the people who only smoked pot were more successful in their efforts to beat opioids — and, crucially, escaped fentanyl. But still — nearly half of them did use fentanyl.

Are marijuana laws helping or hurting public health?

The debate about whether marijuana will help fight the opioid crisis often focuses on how legalization will affect teenagers who aren’t sick. The evidence indicates that teen use hasn’t increased. But use among 19- to 22-year-olds has steadily increased. About 13 percent of them who aren’t enrolled in college use pot daily, according to a national study.

Meanwhile, the opioid epidemic is still taking a huge toll.

What you can do

If you have a chronic pain problem, talk to your doctor about your options. You also might have a candid talk with your doctor about your chances of becoming addicted to marijuana.

It is important to understand that medical marijuana hasn’t been scientifically tested to treat pain. Future prescription drugs may work on brain receptors that marijuana affects. That day hasn’t yet come. 

If you’re considering using marijuana to treat your pain, ask yourself hard questions about your record with alcohol and recreational drugs.

Have you ever driven when you couldn’t pass a breathalyzer test? Do you smoke cigarettes?

Addiction may have biological heritable underpinnings. Is your family full of hard drinkers, smokers, and binge eaters?  

It’s also true that people are more vulnerable to addictions during particular times in their lives. When you’re happy or feel in charge of your emotions, you’re less likely to let a drug interfere with your life. But you should be very careful about how you use substances of any kind when you’re depressed or angry.


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September 19, 2023

Reviewed By:  

Christopher Nystuen, MD, MBA and Janet O'Dell, RN