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Ask A Doctor – CBD & Opioids, CBD Dosing For Pain

CBD & Opioids
Written by Dr. Leah Zachar

Difference between how opioids and CBD work in the body

Question: I am on opioids to control my pain. I want to try the CBD form of cannabis because it does not make you “loopy”. What is the difference between CBD and opioids?

Answer: Opioids help control pain by stimulating a receptor in the spine called the µ receptor. Unfortunately, the longer you use opioids, the less effective they become in controlling pain. Thus, for a person who needs (for example) 30 mg of oxycodone at the beginning of treating the neuropathic pain, may soon find that he needs twice that amount a month later to achieve the same pain control because the opioid becomes less effective.

This is one of the main reasons many people become opioid dependent. CBD works in an entirely different way. It increases the person’s own pain relief hormones, otherwise known as “endocannabinoids” so that the person’s innate pain-control mechanism helps to control the pain. CBD also increases α3glycine receptors. These are in the spine and these receptors result in decreased sensation of neuropathic pain.

In other words, the pain you feel from the nerves, does not travel up to the brain where the pain is “felt”. Though the neuropathy is present, the pain from it is not “felt”. CBD decreases several of the body’s internal pain mediators, such as PGE2, lipid peroxide, and glutathione.

It does NOT bind to the µ receptor therefore CBD is not addictive. CBD, by helping to control pain, and because it does not work in the same area of the body as opioids, is an excellent agent to control pain, while simultaneously helping the person to reduce and eventually eliminate his opioid dependency. However, a word of caution, opioid should be tapered slowly to avoid the uncomfortable known withdrawal symptoms.

Cannabidiol and dosing for chronic pain

Question: How many drops of CBD oil should I take to treat my chronic pain?

Answer: What is important is not the number of drops, but the dose that you take. The dose in each drop of oil must be standardized. Thus, two drops of one brand of CBD oil might be five times as potent than the dose in another brand of CBD oil. Not all “oils” are same potency. Each company that produces cannabis must have their own internal audits to make sure that every “batch” they produce is the same potency as the prior “batch”.

CBD dosages and the duration for which they should be given vary with the disease and the patient’s pain threshold. The dose of CBD given to one patient may be inadequate for another patient with the identical disease. Generally speaking, For chronic pain, the dose of CBD can range from 2 ½ to 20 mg a day by mouth. For sleep disorders, the dose of CBD can range from 40 – 160 mg a day by mouth.

For multiple sclerosis, a mouth spray is often used. Each spray contains 2.7mg of THC and 2.5 mg of CBD per spray. The dose is 1 – 48 sprays /day and as many as 8 sprays/3 hours. ALWAYS remember, that when opioids are taken concurrently, the opioids should be tapered slowly.

Question: I have ulnar neuropathy and carpal tunnel amongst other chronic pain problems including fibromyalgia. How much CBD would I need to take to get relief from these problems?

Answer: The dose can range from 2 1/2 to 20 mg of CBD a day by mouth. Each person’s response to pain is different. All other meds you take must be considered when you start CBD. In general, start at low dose of CBD, and taper up from there. No one ever died from an overdose of cannabis which has been used since time immemorial. If you are taking opioids while using the CBD, the opioids should be tapered down slowly. As the CBD dosage is increased further, eventually you may be able to free yourself from opioid dependency.

Question: I’ve read that CBD oil dosing for chronic pain works best by dosing continuously to achieve a build-up of it in the system.

Answer: One thing I learned in medical school, and always told my medical residents – when it comes to any agent used for pain control that works centrally – meaning in the brain or spinal column always “start low and go slow”. The doctor has no way of knowing how sensitive a patient is to a medication that works centrally, therefore, start low and increase the cannabis or any other centrally acting analgesic that you are using gradually.

Question: Can CBD enhance the effectiveness of some medicines? Can CBD hamper other medicines?

Answer: CBD works well when given with other types of pain medication because CBD works at a different receptor resulting in a synergistic effect and lower dosages need to control pain. CBD is safe. It does not interfere pharmacologically with any other commonly prescribed pain medication and thus is without contraindications.

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If you liked these questions and answers and want more, why not check out the Q&A from the ‘Ask A Doctor – Migraines & Chronic Inflammatory Disease

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About the author

Dr. Leah Zachar

Dr. Leah Zachar, M.D. is a physician who worked for nearly thirty years in Internal Medicine.
She currently is a scientific adviser to CBD Testers. Dr. Zachar believes that there is much that medical cannabis, and cannabidiol in particular can offer to traditional medicine.