A new study out of Great Britain suggests that medical cannabis may lead to improvements in health-related quality of life among patients suffering from chronic illness.
The study, published in the Expert Review of Clinical Pharmacology, analyzed 2,833 patients who are enrolled in the United Kingdom Medical Cannabis Registry. (The researchers said they excluded 443 patients from an original pool of 3,546 because they failed to complete their “patient reported outcome measures,” or “PROMs.”)
They wrote that the “study suggests that [cannabis-based medicinal products] are associated with an improvement in health-related quality of life in UK patients with chronic diseases,” and that treatment “was tolerated well by most participants, but adverse events were more common in female and cannabis-naïve patients.”
“This observational study suggests that initiating treatment with [cannabis-based medicinal products] is associated with an improvement in general [health-related quality of life], as well as sleep- and anxiety-specific symptoms up to 12 months in patients with chronic illness … Most patients tolerated the treatment well, however, the risk of [adverse events] should be considered before initiating [cannabis-based medicinal products],” the researchers wrote in their conclusions.
“In particular, female and cannabis-naïve patients are at increased likelihood of experiencing adverse events. These findings may help to inform current clinical practice, but most importantly, highlights the need for further clinical trials to determine causality and generate guidelines to optimize therapy with [cannabis-based medicinal products],” they added.
Medical cannabis was legalized in the United Kingdom in 2018, but it can only be prescribed when other licensed medications have failed to produce an adequate response.
That limitation was the impetus for the researchers to conduct the study.
“Since 2018, cannabis-based medicinal products (CBMPs) can be prescribed in the United Kingdom by specialist doctors for chronic illnesses where there has been insufficient response to licensed medications,” they wrote in the introduction of the study, which was published online earlier this month.
“However, the National Institute for Health and Care Excellence currently only recommends CBMPs for intractable chemotherapy-induced nausea and vomiting, spasticity in adults with multiple sclerosis, and severe treatment-resistant epilepsy in Lennox-Gastaut and Dravet syndromes,” they continued. “The reason for these narrow recommendations is that current evidence is limited and of low quality.”
Specifically, the researchers said there is “a paucity of randomized controlled trials, due to the challenges of investigating CBMPs in this setting.”
The findings mesh with another study published in January that found a growing number of patients across the United States turning to cannabis to treat their chronic pain.
That study, from researchers at the University of Michigan, found that “31.0% … of adults with chronic pain reported having ever used cannabis to manage their pain; 25.9% … reported using cannabis to manage their chronic pain in the past 12 months, and 23.2% … reported using cannabis in the past 30 days,” and that “more than half of adults who used cannabis to manage their chronic pain reported that use of cannabis led them to decrease use of prescription opioid, prescription nonopioid, and over-the-counter pain medications, and less than 1% reported that use of cannabis increased their use of these medications.”
“Most persons who used cannabis as a treatment for chronic pain reported substituting cannabis in place of other pain medications including prescription opioids. The high degree of substitution of cannabis with both opioid and nonopioid treatment emphasizes the importance of research to clarify the effectiveness and potential adverse consequences of cannabis for chronic pain,” the researchers wrote. “Our results suggest that state cannabis laws have enabled access to cannabis as an analgesic treatment despite knowledge gaps in use as a medical treatment for pain. Limitations include the possibility of sampling and self-reporting biases, although NORC AmeriSpeak uses best-practice probability-based recruitment, and changes in pain treatment from other factors (eg, forced opioid tapering).”
We all know that pharmaceutical pain medications are much stronger than nearly anything you can find in nature. There’s no comparing cannabis, cloves, or magic mushrooms to powerful drugs like fentanyl and isotonitazene. So why are a growing number of people turning away from opioids in favor of milder treatment options? Aside from obvious safety issues with the former, the answer to that lies in part in how we, as a society, view pain in the first place.
Is pain something that should be immediately and completely masked, or are there some healing components to allowing our bodies to feel discomfort? Is our culture of hiding from anything that feels bad, keeping us in a perpetual state of illness?
Pain & pain medications throughout history
Pain is not a condition in and of itself, but rather a symptom of many other diseases or disorders, indicating something is wrong with our bodies. Pain is incredibly complex and can vary significantly between people, even those who share similar illnesses or injuries. Pain can also range in severity, as well as in the way it’s felt. Some variations of pain can include pricking, tingling, stinging, burning, soreness, aching, and many other unpleasant sensations.
The entire spectrum of pain consists of hundreds of different types of disorders and syndromes. For instance, you can experience pain following an injury, or chronic pain related to aging. Pain can also be neurological, like migraines. Heart attacks, cancer, and childbirth all cause different forms of pain. When it comes to clinical diagnoses, healthcare providers typically group pain into one of two categories: acute or chronic. Acute pain comes on suddenly and intensely, and is usually the result of a traumatic injury or surgery.
Chronic pain persists over a longer period of time, and can be difficult to manage. Chronic pain affects very 50 million American adults, and it’s one of the most common reasons people seek medical care. Although some medical professionals consider chronic pain to be its own medical disease, there is always an underlying cause.
Again, pain is our natural warning sign that something is not right. The purpose of feeling pain is to change our course of actions – be it limiting certain activities, eating different foods, doing certain exercises, and so on. It’s remarkably specific in letting us know what activities will further aggravate an area, and in preventing us from doing said activities.
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What the research says
Pain is something that has long-confused physicians, so in an effort to better understand it, they started tracking their patients’ discomfort at all times. For a while, pain was even referred to as “the fifth vital sign”, officially declared so in 1999, but the move was met with great controversy and continues to be a point of contention in the healthcare industry to this day.
Regardless, the goal was for doctors to take more cognizance of pain because it can be an important factor in determining the overall health and mental state of a patient. The problem was that, the quest to gain a better understanding of pain eventually turned into a mission to mask pain entirely, not necessarily treat its root causes.
Some issues come along with pain medications, the most obvious being that if you don’t feel any pain, you may not take the correct actions to manage and heal your ailment, leading to further injury. Another problem that is rarely discussed, is the role of pain management medications in the actual treatment of pain. For a long time, it was commonly believed that pills helped, but recent studies show that many frequently used pharmaceuticals actually hinder the healing process.
It is well established in scientific literature that NSAIDs can impede the healing of broken bones, damaged ligaments, and other musculoskeletal tissues. Many surgeons many avoid suggesting or prescribing these medications because of the growing concern in how they negatively impact callus formation and decrease the activity of COX isoenzymes that decrease the synthesis of prostanoids.
Another drug of great controversy – opioids. How much are these incredibly dangerous drugs that have caused hundreds of thousands of overdose deaths over the last decade, even aiding in the healing process? Short answer, not very much at all – according to recent studies.
A study published in 2017 found that patients who were treating wounds with opioid doses over 10mg per day exhibited slower rates of healing than patients who took less than 10mg or none at all. Other studies have also suggested that opioid use may negatively impact wound healing by reducing immune activation, impacting tissue oxygenation and angiogenesis, and altering myofibroblast recruitment as well as impacting keratinocyte cytokine production, endothelial proliferation and angiogenesis.
Other drugs that can slow wound healing are cytotoxic antineoplastic and immunosuppressive agents, corticosteroids, and anticoagulants. Additionally, all drugs in the pain relief category can theoretically interfere with healing by masking pain and thus allowing you to continue to hurt yourself without immediately realizing it.
My personal experience with pain & pain medications
To not sound completely tone-deaf here, I do understand that certain levels of pain can make life unbearable. I’ve been blessed in not having to experience chronic, debilitating pain personally, but I have had a handful of injuries and surgeries in my life that left me in pain or discomfort for a few weeks to a few months at a time.
I also suffer from frequent migraines and cluster headaches, which come on strong and fast. Normally, I try to take it easy, drink a lot of water, eat food, and avoid smoking until it goes away. Admittedly, I’ll pop an Excedrin occasionally if I don’t have time to tend to naturally, but I try to avoid that as the regular use of any acetaminophen-based drug can cause significant damage to the body, particularly the liver.
Right now, I’m drawing from my experience of giving birth, comparing how it went when I received epidural versus a natural birth. First, it’s important to note that babies whose mothers receive an epidural are more likely to develop respiratory distress syndrome once the child is born. Epidural anesthetic is sometimes combined with opioid drugs as well, which can cross the placenta and add to the risk of developing respiratory depression.
Babies who have are exhibiting such problems likely end up going to the hospital’s neonatal intensive care unit (NICU). While staying in the NICU may not seem harmful on the surface, it means that mother and baby are separated immediately after birth. And when you use epidural, you can’t move your legs for a couple of hours after giving birth, so if the baby is not in the same room with you, that’s even longer spent away from them during their first moments on this earth, and this can have profound effects on the emotional and physical well-being of both baby and mom.
This is what happened to me when I gave birth to my first son with epidural. The labor was about 10 hours, I had to be put on oxygen at numerous points during the process, and my baby was born with some breathing issues that made it difficult for him to breathe through his nose while eating. He was taken to NICU right away, but even while there he had issues for a couple of weeks. At one point during a feeding, he stopped breathing completely for a few seconds and turned blue, it was the most terrifying thing I’ve ever experienced.
Were these issues causes by the epidural? It’s hard to say, but very possible. Especially when comparing that ordeal to the birth of my second son, which was done completely naturally. No problems during the labor which last less than one hour from start to finish, baby had absolutely no issues, and we were discharged in about 1 day.
In my opinion, that’s very telling of the types of complications that can arise when unnecessary medical intervention is at play.
Pain medications – Final thoughts
Pain medications and pain management is a complicated and sensitive subject for many people, patients and medical professionals alike. Pharmaceuticals have their place in modern medicine, but it’s important to take a closer look at their overall role in treating pain over the long term. These recent discoveries place greater importance on treating the root causes of pain, in order to get patients off their medications as quickly as possible.
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Opioid use is out of control in the US, and for many addicts, the whole awful ride started with a legitimate pain issue. So, what to do when it’s your treatment that causes your problem? Maybe, find a better treatment. A new study backs up that ketamine during surgery can lessen the need for opioids to manage pain after. Read on to find out more about this, and why ketamine should immediately replace the drug which is killing close to 100,000 people a year.
This was not a study that involved finding test subjects and having them participate in clinical trials. This study, like many put out today, was done by reviewing previous research to find connections. This method of research must be taken with a grain of salt, as there are no controls, and the study writers have nothing to do with data collection. Even so, though these studies are often thrown together in what seems like a haphazard manner for the purpose of gaining headlines, (often off of misguided, misquoted or misused research), they often do provide some insight, like the study I’m talking about now.
The study, entitled A Systematic Review of the Efficacy and Safety of Ketamine in Total Joint Arthroplasty evaluated data from studies found via the databases: MEDLINE, Embase and Cochrane Central Register of Controlled Trials. The intended purpose was to evaluate how safe and useful ketamine is in primary hip and knee replacement cases; in order to support the combined clinical practice guidelines of different medical associations.
Studies included were published before 2020, and on the subject of total joint arthroplasty treatment. According to the study, “All included studies underwent qualitative assessment and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of ketamine. After a critical appraisal of 136 publications, 7 high-quality studies were included for analyses.” In total, four studies showed intraoperative ketamine as superior to placebo for pain relief after surgery, while three studies didn’t find a significant difference compared to placebo.
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Six studies were analyzed for postoperative opioid use, and of them, five came to the conclusion that intraoperative ketamine allowed for less overall opioid intake after the operation, though the last one did not find a significant difference in comparison to placebo. Four studies also looked at complications, and in those studies it was found that versus a placebo, ketamine brought down the instances of postoperative nausea and vomiting.
In the write-up, researchers state: “Intraoperative intravenous ketamine reduces postoperative opioid consumption and may reduce postoperative pain and nausea and vomiting after primary TJA… Ketamine administered intraoperatively is safe but may increase the risk of postoperative delirium and hallucinations, particularly among elderly patients after TJA.”
Implications of the study
The term ‘intraoperative ketamine’ refers to ketamine used during an operation, not before or after. So its not a study looking at pain management of ketamine versus anything else. Rather, it looks at the outcome of using ketamine vs other medications during an operation. The term ‘arthroplasty’ refers to the replacement of a joint, like hips or knees.
In this process, an artificial joint is put in place of a damaged joint. Though sometime just one part is replaced, it’s very often the entire joint. All studies in this evaluation were done on participants with total joint replacements. Total hip arthroplasty is referred to as THA, total knee arthroplasty is referred to as TKA, and total joint arthroplasty is referred to as TJA.
One of the implications of the study, is that the use of ketamine during an operation, can have a lasting benefit after the operation. Enough so that less opioid medication is then needed to manage pain. This implies that effects of the ketamine go on for a significant period of time.
After all, a medication that simply wears off, requires something new to be taken to counter pain. Think of how much pain is involved with having your hip or knee torn out, and a fake one put in. That’s exactly what’s happening, and it would be extremely difficult to get rid of postoperative pain considering the magnitude of the operation.
However, if the ketamine used during the operation, can create a benefit wherein patients don’t require postoperative opioids – (or less of them), this speaks volumes to the ability of ketamine to bring down the opioid problem. Keep in mind, if its shown to bring down post-operative opioid use for joint replacements, chances are that this is the case for other surgeries as well. And the implication to that is huge, especially in a country (and world) with an increasing problem with opioid deaths.
How big is the problem with opioids? Preliminary overdose numbers for 2021 put deaths at over 107,000 according to the CDC, for the US alone. No number was given for synthetic opioid overdoses specifically, but we can know that the number is high, and takes up the majority of the deaths. We know that because this is a trajectory we’ve been looking at for a while. In 2020, overdose deaths totaled over 93,000, with over 68,000 attributed to opioids. In 2019, the overdose total was approximately 73,000, with around 48,000 earmarked as opioid deaths.
Can ketamine bring down opioid use for pain?
If you’re on opioids because you like how they make you feel; it probably doesn’t matter to you how they affect pain. If you’re on them because you had a pain issue that since resolved, but led to an addiction in the process; it also probably won’t matter to you if ketamine is a better option for pain relief. But if you’re taking opioids to deal with a pain issue now, and that pain issue keeps you on the meds; then this information is much more relevant.
There are two interesting aspects of ketamine. The first is that it treats both acute and chronic pain, but without lowering breathing and blood pressure rates. Opioids depress the central nervous system, and overdose occurs when the body can no longer handle the downer effect; which is an issue because of tolerance to other effects. As ketamine can treat pain without the same kind of depression to the CNS, its not associated with overdose deaths. To the point that there really is no death toll. This isn’t to say no one was ever hurt with ketamine, but the numbers are so negligible, they’re nearly impossible to find.
The other interesting thing about ketamine for pain, is that it lasts well after the treatment. And I don’t mean for 4-6 hours. According to research, it can last for weeks at a time, possibly even months. This is similar to the same thing seen with ketamine treatments for depression and other psychological issues. After however many initial sessions it takes, the effects can last weeks to months for those who do respond. Can opioids do that? Not a chance. One of the big issues with opioid addiction, came from the initial lies around Oxycontin lasting a particular amount of time, which it actually rarely did.
If all of this sounds like not what you’re used to hearing, check out the research yourself. Like this 2020 reviewKetamine vs Opioids for Acute Pain in the Emergency Department, or this 2018 review, A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department, or this 2019 research entitled Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial. All of these show how ketamine gives opioids a run for their money when it comes to treating acute pain.
In terms of chronic pain, this reviewKetamine for chronic pain: risks and benefits, from 2014 shows that after initial infusions, effects can last for up to three months. And this review from 2019 backs up the idea that pain relief is continuing after infusions, though it found a shorter period of up to about eight weeks max. In both these reviews for use with chronic pain, ketamine showed an ability on par, or better, than opioids for actual pain relief; with the benefit of continued effects well after treatment. And all this without the threat of addiction or death.
This new study backs up, in a roundabout way, that ketamine has a long-lasting effect. It strongly implies that ketamine used during a surgery, can influence the need for pain medication after surgery. To the point of lessening the need for opioid medications in postoperative care. Perhaps in the coming months to years, we’ll hear way more about this, and how ketamine in general, can replace the use of synthetic opioids for pain control.
The opioid situation is insanely awful, especially when considering it doesn’t have to happen. What all this research shows, more than anything, is that we’re continuously told the wrong story. And in continuously telling it wrong; more people die.
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There are different pain options out there, though the big issue right now is the growing opioid epidemic. Counter to this, an entire ketamine industry is flourishing in the gray market to help people deal with their pain (among other issues). And another front-runner in this battle is medical cannabis. In a recent study, it was found that medical cannabis use brought down opioid (and other medication) use in participants, in 79% of the population studied.
Details of the study
Published earlier this year, the studyMedical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use looks at self-reporting of pain patients to establish the effects that medical cannabis has on other pain medication-taking. According to the research team, “The purpose of this cross-sectional observational study was to identify and report on the characteristics, ailments, and medical cannabis usage of Florida medical cannabis patients, as well as their perceptions of pain medication use and health functioning after legalized access to medical cannabis.”
Investigators looked at it from a few different standpoints, “(1) characterize the demographics and use patterns of participants who had physician-approved medical cannabis access, (2) to provide information on patient perceptions of changes in health functioning after initiation of medical cannabis use and (3) examine participant perceptions of the effects of medical cannabis access on their use of OBPM (opioid based pain medication)”
In order to do this, researchers recruited 2,183 patients from medical dispensaries across Florida, and administered a questionnaire of 66 questions. The survey took into account demographics, health of participants, current use of medicines, “along with items from the Medical Outcomes Survey (SF-36) to assess health functioning before and after cannabis initiation.”
95% of participants were between the ages of 20-70 years of age. The majority were female at over 54%, 85% were white, and only 47% were employed. ~61% reported that prior to using medical cannabis, they were using other pain medications. All participants were in fact registered medical marijuana users in the state of Florida.
The majority, 79%, claimed a reduction in other medication usage, or completely stopping other medications. 11.47% reported improved functionality. Of the people in the study, 49.92% had complaints of both pain and some form of mental health issue, while just over 9% were solely concerned about pain.
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How did these people use their medical cannabis?
When looking at self-report studies, it means there isn’t a specific testing regime. In some studies, participants are given a specific amount of a specific medication. Or their behaviors are watched within a lab setting. In a self-report study, it’s more about investigators essentially taking a look at what people are doing outside of a lab setting. This means there can be great diversity in behavior, even when its about the same thing.
Researchers found that participants all used medical cannabis in their own ways, though the majority did use it daily. 54.99% not only used it daily, but used it many times throughout the day. A smaller 24.55% used it daily, but not as frequently throughout the day; 9.72% used daily, but only 1-2 times per day; and 8.66% used it daily, but only in the evenings. In terms of how necessary they saw their own use, 60.60% thought they had it right on the nose; while 7.21% thought they might be overusing a bit. 12.22% thought they could possibly use an increase.
In terms of how long these participants had been medical marijuana patients, a small number were long time users of 10 years or more – 7.86%, though the majority had used for less time. 65.10% had used it for one year or less, and 20.99% had been using it for 1-3 years. 90.59% reported medical cannabis as positively effecting their ailments. Less than 2% of participants reported it either didn’t work well, or it didn’t work at all. 88.67% put a high importance on medical cannabis for their quality of life.
Since researchers wanted to compare how life was before and after initiation of medical cannabis, they assessed health functioning and limitations from health issues, prior to starting and after starting. The largest responding group said they improved, or stayed the same (due to a disability). Although some did report the lack of improvement, at no point was it ever a majority that a symptom worsened, although in some cases, this was indeed reported.
Categories where there was a lot of improvement, included ‘physical functioning’, ‘bodily pain’, and ‘social functioning’. After analysis, all categories “indicated significant differences after initiation of medical cannabis use, with all health functioning domain scores showing significant improvement.”
Did medical cannabis really help decrease opioid usage?
At a time when opioid use and overdose deaths are out-of-control, it becomes extremely important for pain patients to have options that are less likely to get them addicted, or result in an overdose death. In 2021 alone, the CDC reported preliminary numbers that put the drug overdose rate at about 107,000. Though this accounts for all drug classes, we know that the grand majority were likely opioid-related. We know this because of the over 93,000 deaths in 2020, over 68,000 were from opioids, and of the ~73,000 overdose deaths of 2019, about 48,000 were synthetic opioid-related. So it stands to reason that a pretty large chunk of the most recent number, is also due to opioids.
At the crux of this issue is a system that continues to allow the problem to fester. Not only has the government done nothing to stop this industry, it continues to promote it through regulation. In fact, earlier this year it proposed to loosen guidelines for prescribing, rather than tighten them; though it should be mentioned that these guidelines have no legal value to begin with. As this is a case of the doctor being the dealer, it makes it that much harder to treat, since the very doctors expected to be looking out for patients, aren’t. And this makes the application of other options, like medical cannabis, not just important, but extremely necessary.
So what did this study turn up in terms of the ability to get patients to use less opioids and other standard pain medications? Prior to medical cannabis initiation, 36.82% were using hydrocodone-acetaminophen; 26.78% were on oxycodone-acetaminophen; and 10-20% reported use of oxycodone, hydrocodone, and codeine by themselves. After medical marijuana use started, the number of patients using opioid medications dropped to under 7.5%.
The medications that had been used the most, were reduced a much as 5X. For example, those using hydrocodone-acetaminophen went down to 7.31% from the original 26.78%, while use of oxycodone-acetaminophen, went down to 4.78%.
Analyses showed that not only were less people using, but they were also using less. As per researchers, “The paired t-tests also showed the same pattern, the mean number of uses for each medication after medical cannabis initiation was significantly lower than before, and the same finding was seen for the mean of the total number of different medications.” They continued, “The average number of those who reported using none of the listed medications was also significantly higher than before.”
So, 60.98% reported using opioids before starting medical cannabis. 70.54% of that number had been on such medications for two or more years before initiating medical cannabis treatments. 93.36% of the previous opioid users reported some sort of change to their standard medication regimens once starting medical cannabis. A majority of 79.25% reported that they substantially reduced the amount of medications taken, or stopped all other medications entirely. 11.47% said they functioned better because of being able to decrease their opioid usage.
While its not a huge percent, it is of note that 2.71% said they stopped all other pain and psychiatric medications. Only 1.77% simply added on the medical cannabis without making other changes. And whereas 4.80% couldn’t be categorized, no one indicated a greater use of other medications after beginning medical cannabis treatments.
This is not the biggest study out there, but the results are rather profound, especially if similar investigations can turn up similar results. The most interesting aspect of a study like this, is that it shows how much patients want to make changes, especially in the way of getting away from more harmful medications.
However, this understanding does come with the caveat that all these participants were looking for another option. They were found in medical dispensaries, after all. It could be that such a population represents the people that medical cannabis can help, while cutting out those who didn’t have as good of an experience and didn’t return to the dispensary for more medication. To know more, we need more research. For now, however, a study like this provides a strong indication that medical cannabis can greatly help those in pain, and that it can help to steer people away from the opioid drugs claiming so many lives.
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As overdose rates rise, governments seem more willing to loosen drug restrictions, than to find actual workable solutions. Opioids are responsible for the biggest number of these deaths and the numbers only grow more each year. What if a possible answer already exists, and we’re simply not being told about it? When it comes to opioids, the issue of pain is integral, and the question of ketamine vs opioids for modern treatment, is a thing. So how does ketamine compare to opioids for pain management, and can it be a substitute?
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Opioids and the overdose toll
We’ve been talking about it for years now. How every year more and more people overdose on drugs, with the grand majority doing so on synthetic opioids. Opioids are a class of synthetically made drugs based on the opium plant. These are unlike the natural components taken out of the plant which are called opiates. Opiates are compounds like codeine or morphine. Opioids are represented by drugs like fentanyl and oxycodone.
Opioids attach to receptors in the central and peripheral nervous systems, and in the gastrointestinal tract. There are three main opioid receptor classes: μ, κ, δ (mu, kappa, and delta), though a total of 17 are known. Opioids are primarily used as pain relievers and anesthetics. They are also prescribed medically for issues like diarrhea and cough suppression.
Users experience an intense euphoria on opioids, which often leads to a sedation and a semi-unconscious state. Opioids are respiratory depressants, which is the main reason they cause so many deaths, as its easy to overdose on them. This happens a lot when tolerance to the euphoria or pain-killing effects increases, leading users to need more and more to get high. Other effects of the drugs include itchiness, nausea, confusion, and constipation.
Opioids can be deadly on their own, but become that much more dangerous when mixed with other drugs, particularly other drugs with a depressant effect. It’s common for overdose victims to have drugs like alcohol or benzodiazepines in their system as well. Alcohol is commonly mixed with other drugs (probably because of its own prevalence in society), and benzodiazepines are often used with opioids to combat the sickness they bring on.
In terms of where we are with overdoses, the latest numbers come from a CDC release on May 11th, 2022. These preliminary numbers show an overdose total of 107,622 for the year 2021. This number includes all drug overdose deaths, with no specific number given for opioid deaths. How do we therefore know the majority are opioid related? Well, we know that in 2020 there were 93,000 overdose deaths, and that there were 73,000 in 2019. We also know that of the 73,000 from 2019, 48,000 were from synthetic opioids, and that 68,000 of 2020’s numbers were related to synthetic opioids as well. It stands to reason that well over 70,000 of 2021’s overdoses, were due to these medications.
One of the big problems with the current crisis, is that its not just about getting people off of a drug they’re addicted to, but providing an ongoing way to handle the issue that got them addicted in the first place. If people are experiencing pain, and using opioids to treat their pain issue, it’s hard after acclimation to a working treatment, to not offer something else. Perhaps if a patient is never given such a medication, they may be fine without it. However, after acclimating a patient to a medication, it can create a situation where they now need it and its expected effects.
Obviously, people have undergone and withstood extreme pain for millennia without the help of synthetic opioids, so there is really no case to continue their use under the circumstances of their danger. However, the question of how to get people off these highly addictive medications still remains. And one of the best answers, is sadly not only not being used, but is barely mentioned at all. And this despite the skyrocketing death toll.
Ketamine is a dissociative hallucinogen created by Parke Davis Pharmaceutical company in 1962 and cleared by the FDA for use as an anesthetic in 1970. Though it was understood from preliminary testing on prisoners that ketamine could treat acute pain, and without the death toll of drugs like opioids, the FDA never officially cleared it for this purpose. It was, however, subsequently used on the fields of Vietnam, if this is any indication of its actual abilities.
Ketamine is legal for off-label use, and this has spawned a gray-market ketamine industry, whereby ketamine is prescribed and administered by doctors in medical clinics. In these settings, the ketamine is used for any purpose the prescribing doctor sees fit, and has become a new mainstay for the treatment of both pain, and psychological issues like depression.
Ketamine vs opioids
Alright, so they’re both painkillers, but the most important question in the conversation of ketamine vs opioids, is can ketamine work for the same things? After all, it wouldn’t make sense to try to replace one drug, with another that can’t help in the same way. Luckily, there is already research into this exact question, and the results look promising for ketamine use in place of opioids.
In 2020 a review was published called Ketamine vs Opioids for Acute Pain in the Emergency Department. The review looked at 870 adult patients who ended up in emergency rooms with acute pain. In all cases the pain could have been trauma or non-trauma related. The patients came from two meta-analyses, in which 11 trials were done in total. Pain measurements were made using the VAS – Change in Visual Analog Scale.
Of the two meta-analyses, Karlow et al. contained trials that directly compared “a sub-dissociative intravenous dose of ketamine with a single IV dose of opioid/opiate analgesia.” While ketamine was related to more adverse effects (e.g. agitation, hallucination, dysphoria, and confusion), the only life-threatening event was associated with morphine.
The other main part of the review came from the Ghate et al. systematic review which compared “low-dose ketamine with opioids in adults with acute pain in the ED.” The eight studies looked at included a total of 609 patients. The review found that “Both low-dose ketamine (dose range: 0.1-0.6 mg/kg IV/SC/IM) and morphine (dose: 0.1 mg/kg IV or 0.5 mg hydromorphone IV) appeared to provide some level of analgesia in individual studies (compiled data was not reported), but no significant difference was demonstrated between the two agents.” This review also found more adverse effects with the ketamine, but nothing life-threatening.
Between these two separate reviews, the authors concluded that “ketamine appears to be comparable to opioids for acute pain control.” They did stipulate that there were several limitations to the studies done, including comparing single doses rather than longer term treatment. They end by saying more research into the matter should be done.
As emergency rooms are a great place to try out pain medications, yet another emergency room piece of research backs up the efficacy of ketamine in comparison to opioids. A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department, looked at whether low dose ketamine is a safe and effective alternative to opioids in an emergency situation. The review covers randomized controlled trials which compare intravenous opioids to low dose ketamine.
As per the usual, more adverse reactions were seen with ketamine treatment, but none were deadly. The authors concluded “Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short-term pain control.”
Another interesting piece of research came out in 2019, and is called Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial. The study examined intranasal ketamine vs intranasal fentanyl, specifically in children with pain in their extremities. The study included 90 children, half of whom were given ketamine, and the other half fentanyl.
Study authors found “Ketamine was noninferior to fentanyl for pain reduction based on a 1-sided test of group difference less than the noninferiority margin.” As with previously mentioned studies, there were more adverse effects in the ketamine group, but all effects were minor and went away quickly. The study authors concluded:
“Intranasal ketamine may be an appropriate alternative to intranasal fentanyl for pain associated with acute extremity injuries. Ketamine should be considered for pediatric pain management in the emergency setting, especially when opioids are associated with increased risk.”
What about chronic pain?
Emergency rooms are a great example of looking at the comparison of ketamine vs opioids for acute pain issues. But what about ketamine for chronic pain? Acute pain represents pain that’s intense and happening right now. Chronic pain denotes a pain issue whereby pain is experienced on a long term basis. Think of the difference between the pain of a standard broken arm, and pain from an ongoing bad back.
One of the interesting things found in this review, Ketamine for chronic pain: risks and benefits, is that ketamine treatment for at least some kinds of pain, can last way past the time of treatment. In fact, the review, which references several studies, says “Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion.”
They conclude, “Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain.” Though the authors make a good point about needing more info, in this study, as per the rest, all adverse reactions were minimal. The main issues of concern brought up were around “CNS, haemodynamic, renal and hepatic symptoms,” though how much of an issue these actually are, is not very clear. Deaths did not come up at all.
Though indeed more research should be done, that several investigations have turned up this ability for such long-lasting effects from shorter treatment regimens, is not only incredible in general, but makes ketamine that much more of a better option vs opioids in the current situation. While we don’t know the extent that ketamine can do this, we do already know for sure that opioids will never last longer than the immediate time frame they are given in.
Another systematic review, Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials investigated “the effectiveness of IV ketamine infusions for pain relief in chronic conditions”, in order to “determine whether any pain classifications or treatment regimens are associated with greater benefit.” To do this, the researchers used Medline, Embase, Google Scholar, and clinicaltrials.gov to gather information. They used “randomized control trials comparing IV ketamine to placebo infusions for chronic pain that reported outcomes for ≥48 hours after the intervention.”
The results? Three of the seven studies usable for the review showed “significant analgesic benefit favoring ketamine, with the meta-analysis revealing a small effect up to 2 weeks after the infusion”, backing up the idea of long-term effects from short-term use. They also found “In the 3 studies that reported responder rates, the proportion with a positive outcome was greater in the ketamine than in the placebo group.”
According to the authors, “IV ketamine is effective for a wide array of chronic pain conditions, although the benefits dissipate with time.” How long? “Use of IV ketamine resulted in a reduction in pain scores between 48 hours and 2 and 8 weeks after the infusion, but the pooled difference in pain reduction at 4 weeks fell shy of significance.” As in, on average, the effects lasted up to about four weeks, but became less significant at that point. When you think about it though… up to four weeks of chronic pain relief with a non-lethal option, sounds pretty damn awesome. Especially in the current situation.
There’s still plenty to learn, and plenty to research, but when it comes to ketamine vs opioids, one of the most important things to consider, is that one causes mass death, and one doesn’t. Evidence shows ketamine as noninferior in terms of both acute pain and chronic pain, and unlike with opioids, it has the ability to reduce pain for weeks after administration, at least in some cases. What with the awfulness of the opioid epidemic going on, once again I have to ask, why isn’t ketamine being substituted for opioids, immediately!?
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When a title like this comes along, it’s enough to make your stomach drop. Amid constant talk of a growing opioid epidemic, which is now said to be responsible for the vast majority of 100,000 completely avoidable deaths a year, the CDC actually wants to make it even easier to get opioids by loosening prescription requirements. If you still have faith in your government to do what’s right by you, maybe now’s the time to take a harder look at that sentiment.
It is a mind-boggling level of insanity that the US government via the CDC wants to make it easier to get opioids amid the biggest drug crisis it’s ever dealt with. But that’s how much it cares about our collective health, as it does this in the face of better options like cannabis, ketamine, and the Zingiberaceae class of plants. We’re on top of this industry and everything that goes on it it. Sign up forTHC Weekly Newsletterfor more stories like this, as well as exclusive access to deals on flowers, vapes, edibles, and tons more products. Plus, we have excellent prices on cannabinoids, including HHC-O, Delta 8, Delta 9 THC, Delta-10 THC, THCO, THCV, THCP & HHC, which won’t break the bank. Check them out in our “Best-of” lists, and enjoy!
It’s in every publication, it’s in tons of titles, and the result of it can really be felt. Opioids have become a horrifying (and embarrassing) mistake by the federal government, which has spiraled out to such degrees, that dozens of people are overdosing every day, making for incredibly high death totals. And this isn’t the coronavirus, which is expected to leave a death toll. These deaths, every single one of them, are completely avoidable.
Opioids are a class of drugs that come from, or are based on, compounds from opium, which can be found in poppy plants. They can appear naturally in nature, like morphine and codeine, which can be extracted from opium. Or synthetically, like hydrocodone and fentanyl. Even naturally occurring versions like codeine are still bought in synthetic form when purchasing opioids from a pharmacy. Opium is often turned into the street drug heroin through processing.
Opioids bind to opioid receptors in the central nervous system, the peripheral nervous system, and the gastrointestinal tract. Though they can bind to many receptors, the three main classes for this are μ, κ, and δ (mu, kappa, and delta) receptors. Opioids are best known, and most used, for controlling pain, but are also used medically for cough suppression and diarrhea. Users on opioids are prone to side effects like itchiness, sedation, nausea, constipation, respiratory depression, and euphoria – the main reason for their addictive quality.
These drugs produce a strong tolerance in users, meaning the dosage must increase to gain the same effects. Opioids are incredibly physically addictive, meaning a habitual user will likely go through a painful withdrawal when stopping. They are often used in conjunction with benzodiazepines to minimize feelings of sickness, and this can help lead to fatal overdoses.
Drugs like heroin are Schedule I in the DEA’s Controlled Substances list, but opioids are prescribed and sold medically under Schedules III, IV, and V. This makes them all more federally accessible than cannabis, which despite all the dangers of opioids and benefits of cannabis, remains in Schedule I.
News: The CDC wants to make it easier to get opioids
This opioid issue has been going on long enough that in 2016, the CDC instituted guidelines on prescribing for opioids. However, in what looks like a total turnaround, and rejection of any care about the current and growing problem, on Thursday, February 10th, 2022, the CDC actually proposed loosening guidelines for doctors prescribing opioids. And this even though the more strict 2016 guidelines obviously didn’t help make the problem any better. So why is the CDC doing this now in light of the current situation with opioids?
Because they’re saying that by doctors prescribing less (they didn’t), doctors have been cutting off patients who need opioids to deal with their pain, prematurely. Which is odd considering the CDC doesn’t regulate these things, and this news story, along with previous guidelines, are not about legal changes. They’re essentially no more than statements, but they’re statements that show a trajectory of thinking, and that’s why they’re dangerous.
These newer CDC guidelines repeat the 2016 guidelines in saying that “opioids should not be considered first-line or routine therapy for subacute or chronic pain”, as well as some acute pain. They also restate that doctors shouldn’t prioritize opioids over non-opioid treatments including things like exercise and physical therapy. This is great! But since it’s already the current situation, it’s also obviously not doing anything to have that in the guidelines.
What did change? The whole stipulation that doctors should avoid making increases to medication in the amount of 90 morphine milligram equivalents or more per day. The thing is, if you’ll notice the language, that was never a rule, just a recommendation (since the CDC is not the regulating body). And considering how little doctors have been paying attention to these guidelines anyway, it almost doesn’t matter beyond being a major slap in the face to show this kind of thinking, especially in light of what’s currently going on.
What was it changed to? The much broader statement of: “clinicians should prescribe the lowest dosage to achieve expected effects.” Gone also is the recommendation (still wasn’t a law) for timelines for these prescriptions. The prior guidelines stated that “three days or less will often be sufficient; more than seven days will rarely be needed.” This would not exist anymore, which could promote doctors putting patients on opioids endlessly.
Of course, whereas its often stated that “the guidelines were resulting in physicians unsafely tapering patients or cutting patients off entirely — in part because of the specific dosage benchmarks included in the guidelines”, the growing number of overdoses, the high number of prescriptions written, and the fact that they’re still being prescribed en masse by primary care physicians (who are not supposed to write such prescriptions), essentially points to this being nonsense.
This update would be one of many proposed changes that came out as a 229-page draft which was updated to the Federal Register. There will now be a 60-day public comment period. The CDC will consider all this before finalizing updates. As none of this is law, it doesn’t make a huge difference except to show a general intent of the governemtn. But if the government really wanted to help – if it really did – it would make it illegal for anyone but a specialist to write these prescriptions. Hey look, I’m just an ordinary citizen who came up with a more useful policy.
While some publications like to tout a decrease in opioid prescriptions, with the AMA in 2021 claiming a 44.4% reduction in the past decade, this logically makes very little sense. And is completely derailed by general statistics. In 2020, NPR wrote how as of 2018 (when statistics were last made available.) that one in five Americans had an opioid prescription filled according to the CDC. In fact, enough prescriptions were being written for half of all Americans to have one. Kind of makes the AMA’s claim one year later sound like a baseless marketing ploy.
To take it a step further, any talk of a reduction in prescribing sounds silly at best. In 2017, over 191 million opioid prescriptions were written, which is actually equal to 58.7 prescriptions written for every 100 people. 45% of those came from primary care physicians who aren’t supposed to write such prescriptions (hence the fact that simply taking away their ability to do so could help hugely). Considering that doctors who aren’t supposed to be writing them were responsible for writing so many – even after the 2016 guidelines were put in place, ends the idea that those guidelines got in the way of anyone getting anything, or that prescription writing for opioids has gone down.
According to the NPR article, in 2018 (two years after the 2016 updates), approximately 40 people were dying of overdoses a day specifically from prescribed opioids. And that’s just deaths, it speaks nothing to the damage caused by those who live with these addictions. This problem is so intense that the CDC estimated the economic burden for all related health care, emergency care, addiction treatment, lost productivity, and criminal justice response to be about $78.5 billion per year. Who pays for that? The same people fed all these opioids – taxpayers.
In 2019, according to hhs.gov (US Health and Human Services) nearly 71,000 people died of overdoses that year. While approximately 14,480 were related to heroin, a massive 48,000 were from prescription opioids, meaning that 62,000 out of 71,000 overdoses were related to opioids. Whereas the agency’s stats put first time misusers at 1.6 million for that year, it listed 10.1 million who misused that year total.
In 2020, possibly due to corona, and possibly just showing a trajectory that had already started, the number of overdose deaths skyrocketed further to 93,331, a 30% increase, according to the CDC. And for 2021? While complete statistics have not been made available yet, some statistics have been released, namely in the way of statistics that point to the overdose number now capping 100,000 per year.
According to the final report of the Commission on Combating Synthetic Opioid Trafficking, put out in February 2022, for the year ending June 2021, there were over 100,000 total drug overdose deaths, with synthetic opioids claiming two out of three of those. So does it make sense that prescription writing has gone down? No, not even a little. And that makes what the CDC is proposing now, preposterous.
The situation is so bad (beyond the visible death statistics), that Big Pharma companies Johnson & Johnson, AmerisourceBergen, Cardinal Health, and McKesson just offered a settlement to Native American tribes of $590 million because of a case waged against them due to the damage opioids have caused that specific community. And this on top of a $26 billion global settlement that must be paid out by multiple Big Pharma companies including Johnson & Johnson, because of damage done.
What about ketamine?
The weirdest part to all this? Or maybe the part that shows the true corruption of the government? It’s already well understood – since back in 1964 – that ketamine works well for treating pain conditions. As ketamine is nonaddictive (its actually used to treat addiction), with a great safety profile including difficulty for causing overdose deaths, it should be the obvious answer. In fact, not only is it great for pain, but because it’s also been shown to be great for addictions, it creates the one-two punch that’s so badly needed right now.
How does the government so specifically know this? Because the first ketamine study done back in 1964 was done with prisoners. As in, members of a government prison were used in the study. The investigation was done via the Parke Davis Clinical Research Unit at the Jackson Prison in the state of Michigan, but assuming the government wouldn’t get an automatic peek at research being done on government sanctioned prisoners, is preposterous at best. Plus, even if results weren’t shared privately with the government, they were published in 1965. The government has most certainly known since then, backed up by tons of follow-up studies that have been released in the years since.
In fact, ketamine works so well, that a huge gray market has sprouted up with medical clinics offering off-label use of ketamine for pain. So this drug with a much safer safety profile, which isn’t addictive, and which can offer relief for all kinds of pain without the threat of death, isn’t even being mentioned, while the CDC plans to backhandedly make opioids even more accessible.
Craziest part of all this? Johnson & Johnson is the only pharma company to have an approved version of ketamine out (likely approved with the hope of diverting from the ketamine gray market) in the form of esketamine. It’s also paying out billions for damages from opioids. Yet when Johnson & Johnson filed for its new drug application for esketamine, pain was never mentioned. It seems the desire is not to fix the problem, but to keep it going, as better methods are continuously being suppressed.
Take cannabis, for example. Which has also shown the ability to deal with pain, or kratom. Or plants like ginger and turmeric from the Zingiberaceae plant family which are consistently written about for their pain benefits. Personally, I drink ginger tea nearly every day to help with the accumulated pain and injuries of ballet, and its often the difference between being able to stand up straight, or not. I cannot express better than this what a massive difference that plant makes.
So thanks to the apathy of the US government, and the pushing of Big Pharma, it looks like the CDC has us all set for bigger increases in deaths with even less guidelines for opioids. I guess this is the best that they could come up with to fight the much better working ketamine system, which stands to help the problem for those who suffer from either pain or addictions to opioids. Which is probably because in the end, even as a pharma product, ketamine is easily made on the black market as well as being offered as a generic, indicating that as it gets more popular, this will not necessarily help Big Pharma, making it undesirable.
And considering that Big Pharma literally started this epidemic, along with the US government which allows it through regulation, it makes sense that the two entities would do everything possible to protect the industry. Even at the cost of your life.
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Disclaimer: Hi, I’m a researcher and writer. I’m not a doctor, lawyer, or businessperson. All information in my articles is sourced and referenced, and all opinions stated are mine. I am not giving anyone advice, and though I am more than happy to discuss topics, should someone have a further question or concern, they should seek guidance from a relevant professional.