cannabidiol and Opioid-Related-Disorders

Topics: Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Anxiety Agents; Antiemetics; Cannabidiol; Humans; Narcotics; Opioid-Related Disorders; Prospective Studies; Substance Withdrawal Syndrome

Multimodal analgesia has become the standard of care for pain management following total knee arthroplasty (TKA). Cannabidiol (CBD) is increasingly utilized in the postoperative period. The purpose of this study was to analyze the analgesic benefits of topical CBD following primary TKA.. In this randomized double-blinded placebo-controlled trial, 80 patients undergoing primary unilateral TKA applied topical CBD (CBD; n = 19), essential oil (EO; n = 21), CBD and essential oil (CBD + EO; n = 21), or placebo (PLA; n = 19) thrice daily around the knee for two weeks postoperatively. This supplemented a standardized multimodal analgesic protocol. Outcomes included visual analog scale (VAS) pain and numeric rating scale (NRS) sleep scores (collected on postoperative day [POD] 0, 1, 2, 7, 14, 42), and cumulative postoperative opioid use (42 days).. Demographic characteristics were similar among the four cohorts. Preoperative VAS and NRS scores were similar among groups. The CBD cohort had a higher mean VAS pain score on POD 2 compared to the EO cohort (CBD: 69.9 ± 19.3 versus. EO: 51.0 ± 18.2; P = .013). No statistically significant differences existed for VAS scores at other times, and no statistically significant differences were observed for postoperative NRS sleep scores or postoperative opioid use at any time point.. Utilization of topical CBD in supplement to multimodal analgesia did not reduce pain or opioid consumption, or improve sleep scores following TKA. These results suggest that the local effects of topical CBD are not beneficial for providing additional pain relief after TKA.

Topics: Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee; Cannabidiol; Double-Blind Method; Humans; Oils, Volatile; Opioid-Related Disorders; Pain, Postoperative; Prospective Studies

Some ecological studies have shown that areas with higher use of cannabis may have lower opioid use and fewer opioid-related problems. Newer studies are questioning this finding. Few individually based studies have been performed. Using data from the Norwegian Prescription Database, this study investigated the individual level effect of prescribed cannabis extract (Sativex®) in prescription opioid users on their opioid use in the following year. Looking at all those filling a prescription for Sativex®, opioid use was only marginally lowered in the follow-up period. Some Sativex® users, however, filled more prescriptions for Sativex® and were able to reduce their opioid use substantially. Further studies are needed to elucidate more details on these patients, so as to know who can benefit from such cannabis-based extracts in reducing their opioid use.

Topics: Adult; Aged; Analgesics; Analgesics, Opioid; Cannabidiol; Databases, Factual; Dronabinol; Drug Combinations; Female; Humans; Male; Middle Aged; Norway; Opioid-Related Disorders; Practice Patterns, Physicians'

Epidemics require a paradigm shift in thinking about all possible solutions. The rapidly changing sociopolitical marijuana landscape provides a foundation for the therapeutic development of medicinal cannabidiol to address the current opioid abuse crisis.

Topics: Animals; Cannabidiol; Epidemics; Health Policy; Humans; Medical Marijuana; Opioid-Related Disorders; Psychotropic Drugs