Is Cannabis the King of Pain Killers?

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There are several fundamental similarities between cannabinoids and opioids. They are both plant-based medicines, both psychoactive, and both used to effectively treat pain. 



Cannabinoid and opioid molecules both work by binding to G-protein coupled receptors that are primarily located in the synapses of neurons and in areas of the brain known for regulating pain. Once activated, cannabinoid and opioid receptors work down similar signaling pathways, such as the MAP kinase pathway. Not only are the cannabinoid receptors, especially CB1, frequently found in the exact same tissues as the opioid receptors,  there are some hypotheses that the two receptors may even come together and interact physically.
The precise mechanisms of pain relief are also similar. Cannabinoids work by dampening the pain signaling from the injured tissue. This mechanism essentially reduces the sensitivity to the pain. In the neural synapses, both cannabinoids and opioids interfere with pain signaling by preventing the release of particular neurotransmitters.
In the case of pain relief, there is definitely crosstalk between the cannabinoid and opioid signaling systems. Providing cannabinoid and opioid medicines simultaneously, enhanced the pain relieving potential, greater than either medicine alone. Studies in animals have indicated that cannabinoid receptor activation by delta-9-tetrahydrocannabinol (THC) triggers the release of endogenous opioids, which may be behind this enhancement effect.
Tolerance to cannabinoids and opioids is developed over time, requiring dosages to increase in order to maintain effects and thereby increasing potential for abuse. There also appears to be a cross-over between cannabinoid and opioid systems in dependence. Some studies found that cannabis use reduced opioid withdrawal symptoms. Cannabinoids could therefore be used to help reduce opioid dependence.
One of the major differences between cannabis and opioids, especially when used for pain, is that the side effects of opioids are typically more difficult to bear than those associated with cannabis. And more critically, overdosing with opioids can result in death, while overdosing with cannabis does not. Respiratory depression is usually the cause of death in opioid overdose because many opioid receptors are found in the brainstem, which controls heart rate and respiration.
Cannabis and opioids work in similar ways within the central nervous system to reduce the brain’s response to pain. Cannabis is now thought to be the leading contender as a replacement for opioid drugs in pain management because of the lower risks and fewer side effects. In addition, the simultaneous use of cannabinoid and opioid medicines may also be a valuable tool for effectively managing pain while reducing the risk for developing tolerance and addiction.

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