Presenter: Michelle Sexton, ND

Original Date: September 22, 2018

Human data indicates that cannabis may augment the analgesic effect of opioids (exogenous or endogenous), have “opioid sparing” properties, and work therapeutically in a synergistic and pharmaco-dynamic fashion. Overdose of opiates is the number one cause of death related to prescribed drugs, and there is mounting evidence that chronic administration of opiates may cause “paradoxical pain”. In addition, side effects of opiates are often intolerable for patients. Recent reports indicate that in states where medical/adult use cannabis is available, there has been a drop in opiate prescriptions for Medicaid enrollees.

This presentation provides an overview of the role of the endocannabinoid system (eCS) in pain, the crosstalk between the endogenous opioid system and the eCS as rationales for using cannabis for pain intervention and tapering of opioid medications. Naturopathic doctors are well-suited to play a role in assisting patients with pain control, opioids tapering and side effects of withdrawal.

Dr. Sexton reviews cannabinoid and opioid pharmacology (THC, CBD, fentanyl, oxycodone, oxycontin, tramadol), forms of administration, dosing and relative contraindications. She also discusses non-opioid add-on analgesics (Gabapentin, lyrica). A protocol implemented at the UCSD Pain Department, for using a community-based approach, is presented as a means to address opioids prescriptions reduction along with some case studies illustrating the range of responses across patients. Focus is put on community partnership with pain management specialists.

1.5 Pharmacology CEUs approved by OBNM