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Cannabinoid-opioid interaction in chronic pain.

Abstract

Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook a study to answer these questions. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2-4, and in the morning of day 5. Blood sampling was performed at 12-h intervals on days 1 and 5. The extent of chronic pain was also assessed daily. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration-time curves for either morphine or oxycodone after exposure to cannabis. Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.

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  • Authors+Show Affiliations

    ,

    Division of Hematology-Oncology, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA. dabrams@hemeonc.ucsf.edu

    , , ,

    Source

    MeSH

    Administration, Inhalation
    Adult
    Analgesics, Opioid
    Area Under Curve
    Chronic Pain
    Delayed-Action Preparations
    Dronabinol
    Drug Administration Schedule
    Drug Synergism
    Female
    Humans
    Male
    Middle Aged
    Morphine
    Oxycodone
    Treatment Outcome

    Pub Type(s)

    Controlled Clinical Trial
    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    22048225

    Citation

    * When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cannabinoid-opioid interaction in chronic pain. AU - Abrams,D I, AU - Couey,P, AU - Shade,S B, AU - Kelly,M E, AU - Benowitz,N L, Y1 - 2011/11/02/ PY - 2011/11/4/entrez PY - 2011/11/4/pubmed PY - 2011/12/30/medline SP - 844 EP - 51 JF - Clinical pharmacology and therapeutics JO - Clin. Pharmacol. Ther. VL - 90 IS - 6 N2 - Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook a study to answer these questions. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2-4, and in the morning of day 5. Blood sampling was performed at 12-h intervals on days 1 and 5. The extent of chronic pain was also assessed daily. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration-time curves for either morphine or oxycodone after exposure to cannabis. Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects. SN - 1532-6535 UR - https://www.unboundmedicine.com/medline/citation/22048225/abstract/Cannabinoid_opioid_interaction_in_chronic_pain_ L2 - https://doi.org/10.1038/clpt.2011.188 DB - PRIME DP - Unbound Medicine ER -