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Cannabinoid-opioid interaction in chronic pain.
Clin Pharmacol Ther 2011; 90(6):844-51CP

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.

Authors+Show Affiliations

Division of Hematology-Oncology, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA. dabrams@hemeonc.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22048225

Citation

Abrams, D I., et al. "Cannabinoid-opioid Interaction in Chronic Pain." Clinical Pharmacology and Therapeutics, vol. 90, no. 6, 2011, pp. 844-51.
Abrams DI, Couey P, Shade SB, et al. Cannabinoid-opioid interaction in chronic pain. Clin Pharmacol Ther. 2011;90(6):844-51.
Abrams, D. I., Couey, P., Shade, S. B., Kelly, M. E., & Benowitz, N. L. (2011). Cannabinoid-opioid interaction in chronic pain. Clinical Pharmacology and Therapeutics, 90(6), pp. 844-51. doi:10.1038/clpt.2011.188.
Abrams DI, et al. Cannabinoid-opioid Interaction in Chronic Pain. Clin Pharmacol Ther. 2011;90(6):844-51. PubMed PMID: 22048225.
* 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 -