People with fibromyalgia substituting CBD for opioids to manage pain
The cannabis-derived substance provides fewer side effects, with less potential for abuse.
Fibromyalgia is one of many chronic pain conditions that remains stubbornly difficult to treat.
As the ravages of the opioid epidemic lead many to avoid these powerful painkillers, a significant number of people with fibromyalgia are finding an effective replacement in CBD-containing products, finds a new Michigan Medicine study.
CBD, short for cannabidiol, is the second most common cannabinoid in the cannabis plant, and has been marketed for everything from mood stabilization to pain relief, without the intoxicating effects produced by the most common cannabinoid, THC. THC, which stands for delta-9-tetrahydrocannabinol, is the ingredient in marijuana that causes people to feel high.
The cannabis industry has exploded, aided by the legalization of medical and recreational marijuana in states around the United States and the removal of hemp-derived CBD from Schedule 1 status—reserved for drugs with no currently accepted medical use and a high potential for abuse—at the federal level.
Previous research shows that some people substitute medical cannabis (often with high concentrations of THC) for opioids and other pain medications, reporting that cannabis provides better pain relief and fewer side effects. However, there is far less data on CBD use.
“CBD is less harmful than THC, as it is non-intoxicating and has less potential for abuse,” said Kevin Boehnke, Ph.D., a research investigator in the Department of Anesthesiology and the Chronic Pain and Fatigue Research Center. “If people can find the same relief without THC’s side effects, CBD may represent a useful harm reduction strategy.”
Boehnke and his team surveyed people with fibromyalgia about their use of CBD for treatment of chronic pain.
“Fibromyalgia is not easy to treat, often involving several medications with significant side effects and modest benefits,” Boehnke explained. “Further, many alternative therapies, like acupuncture and massage, are not covered by insurance.”
For this study, the team focused on 878 people with fibromyalgia who said they used CBD to get more insight into how they used CBD products.
The U-M team found that more than 70% of people with fibromyalgia who used CBD substituted CBD for opioids or other pain medications. Of these participants, many reported that they either decreased use or stopped taking opioids and other pain medications as a result.
“I was not expecting that level of substitution,” said Boehnke, noting that the rate is quite similar to the substitution rate reported in the medical cannabis literature. People who said they used CBD products that also contained THC had higher odds of substitution and reported greater symptom relief.
Yet the finding that products containing only CBD also provided pain relief and were substituted for pain medications is promising and merits future study, noted Boehnke.
The team noted that much of the widespread use of CBD is occurring without physician guidance and in the absence of relevant clinical trials. “Even with that lack of evidence, people are using CBD, substituting it for medication and doing so saying it’s less harmful and more effective,” he said.
Boehnke stressed the need for more controlled research into how CBD may provide these benefits, as well as whether these benefits may be due to the placebo effect.
Clinically, opening up lines of discussion around CBD use for chronic pain is imperative, said Boehnke, for medication safety reasons as well as for “enhancing the therapeutic alliance and improving patient care.”
Additional authors include Joel J. Gagnier, Lynne Matallana and David A. Williams.
Paper cited: “Substituting Cannabidiol for Opioids and Pain Medications Among Individuals with Fibromyalgia: A Large Online Survey,” The Journal of Pain. DOI: 10.1016/j.jpain.2021.04.011
CBD Oil for Fibromyalgia: Is it Effective, Safe, or Legal?
Further research is needed to prove its effectiveness
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.
Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.
David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies.
CBD oil is getting a lot of popular attention as a potential treatment for fibromyalgia. So far, we don’t have a lot of research on it, but we do have some — and it’s promising.
Still, a lot of people don’t really understand what CBD oil is or how it works, and it tends to be wrapped up in the controversy over medical marijuana. That can make people hesitant to try it. There’s also a lot of confusion over whether it’s legal—but there are also some positive changes on that subject.
What Is CBD Oil?
CBD stands for “cannabidiol,” which comes from the cannabis plant. Yes, the cannabis plant is where we get marijuana. However, CBD oil doesn’t have any psychoactive properties, which means it doesn’t get you high.
The substance responsible for the high associated with marijuana comes from a different substance, which is called THC (tetrahydrocannabinol.) Growers who want to maximize the plant’s high use breeds and techniques that focus on higher THC levels. Meanwhile, cannabis that’s grown for hemp is generally richer in CBD than THC, and that’s where CBD is derived from.
CBD that’s extracted from cannabis is being used for a lot of medical purposes, and you can find a lot of impressive-sounding claims online. Are they true? From a scientific standpoint, the answers are more like “possibly” and “some of them appear to be” than a firm “yes,” and it depends on which claims you’re looking at.
People are using CBD oil for a lot of different medical purposes, including:
- Chronic pain and inflammation
- Pain from glaucoma
- Epilepsy, especially in children
- Social anxiety disorder
- Bipolar disorder
- Multiple sclerosis
- Parkinson’s disease
- Movement problems from Huntington’s disease
- Assistance with smoking cessation
- Stopping the growth of cancerous tumors
As of mid-2018, CBD oil is not FDA-approved for any conditions. Research in the United States is in the early stages, though, since for decades, legal restrictions made it extremely difficult to study the medical benefits of marijuana or any of its components. We may see applications submitted to the agency as research continues to move forward.
CBD oil is used in various ways. You can smoke it, swallow capsules, use it under the tongue, in spray or drop form, and topically.
Research for Fibromyalgia
General CBD research is in its infancy, so research on CBD for fibromyalgia could be considered embryonic. We just don’t have much to go on right now. A 2016 survey of the literature concluded that there’s not enough evidence to recommend any cannabis-based treatments for fibromyalgia or other rheumatic conditions.
However, this topic is likely to get a lot of future attention, for several reasons.
First, we have a pain epidemic in the U.S., and fibromyalgia is a major contributor to that. Current treatments just aren’t good enough for most of us, so there’s an enormous financial incentive to find something that’s better at relieving our pain and other symptoms.
We also have an opioid addiction and overdose epidemic. Studies have demonstrated that when a state legalizes marijuana, the number of opioid prescriptions drops. That’s good news for healthcare providers looking for safer pain treatments, law enforcement agencies struggling to control the tide of illegal opioid use, and lawmakers looking for solutions to the opioid problem.
CBD oil is believed to be effective against pain and inflammation, and, in its pure form, it’s generally regarded as safe.
Finally, while anecdotal evidence certainly isn’t scientific proof of anything, we have an abundance of it from people with fibromyalgia who say CBD helps them, and you can bet that when patients who have hard-to-treat conditions tell their healthcare providers something works, it piques their interest.
As for the scientific motivations behind further study, consider that CBD is believed to help relieve:
When it comes to fibromyalgia symptoms, those three are significant.
A 2017 paper published in Expert Opinion on Therapeutic Targets suggested CBD as a possible way to diminish the activity of brain cells called glia, which leads to central sensitization. That’s a major feature of fibromyalgia and other central sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome, and migraine.
Fibromyalgia also involves something called endocannabinoid deficiency. That’s the system that deals with your body’s natural endocannabinoids as well as cannabis products that you may take in. That makes cannabis products a promising treatment.
A 2016 review published in Cannabis and Cannabinoid Research found evidence that CBD is effective in migraine and irritable bowel syndrome, which are related to fibromyalgia. It also stated that some cannabis-based treatments appeared effective for fibromyalgia. The authors stated that CBD is often preferable to patients due to the high and other effects associated with THC.
Some have suggested that CBD can fight inflammation. Fibromyalgia isn’t currently classified as an inflammatory condition, but research suggests that at least some cases may involve inflammation of a body-wide web of connective tissue called the fascia. If that’s accurate, it could be one more reason CBD should be considered.
We don’t have a full picture of the possible side effects of CBD. Some reported side effects include:
- Changes to liver enzymes used to process drugs
- Dry mouth
- Low blood pressure
- Increased tremor in Parkinson’s disease, at high doses
These effects are possible but require more study, according to the World Health Organization:
- Alteration of hormonal levels
- Immune system stimulation at low levels, and immune suppression at higher levels
Addiction and abuse don’t appear to be problems with CBD, and it appears to have a low toxicity level meaning that it takes a lot to overdose.
Non-Drug Fibromyalgia Treatments
Fibromyalgia treatments other than medications include:
Is CBD Oil Legal?
You’d think the question, “Is CBD legal?” would be answerable with a simple yes or no. It hasn’t been, and while it’s getting easier to answer that question, it’s still not cut-and-dried (nor is the question of whether or not CBD oil can result in a positive drug test).
You’ve long been able to find a lot of claims by hemp growers and CBD sellers that their product is legal in all 50 states as long as it contains less than 0.3 percent THC. However, a 9th Circuit Court of Appeals ruling disagreed.
Enter the 2018 Farm Bill. This piece of legislation was wildly popular in both the Senate, where it was passed in June of 2018, and the House, where it was passed in December of 2018 and signed into law soon after. It re-classified hemp as a legal agricultural product, which makes CBD products legal at the federal level.
In states where marijuana and/or CBD is legal, there’s no longer a clash between state and federal law. That’s a win for those wanting to take CBD products medicinally.
However, some states have specific laws on the books banning hemp products. So what does the Farm Bill mean for those states?
Technically, federal law overrules state law. That doesn’t mean that those states will stop arresting and trying people on CBD charges, though, especially if they want to challenge the new federal law. If you’re in one of those states, be safe and talk to an expert about any possible trouble you could get into for using CBD products.
The website ProCon.org has information about which states have laws specific to CBD oil. A site called Governing maintains a map of where marijuana is legal in some form.
A Word From Verywell
Certainly, you have a lot to consider when it comes to any treatment, and even more so when it comes to CBD. Consider the pros and cons—including the legal ones—carefully. Be sure to discuss this option with your healthcare provider to make sure you’re safe, and, as with any treatment, watch for side effects.
With legal changes in-store and more research coming, expect things to change rapidly when it comes to CBD oil and other cannabis-based treatments. We’ll likely know a great deal more about the effectiveness and safety of these products a few years from now.
Frequently Asked Questions
There’s no single answer for this question. Everyone needs to try different treatments and see what works for them.
Common fibromyalgia painkillers include:
– Cymbalta (duloxetine), Savella (milnacipran), amitriptyline
- Anti-seizure drugs – Lyrica (pregabalin), Neurontin (gabapentin)
- Opioids (despite a lack of evidence that they’re effective) – Vicodin (hydrocodone/acetaminophen), OxyContin (oxycodone) and related products
Fibromyalgia needs a customized treatment regimen and there’s no “best” treatment that’s been identified. Three drugs are FDA-approved for fibromyalgia—Lyrica (pregabalin), Cymbalta (duloxetine), and Savella (milnacipran)—but many other drugs and supplements are used to treat this condition.