Should marijuana be the drug of choice for postoperative pain?

by Courtney Caplin MD, DMD
Co-Author Linda Key

Narcotics are used readily in almost all types of postoperative pain management. As a cosmetic surgeon in Oklahoma City, almost every one of my patients is prescribed an opioid after surgery for pain control.

The most common opioids are hydrocodone and oxycodone, which are often combined with acetaminophen (Tylenol). Some of the common trade names are Norco, Vicodin, Percocet. They work by binding to receptors and reducing the sending of pain messages to the brain and reduce the feelings of pain.

There is no question of the efficacy of opioids, but there has been a significant question about the safety of them when used inappropriately, or addiction occurs. The opioid crisis has been a rising issue across the country, and now awareness is becoming stronger in Oklahoma and the Midwest. Although there may always be a place and time to prescribe opioids, could we be missing out on a better option?

Here are a few reasons that could make marijuana; CBD and THC, potential answers to the question of post-operative pain control.

We know that not only do CBD and THC help decrease pain, but they also increase appetite. The increased appetite helps with maintaining nutrition as the body requires more calories when healing than it does at its normal metabolic rate.

Additionally, we know narcotics are notorious for causing post-operative nausea and vomiting. If a patient vomits after surgery, the intra-abdominal pressure rises and could lead to an increased rate of bleeding immediately post-surgery.

Another fact is when the stomach is full of food; nausea sensations decrease with narcotics. So even if a patient decided he or she may still want an opioid in additional to marijuana alternatives, hopefully his or her appetite has been stimulated enough to have a full belly before consuming.

Next, although side stories have been reported about accidents happening while a person is high on marijuana, no known overdoses have been reported, which is a directed contradiction to opioids. And the icing on the cake so to speak is that marijuana does not cause constipation as narcotics do.

To truly start understanding the benefits of the cannabis plant, we need to understand that the plant is made up of many cannabinoids. The best known and most studied would be CBD, THC, CBG as well as CBN.  

These components are known to nourish the endocannabinoid system. The endocannabinoid system is found in all living creatures, including reptiles, fish and birds. This system is currently known to help move the body into an uplifted and pleasurable standing as well as to assist the body back into health after an illness or injury which will be the focus of this article.

The argument usually heard against using marijuana comes from mind-altering component THC. True, THC can give a person a “high,” however that high is not needed to gain the medicinal effects of cannabis as a medicine. A person taking a combination of CBD/THC can experience pain relief as well as reduced anxiety without ever experiencing a high.

CBD and THC are only two of the most studied cannabinoids in the marijuana plant. More cannabinoids being discovered as new research is being done.

It has been shown that CBD can calm anxiety, reduce inflammation and restore general health. It has also been discovered that adding THC to CBD can increase CBD’s ability to decrease pain over 50 percent.

By combining CBD and THC, you can experience the benefits from the plant without experiencing a head change.

There are edibles and some tinctures being offered by dispensaries in combinations of 25:1 or 1:1. What these numbers general mean is that the product description 25:1 would contain 25mg of CBD and 1mg of THC. (Note a 1:1 can be misleading. 1:1 simply means there are equal parts of CBD and THC.)  

It does not mean there is only 1 mg of each. However, it could mean there is 25 mg of each cannabinoid.

This dose would be a very high dose for a new patient and could lead to a very uncomfortable experience.

Should anyone ever make that mistake please note that your endocannabinoid system does not allow for overdoses and you will be fine.  

Determining the correct dosage for each individual is key. An endocannabinoid system which has not experienced cannabis should respond to a relatively low dosage. It is always recommended that a person starts with the lowest dose possible.

If a person is experiencing minor pain such as a headache or sore muscles, they could try just CBD alone a 25 mg gummy for example may work great. Most new users find that they love the lower dosages, and they are amazed at how well they work with none of the side effects.

I know a patient who is an avid marijuana user. She recently had minor surgery, and the only pain medication she used was marijuana-infused gummies. She said the dosage was 25:10. This dosage translates to 25mg CBD and 10mg THC. She did take two at a time, which she said she had a low grade high, similar but less intense than the feeling one may get from taking an opioid.

The recovery appears to be faster when a person does not introduce opioids into their system. Using cannabis eliminates all the uncomfortable as well as dangerous side effects such as constipation, nausea, depression, as well as the possibility of dependence on a dangerous substance.

Although Oklahoma has joined a group of states that have legalized medical marijuana, doctors still cannot prescribe it due to federal law. Here in Oklahoma, what doctors can do is sign the legal paperwork for a patient to obtain a medical marijuana card and make some recommendations.

To use marijuana versus an opioid after surgery is a very personal choice. Opiates currently are the standard of care and common medical practice to relieve post-operative pain; however, with all the new research being presented every day it could be worthwhile for patients to make an informed educated decision about marijuana alternatives.

Copyright The Gayly. 10/15/2019 @ 1:04 a.m. CST