Can I take CBD with opioids (oxycodone, morphine, codeine, tramadol, etc.)?

For people who have acute or chronic pain, finding the right analgesic medication or herbal remedy – including as strong as opioids or as safe as CBD – is life changing. The aim of this article is to answer the question: Can I take CBD with opioids?

Chronic pain can be a nuisance limiting the quality of life of people suffering from such pain. In addition, acute pain also causes much discomfort. With the wide range of analgesics available, people still often find it impossible to control their pain. While opioids are the strongest analgesic, cannabidiol has also shown great potential in the treatment and management of chronic pain.

As such, CBD has piqued the interest of so many pain sufferers. However, there is very limited information as to the benefits or effects of taking CBD with other pain management medications, such as opioids. Are they safe and/or effective when taken together? Read more to find out.

Opioids

Opioids are naturally found in the opium poppy plant and have an important effect on pain. They block pain signals between the brain and the body, thereby relieving moderate to severe pain. People have used opioids for severe head or back aches for millennia. Its current users are mostly patients recovering from surgery, those with severe cancer related pain, pain from a fall, or after car accidents and other types of serious accidents.

Although opioids are an excellent pain relief class of drug, they are also associated with important side effects such as its high risk of addiction when used to manage chronic pain over a long period of time. Other side effects are shallowed breathing, slowed heart rate, loss of consciousness, nausea, sleepiness and constipation. Common opioids are codeine, fentanyl, oxycodone, morphine, methadone, hydrocodone, and tramadol. The dilemma is whether taking CBD with opioids helps the patient or not.

Watch this 2:36 minute video “The effects of opioids on the brain”

Drug interaction when using CBD with opioids

We know that taking two drugs together such as CBD with opioids can lead to drug-drug interactions. Such interactions occur when one drug alters the clinical effect of another. Let’s take a look at what happens when a patient decides to take CBD with opioids.

Taking CBD with morphine and oxycodone

UGT2B7 is an enzyme in the liver that converts morphine and oxycodone to their active forms. When taking CBD with opioids (morphine and oxycodone), CBD will inhibit the production of UGT2B7. This means that morphine and oxycodone will not be changed to their active forms and will not produce sufficient analgesic effects. In this case, taking CBD with opioids might reduce analgesic potency of the opioid.

Taking CBD with methadone

Methadone metabolism occurs in the liver by several cytochrome P450 enzymes, but the most important enzyme involved in its metabolism is CYP2B6. This enzyme allows the liver to break down methadone for the body’s use. However, CBD inhibits the production of CYP2B6 making methadone metabolism difficult. This will lead to an increased amount of methadone in the blood.

When this happens, the patient might experience an increased analgesic effect of methadone. However, increased level of methadone in the blood also means increased side effects. So taking CBD with the opioid methadone can increase the risk of low heart rate, shallow breathing, nausea, sleepiness and loss of consciousness, and potentially methadone overdose.

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Taking CBD with other opioids

Research has also shown that most opioids are substrates of P-glycoprotein (Pgp). P-glycoprotein is an efflux transporter, that moves its substrates from inside the cell to outside the cell. The aim is to reduce the concentrations of these substances in the cells. CBD is an inhibitor of P-glycoprotein. When a patient takes CBD with opioids that depend on P-glycoprotein for their transport, such as morphine, oxycodone, and methadone, it increases the concentration of these opioids in the cells.

While an increase in cell concentrations of these opioids increase pain relief, it also increases side effects such as addiction, loss of consciousness, reduced heart rate, and breathing. And last but not least, it may increase the probability of an opioid overdose.

Conclusion

Making the decision to take CBD with opioids requires you to sit down with your physician and discuss the possible risks of taking the two together and the possibility of dosage control. As we saw above, taking the CBD with opioids may be unsafe, and could potentially increase the risk of an opioid overdose.