Medical Marijuana vs. Morphine
Posted by Glenn Beierle on 07/18/2018 in Medical Marijuana
Updated on July 19, 2018. Medical content reviewed by Dr. Richard Koffler, MD, Board Certified Physiatrist
Chronic pain is a widespread concern for Americans, affecting over 50 million adults in 2015 alone. Despite the prevalence of chronic pain, patients have limited treatment options available. At the moment, prescription opioids like morphine are the most common solution for chronic pain conditions. However, opioid prescriptions come with significant risks. In 2014, a record high of 30,000 people died from opioid overdoses. As a result, many patients and doctors are reassessing their usage of opioid painkillers and looking for a new solution.
In the wake of the U.S. opioid epidemic, many doctors and patients have begun supporting alternatives, specifically marijuana. Though marijuana is a Schedule I controlled substance, it presents a more sustainable solution to the issue of chronic pain. Marijuana serves as an effective painkiller and is one of the more popular alternatives to opioid prescriptions. However, it’s still illegal in many states, and many doctors are wary of prescribing it to their patients.
If you suffer from chronic pain and are considering morphine or marijuana as a solution, it’s important that you understand each option. To help, we’ve compiled the essential facts that you need to know about each substance so that you can make an informed decision.
How Morphine Works
Morphine has a long history of use in the medical field and has maintained a strong position as a popular painkiller for decades. Morphine is a narcotic, belonging to a family of drugs that work on the brain to depress certain functions. The name reflects this fact, coming from the Greek word narcosis, meaning sleep or stupor. Even though it is less potent than other narcotics like Dilaudid, heroin and oxycodone, morphine is still a powerful drug.
Morphine and other narcotics work on the brain and are typically introduced through the bloodstream. Once absorbed into blood vessels, the veins carry opioid compounds to the brain. Once there, transporters move the compounds to their target cells, where they bind to specific receptors to depress brain functions. One of the effects of this binding is the reduction of pain. As the dosage of the opioid increases, however, the compound may affect other areas of the brain, resulting in the depression of other bodily functions, like respiration.
Over time, the repeated use of opioids like morphine will result in a phenomenon called tolerance, when the brain senses the increased binding rates of opioid receptors and reacts by deactivating and removing them. By doing so, the brain decreases the rate of receptor binding, eliciting a reduced response to the drug. To achieve the same level of pain relief, then, patients have to increase their dosage, which increases the risk of harmful side-effects.
Developing opioid tolerance takes time, so it is primarily an issue for patients with long-term chronic pain. For some patients, tolerance can eventually lead to an overdose.
Pros and Cons of Morphine for Pain Management
As a painkilling drug, morphine is highly effective and fast-acting, offering the following benefits as a painkiller:
- Short-term efficacy: Morphine works best as a painkiller in the short-term. It reduces pain quickly and effectively, but tolerance causes the effect to decrease over time. This process makes opioids ideal for post-operative patients who require strong painkillers as their bodies heal from surgery.
- Medical familiarity: Compared to marijuana, the research and understanding of morphine are extensive. With several decades of research and real-life application, physicians tend to prefer morphine for its familiarity and establishment within the medical community.
On the other hand, Morphine does elicit some adverse effects, including:
- Tolerance: As the brain detects increased binding rates at opioid receptors, it acts to decrease the binding rate, effectively diminishing the efficacy of the drug. In patients with long-term chronic pain conditions, this tendency means that the drug loses effectiveness over time, requiring the patient to increase their dosage to experience stronger results.
- Addiction: Addiction occurs when a patient develops a psychological dependence on a drug. Unfortunately, this problem is a common one with many opioid painkillers, including morphine. Addiction combined with physical tolerance to opioids leads patients to take progressively higher doses of opioids to achieve their ideal high. This strategy can lead to more severe side effects and, eventually, an overdose.
- Overdose: In high doses, morphine depresses all brain functions, including essential functions like breathing. Depression of respiration is the most common cause of death in cases of morphine overdose.
- Constipation: Opiates, including morphine, can cause severe constipation in patients. This side-effect is often a nuisance but can develop into a significant and painful health concern if left untreated.
How Marijuana Works on the Brain
Marijuana has been used across various cultures as a form of medicine for over 5,000 years. Unlike morphine, which was historically used as strong analgesia, marijuana was used in the treatment of over 200 diseases, including many painful conditions. The most common use of marijuana was as a treatment for headaches.
Despite its utility and extensive use throughout history, marijuana usage was criminalized in 1942 in the United States. By classifying marijuana as a Schedule I drug, the U.S. government removed cannabis from the pharmacopeia. While there is currently a push for cannabis legalization, as of now, only 34 states and the District of Columbia have legalized medical marijuana use. The law has proven to be a hindrance to the reintroduction of marijuana to the medical community, as it has stifled research and introduced a stigma to cannabis usage.
As a painkiller, marijuana works on the brain through a slightly different pathway than morphine. When introduced into the bloodstream through inhalation or ingestion, the compounds in marijuana travel to the brain and are transported to cannabinoid receptors throughout the brain. However, instead of depressing brain functions like morphine does, marijuana elicits a state of euphoria.
There are two medically essential compounds in marijuana: THC and CBD. THC, or tetrahydrocannabinol, is the primary psychoactive component in marijuana, affecting specific receptors in the brain to produce a euphoric effect. In addition to this, THC also delivers pain relief and reduced inflammation. CBD, or cannabidiol, on the other hand, is minimally psychoactive but medicinally important, acting as an antidepressant.
Like with morphine, tolerance is an issue with cannabis, though not to the same extent. Patients may develop psychological tolerance to cannabis, and their feeling of euphoria may decrease, but there is currently no research to suggest that this tolerance reduces the analgesic effects of marijuana. That being said, habitual users may experience withdrawal if they abruptly decrease or stop marijuana usage, though this issue rarely affects patients using lower doses.
Pros and Cons of Marijuana for Pain Management
Marijuana offers the following benefits as a painkiller:
- Reduced risk: Compared to morphine, marijuana poses significantly fewer risks, proving to have a lower potential for addiction and abuse. Additionally, it is virtually impossible to overdose on pot alone.
- Targeted pain management: Cannabinoids are active ingredients in marijuana that are medically beneficial for specific types of pain. Currently, research is looking into the efficacy of cannabinoids in combating pain related to cancer, multiple sclerosis, HIV and AIDS.
- Nausea and appetite treatment: Cannabis reduces nausea and increases the appetite, which is a useful side effect for cancer patients to help maintain a healthy diet.
- Improved sleep: Research is currently underway to discover the benefits of medical cannabis on sleep in patients with chronic pain, but initial research shows improvement with regards to sleep and sleep apnea.
On the other hand, pot does elicit some adverse effects, including:
- Decreased brain function: Marijuana can slow thinking and reaction times, making it dangerous to use before operating a vehicle. While it has less of an effect on motor skills than alcohol, it does impair other mental functions and decrease motivation, often making daily tasks more difficult.
- Lung damage: When smoked, cannabis can be just as risky as smoking tobacco, potentially leading to lung damage, various cancers and heart disease. For medical use, most doctors recommend vaporization, ingestion or sublingual sprays, each of which produces slightly different results.
- Dosage considerations: Dosing with marijuana is a careful process that varies based on the strain and the patient’s tolerance. The ideal dosage serves as an analgesic, but too little will deliver no results and too much will lead to paranoia and sedative effects. Typically, doctors find that strains with higher THC content work more effectively than those with high CBD content, and many recommend starting at a low dosage initially before titrating up to meet the pain management needs of the patient.
- Lack of regulation: Since cannabis is a Schedule I drug, there is currently no federal regulatory oversight when it comes to the production and distribution of medical marijuana. At the moment, the quality of the final product is regulated by the states, which vary widely in their policies and enforcement. As a result, the purity levels, contaminants and contents of medical marijuana may be completely different from state to state or county to county, even if the sample is derived from the same strain.
Essential Comparisons Between Medical Marijuana and Morphine
Ultimately, marijuana and morphine are two entirely different substances that affect the brain in unique ways. When compared side-by-side, patients must consider the following:
- Length of treatment: Marijuana and morphine are both effective painkillers but tend to be suited to specific types of pain. Morphine is better suited for the treatment of short-term pain since it is fast-acting and strong, but the analgesic effects decrease as the patient builds a tolerance to the drug. Marijuana, on the other hand, is generally well-suited to long-term pain management since its analgesic effects do not change as the patient develops tolerance.
- Research: Because of its status as a Schedule I drug, few research facilities can get the funding needed to do in-depth analysis on the medicinal value of marijuana. Morphine, however, has been analyzed thoroughly, providing evidence of its efficacy in the treatment of most diseases. With cannabis legalization continuing to spread, research on marijuana is expanding rapidly, but it will take time to catch up and prove useful in real-world applications.
- Side effects: Morphine poses significant side effects compared to marijuana, often leading to serious constipation and addiction. Marijuana, if used correctly, elicits fewer side effects and is significantly less addictive.
- Physician opinions: Despite the potential and popularity of marijuana, U.S. physicians tend to prefer prescribing opioids. While some of this preference can be attributed to negative opinions of cannabis within the medical community, it’s further fueled by the relative lack of research supporting marijuana as a medically valuable substance.
- Legal issues: Because marijuana is a Schedule I drug and state laws vary widely, the delivery of marijuana to patients varies widely. Healthcare companies are often unprepared to handle dosing and distribution, and dispensaries don’t always understand the unique dosing needs of a patient with chronic pain.
In short, while marijuana presents impressive potential as a medically viable drug, its status as a Schedule I controlled substance at the federal level is hindering its use and prescription, even in states where medical marijuana is legal. With the current push toward legalization and increased education about medical cannabis, however, marijuana supporters are optimistic that medical marijuana as a painkiller will become accepted in the medical world and achieve more universal regulation and standardization.
Using Medical Marijuana With Morphine
Marijuana and morphine don’t have to be used exclusively — because marijuana works through a different mechanism than opiates, it can be used in conjunction with a morphine prescription. This combination not only helps patients improve pain levels but also reduces the amount of morphine needed to maintain patient comfort.
One study showed that patients who used opioids to treat their chronic pain decreased their prescription usage by 64 percent after adding cannabis to their treatment routine. The same study also reported general quality of life improvements in these patients, including a decrease in side effects.
Physicians can start patients off right away with both morphine and cannabis, or introduce marijuana to a patient’s treatment plan after using opioids for a while. If a patient is currently using opioids, physicians tend to recommend caution when adding cannabis to their treatment plan.
Patients should not attempt to combine these two drugs on their own and should only do so under the careful guidance of a medical professional, which helps mitigate side effects and prevent accidental overdoses. Most doctors recommend weaning off opioids before introducing marijuana, but marijuana can be introduced earlier to minimize the effects of opioid withdrawal.
The Future of Medical Marijuana vs. Morphine
With the opioid epidemic continuing to pose a problem, finding and developing alternatives must become a priority. Even though it’s a viable solution, marijuana is currently in the very early stages of its medical use, which poses many challenges for physicians and patients wanting to use it in their treatment plans. If you’re interested in adding medical marijuana to your treatment plan, it’s best to work with a trusted doctor who is up to date on the latest medical marijuana research.