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Can i take cbd oil with oxycodone for pain

Does CBD Interact With Oxycodone (Oxycontin)?

Information on risks & possible interactions between CBD & oxycodon.

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Pain is the leading cause of debility in the world. Millions of people live with chronic or persistent pain every day. Some take medications; others use natural supplements like CBD.

Here, we’ll cover all the potential risks and side effects that could arise while mixing CBD and opioid pain medications like oxycodone (Oxycontin).

We’ll cover why so many people choose to take these substances together despite the risks and whether or not CBD is a viable alternative to prescription opioids.

Table of Contents

Do CBD & Oxycodone (Oxycontin) Interact?

Yes, CBD may cause the sedative and pain-killing effects of oxycodone (Oxycontin) to have a stronger action. In some cases, this is a positive — CBD may make oxycodone more capable of alleviating tough to treat pain.

However, this effect may also lead to increased risk of side effects or overdose on oxycodone — which can be fatal.

It’s wise to avoid using CBD or any cannabinoids while taking oxycodone unless speaking with your doctor first. Your doctor will assess your level of risk and may adjust your dose of oxycodone or CBD to reduce the potential for harm.

Other Names for Oxycodone

Oxycodone is sold under many different names. All share the same risk and potential interactions.

Other names for oxycodone include:

  • Oxycontin
  • Percodan
  • Endodan
  • Roxiprin
  • Percocet
  • Endocet
  • Roxicet
  • OxyContin

Similar Medications: CBD & Opiates

Oxycodone is classified as an opiate. CBD and opiates all share similar risks for interaction and side effects.

Here’s a list of similar medications that share a similar level of risk when combined with CBD:

  • Buprenorphine (Cizdol & Brixadi)
  • Codeine
  • Pethidine (Meperidine & Demerol)
  • Fentanyl (Abstral & Actiq)
  • Hydrocodone (Hysingla ER, Zohydro ER & Hycodan)
  • Hydromorphone (Dilaudid)
  • Methadone (Methadose & Dolophine)
  • Morphine (Kadian & Roxanol)
  • Tramadol (Ultram, Ryzolt & ConZip)

Is It Safe to Take CBD With Oxycodone (Oxycontin)?

It’s best to avoid the use of CBD alongside oxycodone (Oxycontin). Both substances work through separate mechanisms but share similar effects. Mixing them could lead to an increased risk of side effects and overdose.

CBD may also slow the breakdown of oxycodone and other opioids in the liver — causing serum levels to increase over time (with repeated use). If drug levels get too high, side effects or overdose may result.

Is CBD a Viable Alternative to Oxycodone (Oxycontin)?

CBD is a viable alternative to opioids for managing mild to moderate pain. Many people turn to CBD as a safer alternative due to the lower chances of side effects and addiction from CBD.

However, severe or stubborn pain may not respond to CBD on its own, even in high doses. Opiates are more dangerous and addictive but undeniably more potent than CBD in terms of eliminating pain.

CBD is most effective for inflammatory origins of pain. Opioids are stronger for neuropathic pain.

A study showed that CBD hemp extract decreased the pain in patients with chronic pain and improved their quality of life [1].

One study showed that substituting CBD for opioids in fibromyalgia patients helped relieve their pain better and with lesser side effects [2].

Some use CBD as a way to manage pain while weaning themselves off addictive opiates like heroin. In an animal study, CBD decreased morphine dependence and heroin-seeking behavior in affected rats [4].

What Is Oxycodone (Oxycontin)?

Oxycodone (Oxycontin) is an opioid medication used for managing chronic pain. The opioid class originated from poppy plants. Today, they include both natural and synthetic drugs.

Opioids bind to the opioid receptors in the brain resulting in a release of dopamine (euphoric) and activation of opioid receptors in the central nervous system (blocking pain). Opioids also result in suppressing the sympathetic nervous system, resulting in slowed heart rate, contraction of pupils, slowed breathing, and sedation.

Oxycodone (Oxycontin) Specs:

Trade Name OxyContin, Percocet, Palladone, Vicodin, Norco, Lorcet, Zamicet, Verdrocet, Lortab, Anexsia
Other Names (other generics) Heroin, Fentanyl, Oxycodone, Hydrocodone, Codeine, Morphine, Pethidine
Classification Opioid analgesics
CYP Metabolism CYP3A4 & others
Interaction With CBD Metabolic competitor & agonistic interaction
Risk of Interaction Moderate

What Does Oxycodone (Oxycontin) Do?

Opioids like oxycodone (Oxycontin) bind to specific opioid receptors in the nervous system. There are three principal classes of opioid receptors. They are μ, κ, δ (mu, kappa, and delta). The abilities of an opioid depend on the receptor that it binds to. Each group of opioid receptors elicits a distinct set of neurological responses. These receptors mediate both the psychoactive and the somatic effects of opioids.

When the opioids attach to their respective receptors, they block the pain signals sent from various parts of the body through the spinal cord to the brain. They also trigger the brain to release dopamine, the hormone that makes you feel good. Every time you take opioids, you get feelings of relief from the pain combined with a sense of wellbeing and euphoria. This is the reason why these drugs become addictive.

Using them for a long time may cause a person to develop tolerance, inducing them to consume even more of the drug. If a person gets too used to consuming opioids, abruptly stopping them can cause withdrawal symptoms such as anxiety, restlessness, insomnia, watery eyes, body aches, vomiting, etc. These symptoms can last from a few days to weeks. So, to help ease the withdrawal symptoms in an opioid-addicted person, drugs such as methadone or buprenorphine are given, which bind to the opioid receptors in the brain but do not cause psychoactive symptoms.

There are different types of opioids. The most commonly used ones are codeine, morphine, hydrocodone, oxycodone, oxymorphone, etc.

At lower doses, opioids can make the person feel drowsy. But higher doses can slow down the breathing and heart rate, which could be dangerous.

Because of their addictive nature, use extreme caution when using opioids. Today they are primarily used for treating chronic pains such as cancer. Opioids are also some of the most abused drugs, with users suffering from opioid addiction.

Side Effects of Oxycodone (Oxycontin):

  • Abdominal pain
  • Anxiety
  • Asthenia
  • Constipation
  • Depression
  • Diarrhea
  • Dizziness
  • Fever
  • Headache
  • Hypersensitivity
  • Loss of appetite
  • Nausea
  • Peripheral edema
  • Pruritus
  • Rash
  • Respiratory depression
  • Somnolence
  • Sweating
  • Vomiting

Types of Drug Interactions With CBD

CBD, like many other medications, can interact with other drugs. So it is vital to monitor it very carefully when taking it with other medicines. It is because it may worsen their side effects. If you are using any meds alongside CBD, always be on the lookout for any abnormal side effects.

There are three ways that CBD can interact with other drugs. They are:

1. Agonistic Interaction

Agonistic interaction happens when two medicines have the same effect on the body. They work on the same receptors causing the effects in the same direction.

Examples of medications that could cause agonistic interaction with CBD are:

  • Antihypertensive Medications — These include central agonists, diuretics, ACE inhibitors, alpha-blockers, beta-blockers, calcium channel blockers, and angiotensin II receptor blockers. CBD can cause a drop in blood pressure on working alongside these medications.
  • Antidiabetic medications — These include GLP-1 receptor agonists, meglitinides, SGLT-2 inhibitors, sulfonylureas, and insulin, alpha-glucosidase inhibitors, DPP-4 inhibitors. CBD could increase the blood sugar-lowering ability of these medications.
  • Anti-anxiety medications — These include drugs like benzodiazepines and barbiturates. CBD could make their effects last longer and cause many side effects.

2. Antagonistic Interaction

This is the opposite of the agonistic interaction. It happens when two drugs have effects opposite of each other. If taken together, one drug would cross out the effects of the other, causing a decreased efficacy of the second drug.

Drugs that have antagonistic interaction with CBD are:

  • Immunosuppressants — These include azathioprine, mycophenolate cyclosporine, methotrexate, etc. CBD’s immune-stimulating properties may cause diminished effects of these drugs.
  • Stimulants — These include amphetamine, modafinil. CBD can cause a drop in its effects.
  • Immunomodulators — These include antihistamines like carbinoxamine, desloratadine, levocetirizine. CBD could enhance their sedative action.
  • Asthma Medications — These include drugs like albuterol, fluticasone, montelukast, ipratropium bromide, and theophylline. CBD may hinder their abilities, especially that of theophyllines.

3. Metabolic Inhibition

Metabolic competitors are medications that need similar enzymes to break down the drug molecules. It leads to both drugs competing against each other, causing their metabolism to slow down.

These include medications such as:

  • Blood thinners — CBD could cause an increment in the action of warfarin, enoxaparin, heparin, and others that could be very unsafe.
  • NSAIDs — These include ibuprofen, naproxen, high-dose aspirin. CBD could make them last longer in the body.
  • Opiate analgesics — These include morphine, codeine, hydrocodone. CBD could make them last longer in the bloodstream, creating complications.
  • Antidepressants — CBD can make these drugs last longer in the body by diminishing their metabolism. Antidepressants include trazodone, mirtazapine, vortioxetine, and vilazodone, and others.

Key Takeaways: Is It Safe to Take Oxycodone With CBD?

CBD and oxycodone are both common treatment options for chronic pain. Opioids are stronger, but they carry a far greater risk of dependency, addiction, side effects, and overdose.

For mild to moderate pain, or if seeking pain relief for the first time, CBD is the better option. Many doctors will try this supplement first and only upgrade to opioids if CBD proves insufficient.

It’s wise to avoid using CBD and opioids together because of the potential for adverse effects.

Always speak to your doctor before taking CBD and opioid medications together.

Cannabinoid-opioid interaction in chronic pain

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.

Comment in

Ware MA. Ware MA. Clin Pharmacol Ther. 2011 Dec;90(6):769-71. doi: 10.1038/clpt.2011.241. Clin Pharmacol Ther. 2011. PMID: 22089341

Chen BC, Hoffman RS. Chen BC, et al. Clin Pharmacol Ther. 2012 Jun;91(6):972; author reply 972-3. doi: 10.1038/clpt.2012.27. Clin Pharmacol Ther. 2012. PMID: 22534867 No abstract available.

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Can i take cbd oil with oxycodone for pain

Many promote cannabis as a safe and effective drug for chronic pain management, and have gone as far to argue that cannabis can reduce the need for opioid pain medications. At the same time, it is well appreciated that the co–use of certain substances is generally associated with poorer outcomes than single substance use. In this study, authors found that individuals with chronic pain who combine opioids and cannabis are not functioning as well as those who are only using opioids. Although the exact nature of this relationship is unclear, the results may have implications for medical cannabis in the context of chronic pain management.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Many people argue that cannabis is a safe and effective drug for chronic pain management , and have gone as far to say that cannabis can reduce the need for opioid pain medications and the risks that go with this class of drug . At the same time, the co-use of certain substances is generally associated with poorer outcomes than single substance use . In t his article , Rogers and colleagues assesse d whether individuals who were combin ing cannabis with opioid s to manage chronic pain had less self-reported pain than those using opioids alone, and whether individuals combining cannabis and opioids h ad more mood – related problems. The authors also explore d whether these individuals are more or less likely to have problems with opioids and engage in the use of other substances.

HOW WAS THIS STUDY CONDUCTED?

This cross-sectional study surveyed 450 United States adults who endorsed taking opioids to manage chronic pain. Of these 450 people, 176 endorsed also using cannabis for pain management. Participants were asked about their opioid and cann a bis use, as well as any use of other substances , including nicotine. Participants were also assessed for opioid use problems , a s well as anxiety and depression. Questionnaires administered included 1) the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) , an 8-item questionnaire designed to asses risk of substance use involvement , 2) the p atient Health Questionnaire-4 (PHQ-4) , a 4-item self-report measure comprised of the PHQ-2 for depression and the GAD-2 for anxiety , 3) t he Current Opioid Misuse Measure (COMM) that is used to identify individuals who are exhibiting behaviors of problematic opioid use , 4) the Severity of Dependence Scale (SDS) , a measure severity of dependence to opioids , and 5) t he Graded Chronic Pain Scale (GCPS) , a measure that assesses pain intensity and pain disability . The authors statistically controlled for differences among study participants in age, sex, income, and education.

Participants were adults ages of 18 to 64 (74.67% female, average 38.59 years old , standard deviation of 11.09) reporting current opioid use for pain and current chronic pain that persisted for at least 3 months. The sample was predominately White (77.8%), with another 8.7% identifying as Black/African American, 13.1% Hispanic/Latino, 3.3% Native American/Alaska Native, 0.9% Asian/Pacific Islander 2.7% multiracial, and 1.1% other. In terms of education, a little over a fifth (5.8%) did not complete high school, whereas over a quarter of the sample (31.3%) reported attaining a high school diploma, with 22.4% reporting ‘‘some college,’’ and 40.4% having attained an associate ’s degree or higher.

WHAT DID THIS STUDY FIND?

C ompared to participants using opioids alone to manage chronic pain, those combining opioids with cannabis endorsed greater anxiety and depression. Notably, participants combining opioids and cannabis were also more likely to be taking opioids not as prescribed and had greater scores on an opioid dependence severity scale , and were more likely to be using tobacco, alcohol, cocaine, and sedatives. This overall pattern of poorer functioning and risky substance use is illustrated in the figure below. At the same time, participants combining opioids and cannabis reported pain levels similar to those using opioids alone .

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This paper’s findings suggest that combining opioids with cannabis to manage chronic pain doesn’t help with pain over and above taking opioids alone, although it is possible that those combining opioids with cannabis had greater pain to begin with that was not being adequately managed with opioids alone. At the same time, it should be noted that participant pain scores, on average, were not especially high. Both groups reported pain intensity and pain-related disability scores on the Graded Chronic Pain Scale that were in the low range. It is possible this sample represents individuals with less severe chronic pain. As such, it is possible these results would not generalize to adults with more severe pain intensity and disability.

Problematically, those combining opioids with cannabis had greater anxiety and depression than those using opioids alone, although the absolute differences between groups on these measures was not large. Because this is a cross sectional study (i.e., a single survey providing a snapshot in time), it is impossible to know whether cannabis use was leading to greater anxiety and depression, or individuals with greater anxiety and depression were more likely to be using cannabis to cope. If these more vulnerable individuals are, in fact, using cannabis to cope with difficult mental health concerns, it does not seem to be helping subjectively given their poorer functioning, although it could be that they had higher anxiety and depression to begin with, and cannabis use brought this down to the same level.

Those combining opioids with cannabis were also more likely to be taking opioids not as prescribed and have symptoms of opioid dependence, in addition to endorsing using other substances. It is possible these individuals may represent a subset of people with chronic pain and greater overall substance use-related problems.

Also, these individuals were possibly purchasing cannabis from the illicit market in which strains with higher THC contents predominate (the compound in cannabis that causes euphoria/high). This study cannot tease apart whether CBD (a compound in cannabis thought to have some therapeutic benefits but does not cause euphoria/high) in combination with opioids for chronic pain would be associated with different mental health and substance use outcomes.

  1. As the authors note, because this was a cross-sectional study (i.e., a single survey providing a snapshot in time), it is impossible to know if differences between groups were causes or effects of cannabis use in addition to opioid use.
  2. It is not clear whether opioids or cannabis were prescribed, or the kinds of quantities participants were taking.
  3. The authors also highlight the fact that geographic location was not controlled for in this study. It is therefore not clear how participants’ location influenced results. For instance, it is not known if individuals using cannabis lived in areas where cannabis is legal.
  4. Also, all data in this paper were provided by self-report. Because participants were not objectively tested for substance use (i.e., with laboratory tests), it cannot be known if participants underreported or overreported substance use.
BOTTOM LINE
  • For individuals and families seeking recovery:Results suggest that using cannabis in addition to opioids may not have an additive benefit on pain reduction for individuals with chronic pain. Also, it appears those combining opioids and cannabis may be more likely to experience problems with opioids. Though it cannot be determined if cannabis in addition to opioids for chronic pain leads to greater substance use problems, or people with greater opioid use problems are simply more likely to use cannabis, it is recommended that those taking opioids for chronic pain conditions reduce their risk for developing substance use problems by not combining drugs.
  • Fortreatment professionals and treatment systems:At least for people experiencing mild pain, present findings suggest there may not be a benefit for cannabis use over and above opioid use and indicate that combining these substances is associated with greater substance use problems, and higher levels of negative affect. It is not clear, however, whether there would be benefit for individuals with greater pain severity.
  • For scientists:Results suggest that using cannabis in addition to opioids may not have an additive benefit on pain reduction for individuals with chronic pain and that combining these drugs may be associated with greater drug-related problems. Considering the growing legalization of cannabis around the United States and other countries around the world, more work is urgently needed to better understand the possible public health implications of this drug combination.
  • For policy makers:Results suggest that using cannabis in addition to opioids may not have an additive benefit on pain reduction for individuals with chronic pain and that combining these drugs may be associated with greater drug-related problems. The findings in this paper are preliminary, but they speak to risks associated with combining cannabis with opioids. Funding research in this area is critical considering the growing legalization of cannabis around the United States and other countries around the world. Cannabis legalization, and with it easier, cheaper access to this drug will likely result in more individuals combining opioids with cannabis to manage chronic pain. Based on the findings reported by these authors, the negative public health implications of this could be great, but more longitudinal research is necessary to help understand whether in fact various cannabis components (e.g., THC, CBD) have therapeutic potential for low-moderate pain either alone or in combination with opioids.
CITATIONS

Rogers, A. H., Bakhshaie, J., Buckner, J. D., Orr, M. F., Paulus, D. J., Ditre, J. W., & Zvolensky, M. J. (2018). Opioid and cannabis co-use among adults with chronic pain: Relations to substance misuse, mental health, and pain experience. Journal of Addiction Medicine, (Epub ahead of print). doi: 10.1097/ADM.0000000000000493