Substituting Cannabidiol for Opioids and Pain Medications Among Individuals With Fibromyalgia: A Large Online Survey

Abstract

People report substituting cannabis for pain medications, but whether cannabidiol (CBD) is used similarly remains unknown. CBD products can be CBD alone (isolate), hemp extract (containing <0.3% Δ-9-tetrahydrocannabinol [THC], other cannabinoids, and terpenes), or CBD-cannabis (containing >0.3% THC). In a secondary analysis from a cross-sectional survey, we examined substitution patterns among n = 878 individuals with fibromyalgia who currently used CBD. We sub-grouped participants by most commonly used CBD product (CBD isolate, hemp, CBD-cannabis, no preference) and whether they substituted CBD for medications. We investigated rationale for substituting, substitution-driven medication changes, CBD use patterns, and changes in pain-related symptoms (eg, sleep, anxiety). The study population was 93.6% female and 91.5% Caucasian, with an average age of 55.5 years. The majority (n = 632, 72.0%) reported substituting CBD products for medications, most commonly NSAIDs (59.0%), opioids (53.3%), gabapentanoids (35.0%), and benzodiazepines (23.1%). Most substituting participants reported decreasing or stopping use of these pain medications. The most common reasons for substitution were fewer side effects and better symptom management. Age, hemp products, past-year use of marijuana, and higher somatic burden were all associated with substituting (P's ≤ .05). Those who substituted reported larger improvements in health and pain than those who did not. Participants using CBD-cannabis reported significantly more substitutions than any other group (P's ≤ .001) and larger improvements in health, pain, memory, and sleep than other subgroups. This widespread naturalistic substitution for pain medications suggests the need for more rigorous study designs to examine this effect. PERSPECTIVE: This article shows that people with fibromyalgia are deliberately substituting CBD products for conventional pain medications despite the dearth of evidence suggesting CBD products may be helpful for fibromyalgia. CBD's medication-sparing and therapeutic potential should be examined in more rigorous study designs.

Keywords: Cannabidiol; Fibromyalgia; Hemp; Opioids; Substitution.

Figure 1.. Substitution of CBD for pain medications among study population

Participants reported large decreases in pain medication use across numerous medication classes.

Figure 2. a. Changes in symptoms based on CBD products use. b. Changes in symptoms by substitutions.

Symptom changes ranged from very much worse (1) through very much improved (7). Error bars indicate standard deviation. Brackets indicate pairwise differences with Tukey’s test, with comparisons only conducted for symptom differences that were statistically significant via ANOVA after adjustment using the Benjamini-Hochberg procedure. *: Indicates p < 0.05 **: Indicates p < 0.005

Figure 2. a. Changes in symptoms based on CBD products use. b. Changes in symptoms by substitutions.

Symptom changes ranged from very much worse (1) through very much improved (7). Error bars indicate standard deviation. Brackets indicate pairwise differences with Tukey’s test, with comparisons only conducted for symptom differences that were statistically significant via ANOVA after adjustment using the Benjamini-Hochberg procedure. *: Indicates p < 0.05 **: Indicates p < 0.005