Opioid-sparing effects of cannabinoids on morphine analgesia: participation of CB and CB receptors.

Much of the opioid epidemic arose from abuse of prescription opioid drugs. This study sought to determine if the combination of a cannabinoid with an opioid could produce additive or synergistic effects on pain, allowing reduction in the opioid dose needed for maximal analgesia.Pain was assayed using the formalin test in mice and the carrageenan assay in rats. Morphine and two synthetic cannabinoids were tested: WIN55,212-2 (WIN), which binds to both CB and CB receptors, and possibly TRPV1 channels; and GP1a, which has activity at CB receptors and is reported to inhibit fatty acid amide hydrolase, thus raising levels of endogenous cannabinoids.Morphine in combination with WIN in the formalin test gave synergistic analgesia. Studies with selective antagonists showed that WIN was acting through CB receptors. Morphine in combination with GP1a in the formalin test was sub-additive. In the carrageenan test, WIN had no added effect when combined with morphine, but GP1a with morphine showed enhanced analgesia. Both WIN and Gp1a used alone had analgesic activity in the formalin pain test, but not in the carrageenan pain test.The ability of a cannabinoid to produce an additive or synergistic effect on analgesia when combined with morphine varies with the pain assay and may be mediated by CB or CB receptors. These results hold the promise of using cannabinoids to reduce the dose of opioids for analgesia in certain pain conditions.