- Research suggests that CBD may help relieve difficult-to-manage pain associated with conditions such as rheumatoid arthritis(1).
- Cannabinoids may augment the pain-relieving effects of opioids like oxycodone(2).   Â
- Cannabidiol(3) and oxycodone(4) may individually induce drowsiness. Thus, CBD-oxycodone coadministration may augment the side effect’s severity.
- Before starting any CBD product, one should consult a physician, particularly when taking opioids such as oxycodone.Â
Can Individuals Take CBD With Oxycodone for Pain?Â
Research suggests that cannabinoids, including cannabidiol (CBD), have purported analgesic (pain-relieving) effects(5). However, researchers of a 2020 study indicated that CBD and oxycodone together may induce side effects(6).
CBD, a non-psychoactive cannabinoid in hemp, may relieve symptoms from health conditions with difficult-to-manage pain, such as rheumatoid arthritis (RA)(7). RA is a chronic inflammatory disorder.Â
Oxycodone is a narcotic analgesic (pain reliever) that physicians prescribe when pain is severe enough to necessitate opioid treatment(8). Â
A medical study published in Clinical Pharmacology and Therapeutics examined potential cannabinoid-opioid interaction, including oxycodone in chronic pain therapy(9). The administration method included vaporized cannabis. Â
Researchers reported that coadministration may permit opioid treatments with lower dosages and fewer side effects. More research is needed to determine if CBD-oxycodone coadministration produces similar results.Â
A study published in Neuropsychopharmacology showed that CBD may reduce chronic pain by blocking pain receptors in the endocannabinoid system (ECS) of rodents(10).
Additional human clinical trials are required on CBD’s potential pain-relieving effects.Â
A study suggested that individuals may tolerate dosages up to 1,500mg well(11). It is highly advisable to take small doses of CBD in small increments until they achieve the desired effects. Â
CBD may induce mild side effects and drug interactions(12). Individuals should seek medical advice from a physician before using any CBD product.Â
Studies and Research on CBD’s Interaction With Oxycodone
Opioids, such as oxycodone, may help alleviate chronic pain(13) and acute postoperative pain(14).Â
A study published in Neuropsychopharmacology hypothesized that the coadministration of cannabinoids and oxycodone may increase an individual’s pain tolerance(15).Â
However, another study suggested that cannabidiol may interfere with pain management by inhibiting the cytochrome P450 (CYP450) enzymes(16).Â
CBD and other cannabinoids may interact with CYP450 liver enzymes for drug metabolism(17).  Â
CPY450 enzymes are responsible for the initial metabolism of oxycodone(18).
CBD may produce similar interactions with other CYP450-metabolized drugs. Â
Additionally, research suggested that oxycodone may cause side effects, such as drowsiness, dizziness, headache, nausea, and constipation(19).
The National Institute of Drug Abuse (NIDA) indicated that opioids may cause a euphoric effect, possibly leading to substance misuse and abuse(20). Â
A medical study suggested that cannabinoids may function as an alternative to oxycodone for chronic neck and back pain(21).Â
CBD may have comparable efficacy and a better safety profile to opioids for pain management, according to a 2019 study(22).Â
Another review published in Neurotherapeutics reported that CBD may help individuals experiencing withdrawal from opioid dependence and addiction(23).
Research suggests that cannabis-sourced tetrahydrocannabinol (THC) Â and CBD may help improve opioid use disorder (OUD) functioning as a pain-relieving alternative(24).
However, more research is required on CBD’s interaction with opioids, including its potential to counteract prescription painkillers.Â
Potential Side Effects
Research shows that CBD oil and oxycodone may induce side effects.Â
CBD may produce particular mild side effects, including dry mouth, tiredness, drowsiness, loss of appetite, and diarrhea(25).Â
Meanwhile, research showed that oxycodone may induce side effects, such as dizziness, drowsiness, headache, and nausea(26).Â
Potential Doubling of Side Effects
Taking CBD with other medications with similar side effects may increase the risk of unwanted symptoms, according to Harvard Health Publishing(27).  Â
For example, CBD and oxycodone may both cause dizziness. Coadministration may thus exponentially increase drowsiness in individuals. However, more research is needed.Â
The coadministration of CBD and other opioids may also induce dizziness(28). Â
Does the Form of CBD Matter?Â
The CBD application an individual opts for may affect potential drug interactions. Â
Inhaled CBD through vaping may enter the bloodstream instantly, potentially inducing more rapid drug interactions.
However, vaping may also worsen existing lung conditions(29).Â
Edibles require more time for absorption as they must pass through the digestive tract. However, edibles may eventually interact with other medications. Â
Other administration methods for CBD include sublingually (under the tongue), topically (creams, lotions, balms, and salves), and transdermally (patches).Â
Other Potential CBD Interactions and Risk Factors
The Food and Drug Administration (FDA) expounded that consuming grapefruit while taking several medications may induce adverse side effects and an overdose(30).  Â
Research shows that grapefruit juice inhibits CYP3A4 enzymes(31). In addition, CBD may play a vital role in inhibiting CYP3A enzymes(32). Â
CYP3A is one of the most crucial cytochrome P450 isoforms (variants) for drug metabolism(33). CBD and grapefruit juice may exacerbate the CYP3A-inhibiting effects of each other.Â
Research also suggests that CBD may induce severe interactions with particular prescription medications, including specific anticoagulants (blood thinners) and heart, thyroid, and seizure medications(34).Â
Thus, these medications may be bad options for applications with CBD oil. Additional research is necessary on the potential drug interactions.  Â
Coadministration of CBD and particular pharmaceuticals may be safe. However, Individuals should consult their doctors before taking CBD with other prescription medications or dietary supplements.
Individuals Who Should Potentially Not Take CBD
The government of Alberta, Canada, recommends that particular individuals should consider not using cannabinoids, including pregnant women and those with(35):Â
- Liver disease
- Heart disease
- Addictions including alcohol use disorder (AUD) and OUDÂ Â
- Untreated mood disordersÂ
Individuals with such physical and mental health conditions should consult their physicians or other medical practitioners before using CBD. They can guide them on the proper usage and dosage of CBD products.Â
Legality of CBD
Most United States states have legalized medical marijuana, while the remaining states have legalized CBD extract with possible restrictions(36).Â
The 2018 Farm Bill states that CBD with less than 0.3% THC can be sold and used at the federal level(37). However, the FDA prohibits selling and advertising CBD products as dietary supplements. Â
Additionally, the federal agency has not released an FDA-approved CBD dosing guideline for pain management.
Marijuana is still illegal in the US. The substance is designated a Schedule I drug due to addictive or abusive properties with no officially recognized benefits(38).Â
Individuals should review various state laws regarding cannabidiol use.
- Joints for joints: cannabinoids in the treatment of rheumatoid arthritis.
https://doi.org/10.1097/BOR.0000000000000590 - Cannabinoid-opioid interaction in chronic pain
https://pubmed.ncbi.nlm.nih.gov/22048225/ - What are the benefits of CBD — and is it safe to use? https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
- Oxycodone-related side effects: impact on degree of bother, adherence, pain relief, satisfaction, and quality of life
https://doi.org/10.5055/jom.2010.0063 - Cannabinoids in the management of difficult to treat pain https://doi.org/10.2147/tcrm.s1928
- Potential Pharmacokinetic Drug-Drug Interactions between Cannabinoids and Drugs Used for Chronic Pain
https://doi.org/10.1155/2020/3902740 - Joints for joints: cannabinoids in the treatment of rheumatoid arthritis.
https://doi.org/10.1097/BOR.0000000000000590 - Oxycodone (Oral Route)
https://www.mayoclinic.org/drugs-supplements/oxycodone-oral-route/description/drg-20074193 - Cannabinoid-opioid interaction in chronic pain
https://pubmed.ncbi.nlm.nih.gov/22048225/ - The Endogenous Cannabinoid System: A Budding Source of Targets for Treating Inflammatory and Neuropathic Pain.
https://doi.org/10.1038/npp.2017.204 - Cannabidiol Adverse Effects and Toxicity https://doi.org/10.2174/1570159X17666190603171901
- What are the benefits of CBD — and is it safe to use?
https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700 - Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). https://doi.org/10.1111/j.1533-2500.2008.00204.x
- Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials
https://pubmed.ncbi.nlm.nih.gov/28226340/ - Impact of coadministration of oxycodone and smoked cannabis on analgesia and abuse liability
https://doi.org/10.1038/s41386-018-0011-2 - Potential Pharmacokinetic Drug-Drug Interactions between Cannabinoids and Drugs Used for Chronic Pain
https://doi.org/10.1155/2020/3902740 - An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies
https://doi.org/10.1089/can.2016.0034 - Quantitative contribution of CYP2D6 and CYP3A to oxycodone metabolism in human liver and intestinal microsomes
https://pubmed.ncbi.nlm.nih.gov/15039299/ - Oxycodone-related side effects: impact on degree of bother, adherence, pain relief, satisfaction, and quality of life
https://doi.org/10.5055/jom.2010.0063 - Overdose crisis https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
- Cannabis Versus Oxycodone for Pain Relief https://clinicaltrials.gov/ct2/show/NCT02892591
- Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study https://doi.org/10.1080/00325481.2019.1685298
- Early Phase in the Development of Cannabidiol as a Treatment for Addiction: Opioid Relapse Takes Initial Center Stage
https://doi.org/10.1007/s13311-015-0373-7 - Emerging Evidence for Cannabis’ Role in Opioid Use Disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/ - What are the benefits of CBD — and is it safe to use? https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/is-cbd-safe-and-effective/faq-20446700
- Oxycodone-related side effects: impact on degree of bother, adherence, pain relief, satisfaction, and quality of life
https://doi.org/10.5055/jom.2010.0063 - CBD and other medications: Proceed with caution
https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743 - CBD and other medications: Proceed with caution
https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743 - Â Pulmonary Toxicity and the Pathophysiology of Electronic Cigarette, or Vaping Product, Use Associated Lung Injury
https://doi.org/10.3389/fphar.2019.01619 - Grapefruit Juice and Some Drugs Don’t Mix
https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix - Grapefruit juice
https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/grapefruit-juice - Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety
https://pubmed.ncbi.nlm.nih.gov/21356216/ - Cytochrome P4503A (CYP3A) metabolism: prediction of in vivo activity in humans
https://pubmed.ncbi.nlm.nih.gov/9131486/ - CBD and other medications: Proceed with caution
https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743 - Managing chronic pain with cannabinoids
https://myhealth.alberta.ca/Alberta/Pages/Cannabinoids-and-Managing-Chronic-Pain-.aspx - States with Legal Cannabidiol (CBD)
https://medicalmarijuana.procon.org/states-with-legal-cannabidiol-cbd/ - Farm Bill. U.S. Department of Agriculture
https://www.usda.gov/farmbill - U.S. Food and Drug Administration https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd