Can You Use CBD While on a Pain Contract? - October 2024

Can CBD Interact With Medications Taken Specifically for Pain? 

CBD may induce drug interactions when taken with other medications⁽¹⁾.  

Research showed that cannabidiol may negatively interact with opioids, benzodiazepines, and antihistamines⁽²⁾. In addition to interacting with pain medications, CBD may also interact with over-the-counter (OTC) medicines⁽³⁾.   

Pain contracts may aim to prevent patients from mixing prescriptions⁽⁴⁾. However, some patients may seek non-opioid pain-relieving substances not included in a pain management contract.

For instance, individuals under a pain management agreement may seek CBD as an alternative therapy. They should consult with their physicians before taking other medicines besides prescribed treatments. 

What Is CBD Oil?

CBD oil is a cannabis-derived extract that is diluted with a carrier oil. Cannabidiol is one of over 100 plant-based compounds known as cannabinoids from the cannabis plant⁽⁵⁾. 

CBD oil manufacturers extract this compound from the hemp plant, a variety of Cannabis sativa.  

Unlike the cannabinoid known as tetrahydrocannabinol (THC), CBD is non-psychoactive⁽⁶⁾. Thus, it does not produce euphoric feelings or a “high.”

Studies show that CBD may help reduce or relieve symptoms related to chronic pain⁽⁷⁾, anxiety⁽⁸⁾, and sleep disorders⁽⁹⁾. However, additional research is needed to investigate CBD’s efficacy.

The World Health Organization (WHO) reported that CBD has a generally safe profile⁽¹⁰⁾. However, cannabidiol products like CBD oil may produce mild side effects, including dry mouth, drowsiness, and changes in appetite⁽¹¹⁾.

What Exactly Is a Pain Management Contract?

Some physicians ask patients to sign a “pain contract” or “opioid treatment agreement.” This document contains the guidelines patients must follow to help ensure the safe administration of prescription opioids⁽¹²⁾.  

In 2019, the Centers for Disease Control and Prevention (CDC) reported that approximately one-fifth of Americans experienced chronic pain⁽¹³⁾. Chronic pain continues for months or occurs regularly.  

Doctors frequently prescribe powerful painkillers known as opioids⁽¹⁴⁾. These medications are synthetic or natural versions of opium, a narcotic drug obtained from seedpods of the opium poppy plant.  

While opioids may be highly effective, they can cause health conditions such as respiratory depression and addiction⁽¹⁵⁾. Respiratory depression causes breathing to slow⁽¹⁶⁾.  

Requirements of pain contracts may involve the prescribing and purchasing of medications⁽¹⁷⁾. 

5 Common Guidelines Detailed in Pain Management Contracts 

Various elements are consistent in many pain agreements. It would help if you contemplated the following essential aspects before you sign your name: 

1. Patients Must Take Medications As Prescribed 

Generally, you must take the exact dosage⁽¹⁸⁾. Thus, you cannot decrease the dosage or bypass drug administration on “low-pain” days.  

2. Drug Testing Is Permitted 

When on a pain contract, you must frequently agree to random drug testing⁽¹⁹⁾. These requirements help avoid drug abuse and non-authorized drug usage. 

3. Only a Single Pharmacy Is Allowed

You likely must agree to purchase all prescriptions at one pharmacy⁽²⁰⁾. This requirement aims to prevent drug abuse through filling multiple physician-prescribed medications at various pharmacies. 

4. Replacement Medication Is Disallowed

According to this common requirement, you agree to avoid replacing lost or stolen prescription medicines⁽²¹⁾. Thus, ensure that your medications are always safeguarded. 

5. Prescriptions Must Originate From One Provider 

According to this stipulation, you agree to avoid requesting or taking pain medications from multiple healthcare providers⁽²²⁾. 

Primary Concerns About Pain Management Contracts

Pain management agreements can inform patients about doctors’ expectations and the safe administration of medications.  

However, critics argue that the agreements may diminish the patient-doctor relationship. Their primary concerns include:  

Patients May Become Disempowered

Some critics of pain contracts argue that people with chronic pain become more vulnerable due to the balance of power shifting to the physician⁽²³⁾. 

The Contract’s Phrasing May Demean Patients 

Requirements of pain contracts such as needing to secure pain medications through a single provider and pharmacy may offend some patients. They may surmise that physicians assume they have developed drug addictions despite using medications responsibly.

Precautionary Measures for Pain Management Agreements

Individuals considering a pain management agreement should comprehend all contract details, including rules and stipulations. It would be prudent to inquire about any unclear terms of the deal. 

For instance, if you fail to follow the agreement, your doctor may refuse to prescribe future pain medications. A physician may also dismiss you as a patient. 

Legality and Implications of Pain Contracts for Drug Testing

Research suggests that CBD products may be a promising alternative therapy for chronic pain⁽²⁴⁾. However, one potential issue is cannabidiol’s effects on an individual’s ability to pass workplace drug tests. 

The United States Food and Drug Administration (FDA) requires CBD products sold in retail stores and online to contain no more than 0.3% THC⁽²⁵⁾. 

CBD alone may not produce a positive drug test. However, trace amounts of THC may accumulate over time and result in a false-positive drug test⁽²⁶⁾.  

It is advisable to compare CBD and THC content with product label claims⁽²⁷⁾.

You can check a CBD product’s certificate of analysis (COA) to verify if it contains THC. This document and third-party lab testing may help confirm if products like CBD oil comply with federal and state regulations of cannabidiol. 

Consulting your doctor or another medical professional is indispensable for further insight before taking CBD for health-related concerns, including chronic pain. 

1. Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678684/
2. CBD and other medications: Proceed with caution https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743
3. Ibid.
4. Some Doctors Ask Patients To Sign ‘Pain Contracts’ To Get Prescriptions
   https://khn.org/news/michelle-andrews-on-pain-contracts-and-opioid-agreements/
5. Effects of Cannabidiol (CBD) on the Brain (CBD)
   https://clinicaltrials.gov/ct2/show/NCT04831294
6. Cannabidiol and Other Non-Psychoactive Cannabinoids for Prevention and Treatment of Gastrointestinal Disorders: Useful
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246936/
7. A Balanced Approach for Cannabidiol Use in Chronic Pain
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204604/
8. Cannabidiol as a Potential Treatment for Anxiety Disorders
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
9. Cannabidiol in Anxiety and Sleep: A Large Case Series
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/
10. Cannabidiol (CBD) Critical Review Report
    https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf
11. 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
12. Opioid Treatment Agreements: Helpful or Hurtful?
    https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2016.110905
13. Chronic-Pain and High-Impact Chronic Pain Among U.S. Adults, 2019
    https://www.cdc.gov/nchs/products/databriefs/db390.htm
14. Some Doctors Ask Patients To Sign ‘Pain Contracts’ To Get Prescriptions
    https://khn.org/news/michelle-andrews-on-pain-contracts-and-opioid-agreements/
15. Ibid.
16. Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression
    https://pubs.asahq.org/anesthesiology/article/112/1/226/10219/Incidence-Reversal-and-Prevention-of-Opioid
17. Some Doctors Ask Patients To Sign ‘Pain Contracts’ To Get Prescriptions
    https://khn.org/news/michelle-andrews-on-pain-contracts-and-opioid-agreements/
18. Ibid.
19. Opioid contracts and random drug testing for people with chronic pain – think twice
    https://pubmed.ncbi.nlm.nih.gov/20122120/
20. Some Doctors Ask Patients To Sign ‘Pain Contracts’ To Get Prescriptions
    https://khn.org/news/michelle-andrews-on-pain-contracts-and-opioid-agreements/
21. Use of narcotics contracts
    https://journalofethics.ama-assn.org/article/use-narcotics-contracts/2013-05
22. Ibid.
23. Ibid.
24. A Balanced Approach for Cannabidiol Use in Chronic Pain
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204604/
25. FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD)
    https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
26. Can You Take CBD and Pass a Drug Test?
    https://www.consumerreports.org/cbd/can-you-take-cbd-and-pass-a-drug-test/
27. Content vs. Label Claim: A Survey of CBD Content in Commercially Available Products
    https://www.fda.gov/media/128364/download