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The UK has a significant opioid prescribing problem. It doesn’t dominate the headlines the way the American opioid crisis has, but the numbers are stark: over 5.6 million opioid prescriptions are issued each month in England alone, and the rate of long-term prescribing has risen substantially over the past two decades, despite mounting evidence that opioids are poorly suited to managing chronic non-cancer pain.
If you are one of the many patients who has been prescribed opioids, morphine, oxycodone, fentanyl, tramadol, codeine, or others, for a long-term condition, this page is designed to help you understand how they compare to medical cannabis as a treatment option, and what the research actually says.
Common opioids prescribed in the UK include:
All work by binding to opioid receptors in the brain and spinal cord to suppress pain signals. All carry risks of tolerance, physical dependence, and, at sufficient doses or in combination with other CNS depressants, overdose.
NICE guidance on chronic primary pain explicitly states that opioids should not be routinely offered for this condition. The Faculty of Pain Medicine’s Opioids Aware programme exists precisely because long-term opioid prescribing for non-cancer pain has been shown, in most cases, to provide limited benefit while accumulating significant harm.
Tolerance means the dose that managed your pain at six months may be insufficient at two years. Dependence means stopping opioids, even when you want to, triggers a withdrawal syndrome that mimics severe illness. And unlike short-term use, long-term opioid therapy for chronic pain is associated with:
Many patients on long-term opioids describe a cycle that is difficult to escape: the drug provides some relief, but their overall quality of life has worsened, their world has narrowed, and they feel trapped between pain and medication.
The evidence comparing medical cannabis and opioids for chronic pain has grown substantially in recent years.
A 2024 systematic review and network meta-analysis published in BMJ Open, evaluating randomised controlled trials of cannabis versus opioids for chronic non-cancer pain, found that cannabinoids produced comparable pain relief to opioids, with a more favourable safety profile across key metrics including dependence risk, overdose potential, and side effect burden.
At a population level, a study of patients enrolled in New York State’s medical cannabis programme found that those newly certified for medical cannabis showed significantly reduced opioid prescription receipt compared to matched controls, suggesting real-world substitution is occurring at scale.
A further study tracking 100 chronic pain patients prescribed medical cannabis found that 93% reported a decrease or cessation of opioid use following the start of treatment. A cost-effectiveness analysis published in 2024 found that medical cannabis as an alternative to opioids for chronic pain produced similar clinical outcomes while reducing overall treatment-related costs.
| Opioids | Medical Cannabis | |
| Mechanism | Opioid receptor binding — suppresses pain signals | Endocannabinoid system — modulates pain, inflammation, and sleep |
| Fatal overdose risk | Yes — significant, especially with CNS depressants | No known fatal dose |
| Physical dependence | High — develops rapidly | Lower, but possible with daily use |
| Withdrawal severity | Significant — medically managed tapering required | Milder — irritability, sleep disruption, typically brief |
| Long-term harms | Hyperalgesia, hormonal disruption, and immune effects | Evidence still emerging; no comparable systemic harms identified |
| Targets | Pain signalling primarily | Pain, sleep, mood, anxiety, inflammation |
| NICE position | Not recommended for chronic primary pain | Considered where other treatments have failed |
For some patients, yes, in full or in part. For others, it forms part of a supervised opioid reduction strategy rather than an outright replacement. The conditions where the evidence is strongest include:
It is not a panacea, and treatment outcomes depend on the individual, their condition, and the formulation prescribed. But for patients who have been on opioids long-term and are experiencing diminishing returns, increasing side effects, or a growing concern about dependence, it represents a legitimate clinical conversation.
A More Individualised Approach.
Medical cannabis treatment plans can be tailored to the individual using different cannabinoid ratios, strengths, and delivery methods. This allows clinicians to create personalised treatment strategies based on a patient’s symptoms, lifestyle, and treatment goals.
Many people living with chronic pain also experience disrupted sleep. Certain cannabis formulations may help support deeper, more restorative sleep, which can have a positive impact on overall well-being and daily function.
CBD-rich medical cannabis treatments may also help reduce inflammation associated with chronic health conditions, potentially improving comfort and mobility over time.
Patients using medical cannabis often report broader quality-of-life improvements, including better mobility, improved mood, increased energy levels, enhanced sleep quality, and greater day-to-day comfort.
Medical cannabis generally carries a lower risk of overdose and dependency compared to opioids. However, all treatments should be used under medical supervision.
Some patients use medical cannabis alongside opioids as part of a supervised treatment plan. A clinician can advise on safety and dosing.
Medical cannabis may help reduce pain levels and improve quality of life, but results vary between individuals.
Both cannabinoids may play a role in pain management. Some patients benefit from CBD-dominant products, while others require balanced THC and CBD formulations.
Some patients report symptom relief during opioid reduction, but this should always be medically supervised.
Medical cannabis may be suitable for patients who:
A consultation with a qualified medical cannabis clinician is the best way to determine suitability.
As awareness grows around the risks associated with long-term opioid use, more patients are considering medical cannabis as part of a safer chronic pain management strategy.
A personalised treatment plan may help support:
If you are exploring alternatives to opioids, speaking with a specialist medical cannabis clinic can help you understand your options and determine whether treatment may be appropriate for your condition.
Discover whether medical cannabis could help you manage chronic pain with fewer risks and a more personalised treatment approach than traditional opioids.
Medical Disclaimer
This content is intended for general informational purposes only and does not constitute medical advice. Medical cannabis should be used under the supervision of a qualified healthcare professional in accordance with UK regulations.
