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Is Long-Acting Synthetic Cannabidiol a Solution to Chronic Pain?

P-029 - (Poster #29) Is Long-Acting Synthetic Cannabidiol a Solution to Chronic Pain?

Thursday, September 4, 2025
4:00 PM - 5:30 PM PST
Location:  Exhibit Hall (Level 4)
Background:






Opioids are effective analgesics but their use in chronic painful conditions remains controversial.1 Despite this fact, 22.1% of adults with chronic pain in the United States were prescribed an opioid analgesic in the past three months.2 In addition to tolerance and opioid use disorder, opioids are associated with treatment-limiting side effects. Their widespread use is an indication that we have no better alternatives.

 

Records of the medical use of Cannabis plant go back to 2700 B.C. in China, and Cannabis not made illegal in the United States until 1937. 3 The two main constituents of the Cannabis sativa plant are cannabidiol (CBD) and tetrahydrocannabinol (THC), both of which have analgesic properties, but only THC is psychoactive.

 

The use of any botanical is complicated by the fact that there are many varieties of plants, purity can vary, and dosing of organic substances is not precise. The role of a synthetic CBD product would produce a pharmaceutical-grade analgesic, which in a long-acting formulation would be particularly well suited to replace opioids for chronic pain control.



Purpose/Objectives:






This is a narrative review of the current literature, conducted with the objective of exploring the potential role for CBD, THC, and synthetic formulations of these substances for providing relief to those with chronic pain. Despite the fact that chronic pain is an ancient medical complaint, no ideal solution for this ubiquitous problem has ever been offered. Current approaches to “medical marijuana” are often haphazard and idiosyncratic. This research was to review synthetic product formulations and how they might be used under conventional medical guidance.



Methods:

This is a narrative review of the current literature and was conducted using the PubMed and Google Scholar databases. Searches were conducted in November 2023  for clinical trials and randomized clinical trials relating to CBD, cannabinoids, and synthetic cannabinoids with pain control as an endpoint. This results in 52 hits. In addition, bibliographies were reviewed for other articles.

 
Articles were included if they were clinical trials or randomized clinical trials with pain endpoints; articles not in English, not a clinical trial or randomized clinical trial or not related to pain were excluded.

Results:








The endocannabinoid system has two main receptors, CB-1 and CB-2. Cannabinoids (CBD and THC)  interact promiscuously with these two receptors, which also interact with each other in a dynamic way. Nevertheless, CBD, which has recently proven to have weak affinity to CB-2 receptor, is suggested to mediate its biological activities via alternative mechanisms. First-pass metabolism of oral CBD products reduces its bioavailability to 6-20%, thus route of administration as well as dosing can be important for adequate analgesia.4

 

Chronic pain differs mechanistically from acute pain and pharmacological solutions to date have drawbacks in the form of side effects (opioids) and potential toxicity (NSAIDs). Synthetic formulations of CBD, THC, and combination products of CBD:THC have been evaluated in numerous clinical studies with good results, particularly for chronic cancer pain, gynecological pain, and neuropathic pain or chronic pain with a neuropathic component.

 

Synthetic CBD is considered safe and studies have shown few and mild side effects although dose-dependent adverse effects are possible.

 

The general perception of CBD among laypersons is positive, and some even self-medicate with over-the-counter CBD products. In some cases over the counter CBD reduced or eliminated the use of prescribed opioids In surveys, CBD users report good tolerability and affordability of these products. 5 However, prescribers reportedly do not often mention CBD products to their patients and fewer than half (48%) have ever recommended one. Many prescribers do not feel adequately trained to prescribe CBD (89%) or are unsure of legal restrictions (66%). 6 



Conclusions/Implications for future research and/or clinical care: Chronic pain represents a “silent epidemic,” for which the ideal analgesic is not currently available. CBD is both an ancient remedy and a novel product and one that has the potential to offer safe, effective, long-term relief for a variety of chronic pain syndromes, including the challenging conditions of neuropathy and chronic cancer pain. A long-acting synthetic CBD formulation would be a promising new weapon in our armamentarium against chronic pain. Groundbreaking solutions are just beginning to emerge, including a long-lasting liposomal CBD injection that has been studied in a canine model of osteoarthritis.