South Africa’s first ethically-approved cannabis clinical trials have begun in Johannesburg with the goal to determine if cannabis can replace opioids for pain management, according to a June 21 press release. More and more, cannabis shows potential for reducing or replacing opioids for certain types of pain management.

Biodata, subsidiary of Labat Africa, “is the brainchild of Dr. Shiksha Gallow, a cannabis clinician, and the principal investigator in the trials, which took over 18 months to get official clearance,” the announcement reads. Dr. Gallow is a South African pioneer in the field of international medical cannabis research.

Researchers will observe 1,000 participants who have been taking opioids for pain management for at least three months and are prepared to switch to cannabis as an alternative. Two chemovars currently being used are Tallyman and Exodus—sourced from Labat’s Sweetwaters Aquaponics SAHPRA-licensed facility in the Eastern Cape. Aquaponics is a cultivation technique believed to allow for more benefits. The third strain to be introduced shortly, 9 Pound Hammer, will be next—chosen because of its high THC and CBG profile, and being rich in beta caryophyllene and myrcene.

“We are currently recruiting patients, and data-capturing all the questionnaires and feedback from the patients for the live study,” Dr. Gallow said. “It has been fairly slow. However, more options have been introduced in the live study as suggested by the patients in the pilot study. The pilot results of the study were very promising, as it showed 98% of the patients have some sort of pain relief from the cannabis.”

Researchers were able to wean patients off their opioid treatment. Flower contained a high amount of THC, 15-25 mg THC, with 0.5 mg of CBD. The Oil (1:1 ratio) balanced formulation contained 15-20 mg THC/15-20 mg CBD. In the pilot group of patients under 55 years old, they preferred to smoke flower, while patients over 55 years old preferred the oil. Patients who smoked cannabis gained relief almost immediately, while the oil took time.

Dr. Peter Grinspoon is a medical cannabis specialist at Massachusetts General Hospital and an instructor at Harvard Medical School, as well as the son of psychiatrist and longtime cannabis advocate Lester Grinspoon. You can watch him discuss America’s opioid crisis on HarvardX or similar topics on TEDx.

“First of all, I think cannabis is really good for mild to moderate pain,” Dr. Grinspoon tells High Times. “I don’t think it works for severe pain. So I think it depends a little bit on what the patient’s conditions are and how severe their pain is, and it’s not just a question of being on cannabis and opiates or off cannabis and opiates. Together, they work very well. Synergistically, they co-work on some of the same receptors.”

Grinspoon added that people who resort to that alternative can achieve a better quality of life, and cannabis is generally safer than opiates. “But I think for other people they’ll probably achieve a dose reduction, which will also be a huge harm reduction [benefit]. So again, it’s not really binary, like off opiates or not off opiates.”

There’s evidence showing other people have reduced opioid use with the help of cannabis—which is what makes it incredibly stupid to test people on opiates for cannabis because it is probably helping them.

“There’s no reason for a pain specialist to view it as the enemy,” he said.

“We don’t really know how effective opiates are,” Dr. Grinspoon added, since there are people under withdrawal symptoms who have pain that’s hard to separate from chronic pain. But then again, there are people with severe pain like phantom limb pain who absolutely need opioids.

“It’s either opiates non-steroidals which, you know, like your Advil, your Motrin, and those aren’t safe either,” Dr. Grinspoon says.

“Those things are really dangerous, and can cause heart attacks, gastric ulcers, and a lot of kidney damage. So the question is like, what is the least harmful medication to use for chronic pain? There’s no free lunch. All medications have side effects, cannabis certainly have side effects, but I always ask myself, ‘what is the least dangerous thing to use and often?’”

Cannabis is definitely safer than opiates, he said, and he wonders if in some cases it’s safer than the non-steroidals.

In the meantime, research showing the true potential for cannabis in the field of pain management is growing. Dr. Gallow’s team of researchers in South Africa renewed this study for another year.