DEAR DR. ROACH: Would you please offer your take on this situation regarding pain management and opioid use? I suffer from chronic pain due in part to degenerative disc disease and stenosis. Combined with neuropathy, severe arthritis and fibromyalgia, this has rendered me unable to work or to even perform the most basic tasks like walking, standing more than a few minutes or anything requiring bending, lifting or the like. I had to retire early because I could no longer work effectively.
I was put in the care of a pain management expert, who was liberal with the meds, but I wanted to keep their use to a minimum, so I applied for and received a medical marijuana card and began limited use, mainly at night to help me sleep. The idea, in my mind, was to not keep increasing my opioid dose and use a more benign, natural method.
Chronic pain patients on opiates are subjected to urine tests to confirm that we are actually taking the meds and not selling them on the street. Upon seeing the results of the urine indicating THC, my pain doc immediately terminated my treatment as I supposedly violated our "contract" by using "illicit drugs." I never thought that using legal medical marijuana would constitute "illicit" drug use.
For six months, I have been trying to find a pain doctor to take me as a patient. I finally got a doctor to take me, but it has been six weeks, and I still can't get any medicinal help, and I haven't touched the medical marijuana. I am literally in agony daily.
Why is there such a pushback against medical marijuana? I found it to be very helpful. For instance, it helped with constipation, erectile dysfunction, seemed to reduce inflammation in my joints, and helped me get to sleep. I have never heard of a marijuana overdose nor have I ever heard of anyone dying from marijuana. I would have thought that reducing opioid use would be the main objective but have been told that it is preferable to up the opioid dose rather than use medical marijuana.
My wife has been a nurse for 40 years, so we know a lot of doctors. Virtually every one we talk to agrees that medical marijuana is a good thing except the pain people. Please help me understand their stance. -- Anon.
ANSWER: I can't help you understand their stance because I don't agree with it.
The data on cannabis for chronic pain is mixed, but most studies have shown modest benefit for chronic pain and sleep. Like all treatments, there are adverse effects, but as you say, severe side effects are uncommon, especially considering the risks of chronic opiate use. Most pain experts who prescribe cannabis do so in order to reduce the use of opiates. The critical issue is that it seems to be working for you.
I can't agree with you that medical use of cannabis is always a good thing. I certainly have had patients who have not had good responses. The long-term data on cannabis use for chronic pain is nearly nonexistent. The barriers to studying cannabis in this country are high, so we don't really have good evidence to guide us.
Without good data, we are left with clinical judgment and hopefully a sense of empathy that your doctors seem to be utterly lacking in.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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