Sarah Zhang recently looked at a pathbreaking effort by James Feeney to expand the use of medical marijuana in the U.S. He’s surgeon in Connecticut conducting a clinical trial to compare the use of marijuana and opioids when it comes to treating acute pain, rather than chronic pain. Here’s Sarah:
That distinction—acute pain from an injury—[is] an important one. A small body of evidence suggests that medical marijuana is effective for chronic pain, which persists even after an injury should have healed and for which opioids are already not a great treatment. But now Feeney wants to try medical marijuana for acute pain, where opioids have long been a go-to drug.
That tendency to prescribe pills has fueled the opioid addiction crisis in the U.S., thus increasing the need for non-addictive alternatives like marijuana—now legal for medical use in 28 states and for recreational use in eight (plus D.C. for both). The rules for when doctors can prescribe pot to their patients vary state to state, but those rules rarely apply to acute, short-term pain. That’s exactly what the following reader experienced, and cannabis was a godsend for her:
I had a bilateral mastectomy, then chemo, then radiation on both sides, since I had cancer in both breasts. It was a huge radiation field and a little over a third of the way through my skin was so badly burned that the two old soft-cotton tee shirts I wore to bed were stuck to my skin and bloody when I woke up in the morning. It was so bad that I had to stand in a warm shower for a long time to loosen the connection between my flesh and shirt to get it off.
A friend brought me some THC-laced cookies and that solved the problem. No pain, as well as no anxiety. I nibbled on them for about three weeks. They were very strong and each cookie got me through several days. I stopped eating them when the pain went away, and I had a few left over that I didn’t use.
This next reader, in contrast, has chronic pain, but he only uses cannabis for the short-term bursts of peak pain:
I am a 53-year-old, college-educated white male working as a software engineer in the Silicon Valley since high school. I have been a recreational user of cannabis for most of my adult life, as I prefer it over alcohol—which I drink only when I can’t get cannabis.
I have a chronic foot condition for which my doctor has prescribed OxyContin, as well as hydrocodone for peak pain. My use of Oxy has been consistent, but I was using the hydrocodone more than my doctor was happy with. Of course, once I was put on the opioids, I could no longer use alcohol.
Two years ago I obtained a recommendation for medical cannabis and have been able to significantly reduce/eliminate my hydrocodone use by relying on cannabis for peak pain. I have no negative side effects and no longer have to worry about running out of pills.
There are several things that surprised me about using cannabis as medicine:
- My insurance doesn’t cover cannabis, which can be quite expensive.
- I have to travel to a dispensary, since my local county has banned them.
- Taking a pill is much easier than finding the time/place to smoke cannabis. I was hoping to be able to use edibles, but that turned out to be less effective and hard to control dosage/effects.
- I began to resent having to use it because it took away from my enjoyment of cannabis recreationally. To be effective for pain, I need to use more of it than I would recreationally, and it changed from something I chose to do into something I had to do.
But overall I’m much happier and safer using cannabis to reduce my opioid usage. Ideally I would get off the Oxy, but that will take time, and I’m too busy at work to get sick from withdrawals. I also don’t think cannabis can provide the base level of pain control that the Oxy provides. TBD.
This next reader opted for CBD—cannabidiol, the part of cannabis that doesn’t get you high but still has medical benefits—and it helped him fight his opioid dependency:
I had hip and back surgery in 2014 and ‘15, respectively. I was in severe pain for three years, and after one of my surgeries I was prescribed Oxycontin and Oxycodone for over six months. My prescriptions went from 12 pills a day immediately after surgery to “As needed,” but I couldn’t sleep without the pills. I lost 15-20 lbs during this time and eventually could not sleep more than one hour a night without the opioids.
I had never traditionally used marijuana, but thankfully, one of my friends gave me a week’s worth of CBD. The first night I slept 16 hours, after three nights I got my appetite back, and after seven days I had zero “cravings” for a pill. The experience was night and day for me, somewhat literally. I went from being a zombie to being a contributing member of society.
CBD also worked for this reader:
For over 20 years, whenever I got phantom pains, I took handfuls of gabapentin to go with an analgesic. Essentially, I would end up stoned out my mind on gabapentin, which (I guess) allowed the analgesic to work. Gabapentin is not an opioid, but it definitely had a negative impact on my life.
Recently I was talked into going to a local pot store to try out a cannabinoid, and the results have been astounding. I don’t get stoned—I’m able to think clearly and can work—and the pains are treated. I have concerns about the lack of evidence regarding dose limits and the long-term effects, but I am very happy to be off the gabapentin.
This final reader testifies to the pros and cons of both opioids and cannabis but ultimately opted for the latter—and he’s willing to break the law for it:
I have a lower-back condition, where the nerves that run through the lowest part of my spine do so a bit too close to the bone and tend to rub against it. Over time this causes a degree of inflammation which is rather painful and often reaches a 6 or 7 at its worst. It’s sharp, pulsating, dull, and a variety of other pain descriptors all at once. Long story short, it hurts!
I discovered that marijuana worked for my back pain after coming home from Washington state. One evening laying on the couch, my back was in full flare-up mode. Shifting, bending, stretching ... nothing helped. I decided to try an edible I had brought back from the PNW [Pacific Northwest].
One hour in, ALL of my back pain was gone. Obviously I was also experiencing significant psychoactive effects, but my pain was GONE. I found this fascinating.
However, because of how stoned I was, I realized that this was not a medical option for the daytime. As the stash of edibles ran out, I resorted to going to the spinal intervention pain management clinic, where I get Selective Nerve Root Block injections every few months. This took care of 90 percent of the pain. Only when I’m seated for long periods of time, or when I have an odd occurrence of some sort, does the pain flare up. I’m prescribed 60 Norcos (hydrocodone) to be used once to twice per day (one pill at a time). In addition, I’ve been given Zanaflex (tizanidine) as well as Soma (carisoprodol) as muscle relaxers.
I will be the first to acknowledge that all of these do help—tremendously. However, because my condition is chronic, I have to take them every day. This leads to many issues related to my digestive system—constipation when taking the pills, diarrhea when not—as well as a mild physical dependency.
After the last time experiencing physical withdrawal from opioid use (about two months ago), I decided that enough was enough: Cannabis was going to be my go-to for consistent evening pain mitigation. Since I live in a non-medicinal/non-recreational state, I have no legal access to marijuana. However, I’m willing to risk it for the sake of virtually no gastrointestinal side effects or the possibility of physical dependency.