Yesterday the Bend Bulletin's magazine insert, "High Desert Pulse," included a fascinating cover story: When pot means no prescription for pain -- Doctor/patient divide over marijuana.
Download When pot means no prescription for pain; Doctor:patient divide over marijuana PDF
Countless patients suffering from debilitating conditions such as MS, arthritis and post-traumatic stress disorder have made extraordinary claims about how using marijuana reversed the course of their medical conditions and turned their lives around for the better. Many report marijuana relieves physical pain better than powerful prescription opiates and even allowed them to stop taking the medications.
But the medical research thus far has not reached the same level of enthusiasm. In many cases, no study or doctor can support or explain the often outlandish anecdotes about how marijuana cured patients’ cancer or restored their vision, for example.
Even for its more common applications, marijuana has shown only modest results. A recent scientific review of 79 studies found only moderate evidence it helps with chronic pain and the muscle spasms that are a hallmark of MS.
And yet, the claims keep coming.
That puts doctors — who are scientists, heavily reliant on data — in a difficult position. Do they trust the anecdotal evidence of countless people who say marijuana saved them, or do they go by what the scientific literature says?
The answer for most has been to avoid the subject entirely, especially because the U.S. Drug Enforcement Agency still considers marijuana a Schedule I controlled substance. Even in states such as Oregon that have legalized medical and recreational marijuana, doctors still face the threat of losing their licenses or prescribing privileges if they’re found to have recommended marijuana to patients.
A major point of contention among doctors, medical marijuana users and advocates is doctors’ refusal to prescribe opiate pain medications to patients who use marijuana. Many doctors feel that since both marijuana and opiates are sedatives, their combined effects could produce severe impairment. Prescribing the drugs to marijuana users also could expose doctors to legal liability if the patients are injured as a result. Patients argue that using marijuana eventually allows them to get off most or all of their opiates, but that it can be a gradual transition.
Kudos to reporter Tara Bannow for clearly explaining this debate over how medical marijuana and narcotic painkillers should be used to help people. As noted in the passage above, the Federal government's absurd classification of marijuana as a Schedule 1 drug (along with heroin) is one of the confusing factors here.
The article helped me understand something that has perplexed me: why do most medical marijuana patients in Oregon get their application approved by a doctor who specializes in this area, rather than their regular doctors?
Apparently because most doctors are reluctant to sign off on a medical marijuana card because they're afraid of running afoul of the federal prohibition on using marijuana -- even though both medical and recreational marijuana are legal in Oregon.
For one, because so many primary care physicians refuse to sign patients’ approval documents for Oregon’s medical marijuana program, patients are forced to see doctors who specialize in medical marijuana approvals. That means relatively few doctors in Oregon sign hundreds of approvals for the medical marijuana program, and they tend to work out of what Le calls “signature mills.”
Newspaper stories often make it sound like this is a scam. But the truth is more that patients wanting to try medical marijuana to relieve pain, or for other legal reasons, have no other place to go than to clinics organized by medical marijuana dispensaries.
What struck me the most about this story was a glaring contradiction.
How is it possible that doctors quoted in the piece could simultaneously say (1) Medical marijuana shouldn't be used by patients with chronic pain because it isn't effective, and (2) Medical marijuana shouldn't be used along with opioids because it has the same effects as narcotic painkillers?
Huh? If marijuana isn't effective, then what's the harm in taking it along with a prescription painkiller? And if it is effective, then why not encourage patients to use cannabis for pain relief rather than much more dangerous prescription drugs?
This chart tells the tale:
Prescription painkillers caused 16,917 deaths in 2011. Marijuana, 0. None. Zilch. Nada. Yet doctors continue to punish patients who want to use a safe herb for pain relief, pushing them toward dangerous drugs like Oxycontin.
Bogoger, whose doctors were unavailable for comment, said marijuana relieves his pain, gives him an appetite (something the pain meds took away) and puts him in a better mood. But since he’s been using it, doctors have refused to prescribe him pain medication. He said doctors look at his records, which show years of pain medications and — more recently — marijuana use, and assume he’s a drug addict trying to get high, Bogoger said.
This is crazy. Research shows that states with medical marijuana laws have fewer opioid overdose deaths. So obviously marijuana is beneficial to patients seeking pain relief, not a danger.
US states with laws that establish access to medical cannabis have lower rates of mortality due to opioid overdoses, according to a new study.
This finding suggests that some patients who used to get their pain relief from prescription opioid analgesics may be switching to medical marijuana now that it's available legally, and this transition may be associated with lower rates of mortality related to opioid overdose.
"I have treated lot of patients who have pain," said lead study author Marcus Bachhuber, MD, a primary care physician and clinical scholar, Philadelphia Veterans Affairs Medical Center and Robert Wood Johnson Foundation Clinical Scholars Program, Pennsylvania. "Some would tell me that they tried prescription painkillers, that those didn't work, and that marijuana was the only thing that worked for their pain."