Opioids, Medical Cannabis and the Treatment of Chronic Pain
There is abundant evidence that medical cannabis is an effective treatment for chronic pain. It has far, far, fewer side effects than the “dreaded opioids” we hear so much about in the news these days. I need to be clear here: I’m not philosophically opposed to the use of opioids in the treatment of chronic pain. Furthermore, I think it’s a travesty that legitimate chronic pain patients are stigmatized for using them. All you have to do is read Brian Goldstone’s article, The Pain Refugees in Harper’s Magazine, to realize that legitimate pain patients are being denied treatment in our opioid paranoid world. (Believe me, I understand that the over-prescription of opioids is a real, and significant, problem; I’m just saying it is not the only problem and we need to be thoughtful in our response to it.)
That said, it is also clear that treating chronic pain with opioids is more than a little problematic. Opioids are a fabulous medication short term! They block pain receptors on a patient’s neurons so that the pain signal never makes it to her brain. The trouble is, that after several days of this the brain, which needs to register pain in order to keep the patient alive, creates more pain receptors on the neurons. This impacts a pain patient in two ways. First, it develops tolerance. The patient enters a cycle where he will now need more medicine in order to block those newly created pain receptors. In response, the brain will create more pain receptors still, requiring even higher doses of opioid medication . . . and so on. But here’s the real problem: you can only go around that circle so many times before the damn medication just stops working!! And when a patient gets to that point, his brain has created vastly more pain receptors on his neurons than when he started. Each of those new receptors is capable of sending pain signals to the brain. The whole process has served to make the patient far more sensitive to pain than he ever was before.
Short term opioid use takes away pain; long term opioid use creates more pain!!! It is counter-productive. Of course if opioids are the only strategy that works to control a person’s pain, then the patient and the doctor have to maintain the delicate balance between using them to treat the pain, and doing what they can to minimize the side effects – tolerance included. Trust me; it’s not easy. Please have compassion on those who are in this position.
But it turns out that opioids are not the only treatment available for chronic pain—not even close. This entire site is dedicated to the many strategies we can use to address it. One of those is Medical Cannabis. There is a great deal of evidence to suggest that Medical Cannabis is a very effective strategy for treating chronic pain with far, far, fewer side effects than opioid medications, and no worries about tolerance. But there is something you need to know about using it: Medical cannabis treatment is NOT one thing!! You can’t just pick up some weed at your local dispensary, smoke it, and expect miraculous results. There are myriad strains of cannabis and many modes of administration. You will need to experiment in order to find out what works best for you—there is no way around it. I wrote Guidelines for Medical Cannabis Treatment, linked below, to help you do just that. If you need more help figuring it all out, I am a Chronic Pain Coach, certified by Michael Moskowitz, MD, MPH, and I hold a Certificate in Cannabis Science from the University of Vermont. If you have a medical cannabis recommendation from a doctor, I can work with you as you find the treatment that best serves your needs.
Medical Cannabis is not a magic bullet in the battle to defeat chronic pain; there is no magic bullet. We need to take a comprehensive approach to treating chronic pain. Pain patients need to take neuroplasticity seriously so they can learn to counter-stimulate the brain and so re-train their brains not to feel pain. They also need to realize that gaining freedom from chronic pain is a transformational process—it takes courage and tenacity. But along the way, Medical Cannabis is an enormously helpful strategy in our efforts to treat chronic pain. If I can be of help in your effort to gain freedom from chronic pain, please be in touch.