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Pain Management Without Side Effects:
Curing a Schedule II Habit with a Schedule I Plant

BeeHC

After 12 years, James Nick (not his real name) is free at last. Reliant on morphine to manage severe pain, he had been despondent. He’d tried to get off of the drug several times, almost dying in the process more than once.

Nick suffers from trigeminal neuralgia, a disorder in one of three trigeminal nerves found in the face. His condition appeared after a surgeon severed the fifth cranial nerve, which controls facial sensation and motor functions such as chewing, while trying to repair another botched surgery that had left him hospitalized with a gushing nosebleed. He feels intermittent intense pain in his ear, eye, lips, nose, scalp, forehead, cheeks, teeth, jaw and on one side of his face. With what one of his doctors described as an extremely rare and extremely mutilated fifth cranial nerve, he’s both in pain and numb.

“Half of my tongue is numb; half is not,” he explained. “Half of my face is numb; half feels like it’s being stabbed by ice picks. I have no blink reflex in my left eye.”

Trigeminal neuralgia is also known as the Suicide Disease. Its unforgiving nature leads most to despair and it is considered one of the most painful chronic afflictions known to humans. One doctor after the next tried to fix Nick’s ailment, but none were successful.

Last March, taking 400 milligrams of morphine and 90 milligrams of OxyContin a day, he’d had enough.

“Morphine is indiscriminate with what it cuts off,” he said. “It cuts off the pain. It cuts off your sexual desire. It cuts off your social life. It cuts off your ability to drive at night. It cuts off your world.”

For Nick, one of the greatest downfalls of the drug is that for years he’s been treated like a criminal.

“When you’re on a Schedule II drug, the DEA decides your medical treatment,” he said. “The pharmacists at Walgreens and Albertsons are the narcotics police. When it comes to chronic pain patients, the definition of compassionate care is this: You are getting morphine.”

Reliant on opiates, he became initiated into a realm of suffering known only to chronic pain patients. Treated like a criminal and a junkie, his medications were often withheld. When his prescriptions ran out after 25 days, he became familiar with the absolute torture of being held off for 31 days.  

His monthly supply of narcotics had drawbacks. The combination of pain and pills made it difficult to accomplish the most basic activities. With his career in sales over, he found comfort in the art of calligraphy. Gradually, though, when all motivation and coordination left, he put down his pen. He struggled with things as basic as walking, an activity he used to pass hours each day.

“A few years ago I walked up to a corner and forgot how to cross the street,” he said. “That information fell off of the radar, and I could not figure it out. Listen, what morphine does is it puts you at square one. It gives you no advantage. It robs you of many of your talents and your thinking processes.”

For awhile he was given Fentanyl, a rapid onset, short duration narcotic that is much more potent than morphine. “For a whole year I was on it, and it was all I could do to not kill myself,” he said.

William Courtney, MD, a cannabis physician in Mendocino, California, became a great advocate of the non-psychoactive use of cannabis following epiphany. A traditional physician until reading, in 2004, that a molecule in cannabis has the ability to jump-start an immune system by enlivening neuropathic activity via two-way communication, he’s pretty much gone beyond viewing the plant as medicine.

While Courtney considers cannabis as a dietary essential capable of warding off immune disorders, many of his patients suffer from pain. He’s all too familiar with pain management protocol in the United States, as well as the dysfunction that thrives in a world bought by pharmaceutical giants.

“Doctors are fearful of working with people like that (chronic pain sufferers) because it’s hard to control and the doses keep going up,” he said. “They’re fearful that the DEA will think that they’re handing out pain pills. It’s hard to separate out chronic pain from chronic drug seeking. They are both desperate situations. You have no hands-on way to resolve opiate addiction from chronic pain so everyone kind of throws their hands up and refers them to somebody else.”

Courtney sees Vietnam vets, accident victims, retirees from the heavy labor of the logging industry, students who’ve been injured in sports or with dirt bikes or skateboards, victims of collisions and falls and patients with chronic conditions such as rheumatoid arthritis.

“Chronic pain is a difficult thing to manage with these short acting substances,” he said. “They’re either going to be hard on the liver or hard on the kidneys or hard on the intestinal lining with GI bleeding.”

Most of his patients arrive with mounting side effects following years of prescription narcotic treatment.

“There is not a narcotic substance out there that is meant to be used daily as a supplement,” Courtney said. “It’s fine if you have an accident and you’re in excruciating pain and you’re on them until they fix the problem. The opiates work fine with that intense first pain, but if you’re going to end up with a chronic arthritic condition and be in pain every day for the next 10 years of your life, opiates are just a miserable approach to it. The tolerance builds and the drug is changed again and again. Pretty soon you’re taking some methadone equivalent because nothing else can touch it any more.”

In addition to well-documented ethical dilemmas surrounding pain and pills, and no shortage of people categorizing chronic pain sufferers as drug seekers, we have a plant offering a solution and the United States government maintaining that it has no medical benefit.

Nick, 59, had smoked marijuana recreationally on and off since the 1960s and even went to Woodstock in 1969, but he didn’t want to find his cure on the black market.

“I’d always suspected that there was a possibility that it could help me, but I’m too old to do time,” he said. “I’m a guy with short hair. I’m out of the loop and out of that world.”

He eventually brought his stacks of medical records to a doctor and received a recommendation for medical marijuana.

“I prayed for this, to the cosmic muffin, the big Twinkie, God, whatever you want to call it,” he said. “I did try to tap into that energy to ask for help and guidance, for support and strength, because I was really ready to kill myself.”

Determined, he found a dispensary / wellness center in Denver that offered a compatible balance of the cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).

BeeHC

The marijuana beat is not unlike a 12-step program where anonymity plays an important role. Scores of well-publicized arrests following media attention make Colorado a hotbed of paranoia. Following the arrest of Chris Bartkowicz in 2010, Colorado DEA agent Jeff Sweetin said to a Denver Post reporter, “Technically, every dispensary in the state is in violation of federal law. The time is coming when we go into a dispensary, we find out what their profit is, we seize the building and we arrest everybody. They’re violating federal law; they’re at risk of arrest and imprisonment.”

Sweetin’s threat was made despite 14 states having passed medical marijuana legislation in the face of overwhelming public support. Even the long-standout state of Arizona finally approved medical marijuana legislation a few months later.

“You’d think that there would be some sanity in all this, but then again, you’re dealing with the government,” said Robert J. Corry, a Denver-based civil rights and criminal defense attorney. “I’m not formally advising anyone to not talk to the press, but I think that they’re all figuring out on their own that it carries some risk. Marijuana still has an outlaw ethos to it, and media coverage tends to be sensationalized.”

No surprise, but the owner of the Denver wellness center that worked with Nick, now known as Sam Moser, requested anonymity.

In the same vein as growers, dispensary personnel and medical professionals all over the country are doing, Moser’s in search of CBD. Despite all of the hoopla surrounding CBD, supply is tight. For decades, black market marijuana was bred for high-THC content. The CBD has been all but bred out by growers in search of the greatest buzz.

CBD tempers the psychoactive qualities of THC; it supports the pain-killing benefits of THC; and it features its own pain, inflammation regulating and strong antioxidant properties. Recent studies point to CBD’s potential as a cancer and diabetes deterrent, and even for shrinking tumors.

Courtney considers the best document on the medicinal value of cannabis to be United States Patent # 6,630,507 B1, owned by the United States of America as represented by the Department of Health and Human Services, Washington D.C. The patent document — entitled Cannabinoids as Antioxidants and Neuroprotectants — raves about the usefulness of cannabinoids in treating myriad oxidation-associated diseases, including inflammatory and autoimmune diseases, and as neuroprotectants, which could mean anything from stroke or head injury or Alzheimer’s, Parkinson’s or dementia. He offers the patent’s link on his Web site, www.cannabisinternational.org.

“In the 1980s, when there was no medical model anywhere, it was important to grow for the THC,” said Moser. “If you go back to the 1970s and 80s strains, like Acapulco Gold and Columbian Gold, those strains had much lower THC, like six to 10 percent; the CBD was also around five to six percent, so there was a lot more balance. Now, with everything that’s happened with medical marijuana in this country, the focus is on what was lost over the past few decades. The THC is important and the CBD is equally important.”

Moser works closely with growers and with reputable labs that test strains. He said that the key for anybody dealing with chronic pain or addiction is in finding both the right blend of THC and CBD, and using a combination of delivery systems. He doesn’t recommend any one stain, but feels that without a balance of CBD a pain sufferer is likely to experience anxiety.

“If you get a high-THC strain, and I’m talking about something that’s on the level of 20 to 25 percent, a patient might have a bad experience,” Moser said. “CBD comes and takes all of that away. It relaxes you. The pain control is a million times better and you’ll notice the patient respond in a different way. So that really is the key to working with these guys in developing a strategy that not only weans them off of pharmaceuticals, but also controls the pain that they have right now.”

Nick extends high praise to a compassionate caregiver. “The importance of medical marijuana in terms of caregivers is that you’ve gotta find somebody who listens,” he said. “They didn’t interrupt me when I’d go in there and say, “Looky.” Things kept changing with all of the morphine and Oxy-Contin that I was on and all of the pain that I was experiencing. We needed to fine tune things until we came up with exactly the right thing, which is what I’m on now.”

For the first time in a long time, Nick is off of morphine. He returned to his doctor in December. “I handed him my bottle of morphine. He counted them and said, “Son of a gun; I’ve never heard of it. I’ve never seen it. If I wasn’t looking at it, I wouldn’t believe it.””

Nick is practicing calligraphy again “Medical marijuana has released me from a ball and chain existence and has expanded my world.”

With cannabis, this patient no longer suffers the stigma that comes with opiates. “Pot does what the Schedule II drugs do without the drawbacks,” he said. “You don’t have to go to the doctor every month. You don’t have to have your blood levels constantly checked to see if the drugs are destroying your liver. You don’t get treated like crap and you’re not hooked into the system. There is no addiction. I have pain relief where I decide what’s needed where and when.”

Nick is not free of pain, but describes the pain as less severe without the fogginess of synthetic drugs.

“They say that one of the most frustrating things for doctors, and why they do not want to work with chronic pain patients, is that we don’t get better,” he said. “Well, I am better because of medical marijuana. I look forward to the future, and I’m not suicidal anymore.”

Nick wants others to know that freedom from prescription pain killers is achievable.

“Tell other people that they can do this too,” he said. “Listen, God wouldn’t have put it here if it didn’t belong. End of story.”


© 2011 Mary Lou Smart

 
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