The Atlantic Monthly: Patients ditching opioid pills for weed...

[drusso]

https://www.theatlantic.com/health/...a-cannabinoids-opioids/515358/?utm_source=twb

"Marijuana might have a bigger role in curbing this drug abuse than previously thought. Its potential uses are actually threefold: to treat chronic pain, to treat acute pain, and to alleviate the cravings from opioid withdrawal. And it has the advantages of being much less dangerous and addictive than opioids."

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[Aether2000]

It's all about perception of it being "natural" and therefore without harm. Forget about all the studies that show for most chronic pain it is largely ineffective clinically.... But if it gets people off of opioids, why not?

 

[101N]

Yea but, Dan Clauw is not a guy to be taken lightly: http://www.jpain.org/article/S1526-5900(16)00567-8/abstract

 

[Ducttape]

yes... a retrospective study by a physician who is known to express anti opioid stance with 2nd author the owner of a medical cannabis dispensary in one of the most liberal cities in the US with regards to marijuana....

conflict of interest???

(I lived in A2 for 6 years. I "was around" for at least 6 "Hash Bashes"... or was it 7...)

 

[101N]

Not so fast. If, as Mark Sullivan postulates below, a lot of CNP in working-aged adults is really SLS or 'central pain' then maybe
cannabis is just a 'safer' escape from existential suffering.

Although opioids are beneficial when taken for less than three months, studies of long-term use show that the drugs, while they may relieve pain, do little to improve function. Those who take the drugs for the longest periods of time, and in the heaviest doses, tend to be patients with psychiatric and substance-abuse disorders—a phenomenon that Mark Sullivan, a professor of psychiatry at the University of Washington, has called “adverse selection.” Sullivan told me that in poor, rural regions doctors are using opioids to treat a “complex mixture of physical and emotional distress.” He said, “It’s much more convenient for both patient and physician to speak in the language of physical pain, which is less stigmatized than psychological pain.” Some of these patients could be said to be suffering from what his colleague calls “terribly-sad-life syndrome.” “These patients are at a dead end, life has stymied them, they are hurting,” he said. “They want to be numb.” He believes that doctors are inappropriately adopting a “palliative-care mentality” to “relieve the suffering of people who have had very tough lives.”

 

[drusso]

Not so fast. If, as Mark Sullivan postulates below, a lot of CNP in working-aged adults is really SLS or 'central pain' then maybe
cannabis is just a 'safer' escape from existential suffering.

Although opioids are beneficial when taken for less than three months, studies of long-term use show that the drugs, while they may relieve pain, do little to improve function. Those who take the drugs for the longest periods of time, and in the heaviest doses, tend to be patients with psychiatric and substance-abuse disorders—a phenomenon that Mark Sullivan, a professor of psychiatry at the University of Washington, has called “adverse selection.” Sullivan told me that in poor, rural regions doctors are using opioids to treat a “complex mixture of physical and emotional distress.” He said, “It’s much more convenient for both patient and physician to speak in the language of physical pain, which is less stigmatized than psychological pain.” Some of these patients could be said to be suffering from what his colleague calls “terribly-sad-life syndrome.” “These patients are at a dead end, life has stymied them, they are hurting,” he said. “They want to be numb.” He believes that doctors are inappropriately adopting a “palliative-care mentality” to “relieve the suffering of people who have had very tough lives.”

Maybe their endocannabinoid system is dysregulated...

Neuro Endocrinol Lett. 2008 Apr;29(2):192-200.
Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?
Russo EB1.
Author information

Abstract
OBJECTIVES:
This study examines the concept of clinical endocannabinoid deficiency (CECD), and the prospect that it could underlie the pathophysiology of migraine, fibromyalgia, irritable bowel syndrome, and other functional conditions alleviated by clinical cannabis.

METHODS:
Available literature was reviewed, and literature searches pursued via the National Library of Medicine database and other resources.

RESULTS:
Migraine has numerous relationships to endocannabinoid function. Anandamide (AEA) potentiates 5-HT1A and inhibits 5-HT2A receptors supporting therapeutic efficacy in acute and preventive migraine treatment. Cannabinoids also demonstrate dopamine-blocking and anti-inflammatory effects. AEA is tonically active in the periaqueductal gray matter, a migraine generator. THC modulates glutamatergic neurotransmission via NMDA receptors. Fibromyalgia is now conceived as a central sensitization state with secondary hyperalgesia. Cannabinoids have similarly demonstrated the ability to block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, IBS and related disorders. The past and potential clinical utility of cannabis-based medicines in their treatment is discussed, as are further suggestions for experimental investigation of CECD via CSF examination and neuro-imaging.

CONCLUSION:
Migraine, fibromyalgia, IBS and related conditions display common clinical, biochemical and pathophysiological patterns that suggest an underlying clinical endocannabinoid deficiency that may be suitably treated with cannabinoid medicines.

 

[lobelsteve]

Yup, the OTHER Russo.

 

[Aether2000]

Wow! If we had only discovered in 1995 that chronic pain is actually a cannabinoid deficiency instead of an opioid deficiency, we would have a society bathing in weed smoke rather than in narcotics. Could have been a different world now....

 

[Mad Jack]

It's all about perception of it being "natural" and therefore without harm. Forget about all the studies that show for most chronic pain it is largely ineffective clinically.... But if it gets people off of opioids, why not?

We don't have a marijuana overdose epidemic going on, so I'm all for it. Opioids have dubious effectiveness profiles for many types of chronic pain, so why not give patients something they won't OD on, suffer terrible withdrawals from, or turn to heroin when their prescription no longer gets renewed.

 

[willabeast]

i had a paraplegic patient once with neuropathic pain. Marinol helped him sleep at night. stable low dose for years. when i retired his PCP refused to take over his Marinol so i gradually tapered him off. PCP felt he might get into trouble with admin or DEA.

La vie est une tragédie pour celui qui sent, et une comédie pour celui qui pense.

• Life is a tragedy for those who feel, and a comedy for those who think.

https://en.wikiquote.org/wiki/Jean_de_La_Bruyère

 

[DrCommonSense]

We don't have a marijuana overdose epidemic going on, so I'm all for it. Opioids have dubious effectiveness profiles for many types of chronic pain, so why not give patients something they won't OD on, suffer terrible withdrawals from, or turn to heroin when their prescription no longer gets renewed.

Never saw anyone get off narcotics despite having legal "medical" MJ in my state.

Very skeptical of this.

 

[Mad Jack]

Never saw anyone get off narcotics despite having legal "medical" MJ in my state.

Very skeptical of this.

I'm saying maybe we shouldn't be starting some patients on opioids in the first place, because once you're hooked, you're hooked. The time I spent rotating through addiction medicine basically showed me that for the majority of people that become physically dependent on opioids, it isn't a matter of if they'll relapse, but when. Never putting them in the position to become addicted in the first place would be a desirable outcome.

 

[DrCommonSense]

I'm saying maybe we shouldn't be starting some patients on opioids in the first place, because once you're hooked, you're hooked. The time I spent rotating through addiction medicine basically showed me that for the majority of people that become physically dependent on opioids, it isn't a matter of if they'll relapse, but when. Never putting them in the position to become addicted in the first place would be a desirable outcome.

You can do that, I will continue to write Norco or some other product for my 70 year old patient with zero mental health issues who has never abused a medication in their life.

I highly doubt I will see any of them in the addiction unit.

 

[Mad Jack]

You can do that, I will continue to write Norco or some other product for my 70 year old patient with zero mental health issues who has never abused a medication in their life.

I highly doubt I will see any of them in the addiction unit.

The 17.6% of people in the United States that all suffer from chronic pain don't all fit into the "70 year old patient with zero mental health issues who never abused a medication in their life" category. You can have pain and a tendency toward substance abuse. Marijuana makes a fine choice for people with a high probability of opioid abuse.

 

[DrCommonSense]

The 17.6% of people in the United States that all suffer from chronic pain don't all fit into the "70 year old patient with zero mental health issues who never abused a medication in their life" category. You can have pain and a tendency toward substance abuse. Marijuana makes a fine choice for people with a high probability of opioid abuse.

Never said they did

I always recommend the young druggies that come in demanding Oxy/Norcos/etc to take THC and not narcotics.

Interestingly, almost all of them are already doing THC while asking for the narcs. This comes up when I tell them about the UDS they would need before even considering narcotic medications. They just don't have their "medical" card yet.

When I recommend them to get a medical card and forget the narcs, most of them don't appear happy with that suggestion.

None of them are happy when I suggest Behavorial therapy as well.