Patient testimonials and a small body of research suggest cannabis can be used to lessen the dependence on painkillers

Posted by 21pc on October 23, 2014

Nikhil Swaminathan, Al Jazeera America

When Ian Young went to get a massage in August 2008, he had already been living with pain for more than decade. A car accident with a drunk driver in 1997 had left him with lingering discomfort in his neck. Deep tissue massages, along with gym workouts and stretching, were his primary means of treating his pain.

But this massage wouldn't provide any relief. Immediately after, he experienced sharp pain and swelling around his neck. Doctors later told him he had four bulging discs at the top of his spinal column. The diagnosis would lead to a nearly six-year dependence on prescription painkillers.

Young began taking Percocet daily. Percocet is a brand name for the opioid oxycodone; another is OxyContin. Opioids, like oxycodone and hydrocodone (sold as Vicodin), are derived from the poppy plant, also the source of the narcotics heroin and opium. According to the Centers for Disease Control and Prevention (CDC), the U.S. is in the midst of an epidemic of opioid painkiller abuse. Deaths from opioid overdoses have tripled since 1999, now taking the lives of more than 16,000 Americans yearly. (Fault Lines examines the opioid epidemic in the U.S. in "Opioid Wars," airing Saturday, October 25, at 7 p.m. Eastern time/4 p.m. Pacific on Al Jazeera America.)

After a surgery to fuse two of his bulging discs in 2011, Young’s painkiller dosage topped out at 240 mg of hydrocodone and 225 mg of oxycodone per day. He’s taken as many as 15 different medications at a single time, some for pain and others to counteract the painkillers’ side effects, like constipation or fatigue.

He simply needed all of those meds to function. “My pain is different every day, it's dull, sharp, stabbing,” Young said. “Sometimes it can be just a lingering, throbbing pain sitting in the back of my neck agonizing me.”

Despite his dependence, he grew tired of having to keep track of the pills he’d taken on a given day. “Every time I went in for refills or checkups, I would say, 'I can't live this way,' Young said. “I was probably taking more prescriptions than my grandfather.”

With the help of a pain management specialist at the University of Washington, he began to wean himself off opioids starting three years ago. Since this past March, the now-41-year-old Internet entrepreneur has been essentially opioid-free.

Young applied a kitchen sink approach to phasing out his pain meds, turning to mind-body relaxation techniques, like acupuncture, and herbal and Chinese medicine. But one of the keys to his post-painkiller existence has been medical marijuana.

Twenty-three states allow marijuana to be used, at least medically. But in the eyes of the federal government, cannabis is on par with heroin, LSD and ecstasy—a so-called schedule 1 drug that is said to be highly addictive and have no medical value. Manufacturers of opioid drugs, like Perdue Pharma, the maker of OxyContin, financially back several high-profile groups that lobby against marijuana legalization across the country.

A resident of Seattle, Young took advantage of Washington state’s 2012 decision to legalize pot. He is now one of an estimated 2 million people in the U.S. who use medical marijuana to treat a variety of ailments, according to the group Americans for Safe Access. Among pot’s possible uses, say many pain specialists, is to help patients reduce their dependence on opioids.

A pain-relief alternative?

Chronic pain is one of the primary reasons that people seek out medicinal cannabis. A 2013 survey of nearly 350 patients at a medical marijuana clinic in southwestern Michigan found that more than 85 percent used the drug to treat pain.

Barth Wilsey, a pain specialist at the University of California, Davis Medical Center, began hearing positive accounts of medical marijuana from patients 20 years ago. But we was a “real believer” in opioids for treating pain, so it came as a surprise when the CDC began reporting on the overdose epidemic in 2010.

“People have reversed direction in prescribing opioids, trying to get people to less than 100 mg per day,” Wilsey said. “I went to learn how to do acupuncture specifically to reduce the role of opioids in my practice.”

In the early-2000s, not long after the state of California legislature set aside $10 million over 10 years for medicinal cannabis research, Wilsey began studying marijuana’s effect on neuropathic pain. It’s the sort of pain Ian Young suffers from, caused by injury to the nervous system or spinal cord. A recent study Wilsey led showed that patients can get short term pain relief from cannabis that contains only 1.3 percent tetrahydrocannabinol (or THC), the ingredient that gives marijuana its psychotropic effects. Pot used for recreational purposes has 6 to 12 percent THC, he said, but can go as high as 20 percent.

After experimenting with several strains of marijuana for his pain, Young landed on one called “20:1,” named for its ratio of the chemical cannabidiol (another of the plant’s primary constituents) to THC. “I don't get high off of it,” he said. “But I get extreme pain relief immediately, like an opioid.”

Breaking dependence

While Wilsey’s work suggests that low-THC marijuana can offer some pain relief, there's little research to indicate where it can fully supplant the powerful painkilling effects of opioids. Ian Young, for one, isn’t sure if cannabis would have been effective for the pain he felt after his neck fusion surgery in 2011.

“Opiates are really good in treating acute pain, like if you break your arm,” said Ken Mackie, a neuroscientist at Indiana University. “Medical marijuana is probably better for treating chronic pain, where the goal is to increase a person's quality of life, ability to communicate with family and friends and hold down a job.”

A study published in late-August in JAMA Internal Medicine, a journal of the American Medical Association, found that since 2010 opioid overdose rates in states with medical marijuana law grew by 25 percent less than expected. While researchers can’t definitively link cannabis laws to those decreases, study leader Marcus Bachhuber of the Philadelphia VA Medical Center, offers two possible explanations for the effect.

“One is that people with chronic pain choose a less toxic alternative over a more toxic one,” he said. “The other is that the availability of marijuana changes the way that people abuse or misuse opioids.”

Donald Abrams, a professor of medicine at University of California, San Francisco, who has studied the effects of medical marijuana on pain since the mid-1990s, says that every day he sees patients who are weaning off opioids using cannabis. “I hardly need to do research to prove that cannabis helps people loosen their dependence on opiates,” he said.

Nevertheless, in 2011, he published a small study of 21 patients that found that the addition of marijuana to a twice-daily opioid regimen led to a 25 percent reduction in pain. It suggests cannabis could allow pain patients to lower their opioid dosage and still get pain relief.

So far, marijuana has been crucial to helping Ian Young kick his reliance on prescription painkillers. He no longer has to make frequent trips home to take a handful of pills, allowing him to start kayaking and generally become more active.

“In the past six months, I've taken one oxycodone. The rest of the time I’ve been taking cannabis,” Young said. “Even today, I can't believe I’ve gotten here.”

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