My pain doc wants me to switch from opioids to cannabis.

Alice:
I do not think your pain management physician has any intent but to offer you a legitimate alternative to opiates in suggesting cannabis to treat your neuropathic pain.
The truth is that neuropathic pain is often not best treated with opiates.
The rationale for legal cannabis (CBD without THC) for neuropathic pain follows its clinical benefit in treating conditions such as epilepsy. It is able to lower/slow neuronal impulses. Neuropathic pain typically is exemplified by hyperactivity of neural firings.
Calming and quieting of neuronal activity is at the heart of pain management for neuropathic pain. That is why neuropathic pain management often includes anti-epileptic medication (ex. Depakote, Tegretol).
I have my own opinions about why cannabis does not receive more positive press about legitimate medical uses and benefits. The beamouth pharmaceutical firms do not stand to gain financially from legalization of CBD. Powerful lobbying groups and financial interests drive our healthcare system in ways that are not seen by the public and that do not necessarily benefit the patient.
Keep an open mind.
Do your own research. Dig deep.
And always, what works for one person may or may not work for another. Every person has a unique chemistry of enzymes and hormones that affect how medications are metabolized and processed.
Pain, in particular, is a highly subjective experience. There is no objective measure of pain intensity that can compare one person’s pain experience to another. Nor does pain affect people in the same way with regards to daily function and quality of life.
But know that long-term use of opiates, in and of themselves, do have defined risks and collateral damage.
Secondary adrenal insufficiency, a topic that I frequently mention due to my own association with primary adrenal insufficiency/Addison’s disease, has recently been added as a Black Box warning as an identified risk of opiate use. I can guarantee you, adrenal insufficiency is NOT a condition that anyone wants to acquire. It is a life-altering condition with few options for treatment. My quality of life with Addison’s disease is poor/low/humble.
Centralized pain syndrome is an additional risk of continued use of opiates. The central nervous system actually becomes more sensitized to the experience of pain. That is, long-term use of opiates can contribute to more pain.
Bottom Line: Cannibis has a legitimate role in medicine whose potential uses are under continued study but whose access/use may always be mired in social controversy.
Karen

Alcie, Karen has provided you with some great information about the use of cannabis. Every individual is different on how they feel it helps. It's truly a mixed bag, some says it helps & then another will say it doesn't. It's no different than with pain meds. The ones that say it helps them, they tried the cheap stuff & found it was worthless. They buy from a reputable store with knowledgeable people. The cost factor is also a consideration because it can be pricey & they couldn't afford to continue with it.
Since it is legal in your state, I would call a dispensary & ask about the tax. I would not be surprised if there is a tax simply because this is something that they claimed would help generate more money for the state. You can also google it for your state & look there to see if there is a tax on it.
As far as Clonidine is concerned it is am older drug used to treat high blood pressure. It is used off label to help with withdrawal symptoms when getting off of opiates. Methadone is not to be used for short term use. The CDC recommended 2 years ago that drs stop prescribing Methadone for treatment of chronic pain. It has some real potential bad side effects.
Lots of drs are now rxing this to their patients in the legal states.

First, your doctor can prescribe you opioids while you're using MJ. There is no legal nor medical reason why not. In fact, using MJ can not only reduce your needed opioid dosages, but also make the opioids you use safer since MJ is a mild respiratory stimulant and significant bronchodilator. My doctor, for example, allows patients to use both -- and I know a good number of other pain doctors who do the same. In fact, the pain management society in my state has a policy position supporting it. If your doctor won't let you -- it is on him/her, biased, uneducated.
As for its benefits, one issue to bear in mind is that too much THC can make pain worse... i.e. it is biphasic.
It is best to start with high CBD strains (e.g. AC/DC or Pennywise), while also trying something like a 3:2 CBD to THC for breakthrough (e.g. Harlequin). Many studies indicate that much of the pain relief is achieved at just 1-2% THC.
Note that CBD is active on the CB2 receptor and also helps your endocannabinoids bond to receptors. Its main effect is anti-inflammatory, preventing cytokine release. THC too works as an anti-inflammatory but in addition also (a) raises nocioceptor thresholds (i.e. the signal needed to propagate pain through the nervous system); and (b) affects the subjective experience of pain (through action on the right amygdala), making it easier to not notice.
Importantly, MJ is not quite a CNS depressant. First, there are next to no CB1 receptors in the brain stem, one key reason why it is so safe. Also, while it reduces response time and has other sedative-like effects, it actually increases right-brain neuronal activity (per fMRI data). In fact, the increase in that activity is the likely cause of the reduced response time (exaggerated attention on thoughts dissociate from some sensory processing).
Overall, here is my personal experience:
a) I use a 10:1 CBD to THC vape pen a couple times each day. As a result, I've been able to reduce my opioid dosage by about 50%. I'm definitely in less pain through the day. I don't find that the vape immediately affects my pain levels, but rather daily dosing increases the available cannabinoids in my system which reduces the inflammation secondary to nerve-root impingements. Think about this as analogous to using a daily vitamin - you're supplying your body with a resource.
b) I've tried many stronger THC strains and some (e.g. Blue Dream) are excellent for pain (due in part to specific terpene profiles). The problem is that I do not like to be "high." So, while its effects may be even better than opioids, I find its psychoactive to be very unpleasant.
c) I take a very low-dose 1:1 CBD THC edible for sleep, which is as effective as xanax... the dosage is just 2.5mg of each. If I take two (5mg), my thoughts intensify and I can't sleep.
d) 1:1 CBD THC transdermal ointments are fantastic for local pain (e.g. a muscle in painful spasm). The problem is that I don't like to smell like MJ, they only seem to last for a couple hrs, and since my pain is so widespread, frequent broad applications are a nuisance/messy/stinky.
Let me emphasize that if you're going to work with your pain management doctor on this, s/he needs to give you a couple months minimum to explore, to let you use your current opioids and through trial and error see what MJ options (if any) work for you. Pain doctors who have been working with this for years find that patients are able to reduce their opioids by around 80% (e.g. no more oxycontin, but just an oxycodone or two for BT episodes).
I received my patient card earlier this year, and it took me three months of trial and error until I found a dosing regimen that helps with pain without interfering with my mental focus. IMO, that should be the goal, and if your doctor doesn't give you the time needed to reach it, the consequence may be you'll either give up on MJ or just migrate into higher THC psychoactive dosage which while helpful with pain will more likely interfere with life activities. So, any doctor who has learned enough to understand the pain benefits and safety of MJ should work with patients to reduce their opioids over a period of months -- expecting a sudden shift from one to the other is unprofessional.

Karen,
Feel free to contact me if I can be of any help. I've been in meetings with the Health Department, Bureau of Narcotics, representatives from the medical licensure board, etc... no opposition to prescribing opioids to MJ license holders except, insanely, from angry doctors in my state who feel victimized by the campaign against opioids. But as noted, there is no legal or medical reason to oppose it. Even the CDC supports it... and barring patients or not giving them the time and flexibility they need interferes with their chance to reduce the risks of opioid use... totally anti-medical.
Some doctors here have incorporated a rider to pain contracts which allow patients to try MJ and if effective, will, by X month, reduce their opioids by Y%. Other doctors just go case by case. Have your doctor look at Dr. Mark Wallace's (UCSD) practice & publications on clincal practice. He consulted with my state's pain society.

I asked my PM dr last visit about using CBD oil. It is legal in my state and it is available on Amazon! He said sure, try it. I was concerned of course that it would be a problem with the RXs I get from them and that on the next drug screen I would have a problem. He said just tell them you used CBD oil if there is a problem! No big deal to him. He suggested caution with making sure you are getting the right stuff as it is so widely available. There are companies that have it available that seem to have good documentation.

I have tried it a few times and really like that it helps without making me feel high or out of it.

Good luck to you, Karen!

Hi, Cogito...I did not buy any oil on Amazon, I was just saying it is available. My PM place actually offers legal mj but it is handled differently than the side I go to for PM. At this point I am trying to make what I have work. You are very knowledgeable!

Great information all! I really appreciate the information and the points of view. Thanks a bunch!

My pain doc will not allow his patients to use marijuana until they have stopped opioids. I've been researching ways to stop, but the medicines prescribed to help are all ones that I have tried in the past and have had bad reactions or found totally useless. I don't agree with my doc's method, but I have no choice, because changing docs isn't likely to be possible here.

I will not smoke or vape. I would not be allowed to visit my grandchildren, and it's something I just can't do. I will try some CBD externally on my excruciatingly painful ankle (3 surgeries after bad, twisted break and no relief with opioids), but not near an appointment or any blood test. How long does it take to clear the system? My cousin says use the cream, not the oil. ?

How about travel? We can take CBD with us if it's from hemp, but crossing a state border, including flying, is illegal with MJ according to TSA, although some people sneak it on planes. And forget going out of the country. It's still federally illegal and illegal in many countries. Some of my family live in states where even medical MJ is only legal for restricted use. Whatever that means.

Cognito:
I appreciate the sharing of knowledge that you have on medical marijuana/cannabis. I am talking to my Palliative Care physician later this week about adding it in.
Karen

Cogito...I think CBD oil is great...Not too much anything just seems to make other things more effective or more easily tolerated. Have you heard of any digestion issues? I think it should help and hard for me to judge since I am on a new psoriatic arthritis med just wanted to get an opinion. Thanks!

--Pitmom I posted right after you. I am no expert but I wonder about all the claims for mj products with no downside...Is that possible? Almost too good to be true. But these things have been around forever we are just making them ok for mainstream I guess. Have a good day!

Post Edited (Darla) : 12/19/2018 5:05:39 AM (GMT-7)

Cognito:
You bring up relevant points in the question of “Why?” has cannabis has been so harshly criticized . . .

Simply follow the trail back to Big Pharmaca and profits and powerfully organized lobby groups that influence healthcare.

Cannabis was never mainstreamed into any research and development by the consortium of pharmaceutical companies. Legalization of cannabis has brought a new cottage industry to the foreground, but it remains a threat to pharmaceutical profits and, honestly, wider financial interests throughout the US healthcare system.

The US has one of the worst ratings among developed countries in terms of patient outcomes and quality of care. It ranks toward the bottom. You can easily Google this to see exact listings. And yet, the US per capita expenditures for healthcare are the highest in the world.

Cannabis has many beneficial properties that people could benefit from. It’s use, however, remains shrouded in controversy and mis-information.

If the current revelations about FaceBook, unauthorized sharing of personal data, and the growing exposure of entities who are trying to spread false information to influence people’s opinions tell us nothing us . . . it points to the critical importance of using your brain and guarding your cognitive thinking skills in all aspects of your life.

Navigating day-to-day life is not easy. It certainly is more difficult than when I was a young adult and gently treading with independence. There is a lot of extraneous noise and interference that bombards us from multiple directions.
Karen

I know we are not to discuss identifying information but darn. cogito!! I am so curious about your background! Leave it unanswered and I am not really asking just admiring your smarts, lol.

Alcie, did you get a written recommendation (prescription) from your doctor? Did you purchase it at an approved business? Or did you get something that says CBD with nothing in writing from your doctor?