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Scared - Pm said MJ or methadone

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Posted 3/13/2019 5:54 PM (GMT 0)
Three months ago my PM said consider marijuana, but you have to go off opioids first. (See previous post.) This visit I said I could try mj but couldn't just stop taking all my meds first. So now my choice is mj or methadone. I said I absolutely would not consider methadone! I have three more months to reconsider. Or what, I don't know. I'm terrified he's going to cut my meds or stop them entirely.

OK, I'm on 90 morphine equivalents, but I would happily switch to something lower. Oxycontin doesn't do much and only lasts half as long as it is supposed to. 20mg twice a day = 60 equivalents. My hydrocodone works just fine at 7.5mg x 2 = 15eq, and tramadol 50mgx3 = 15. I only use for the tramadol for the happy effect. Oddly, oxycodone at 7.5mg worked better than the oxycontin 20mg (same stuff but time release). I think the reason for switching me to oxycontin was so that I was on a time release, not 3 instant release meds. I'm morphine non-reactive and some meds like fentanyl and codeine don't work and just make me sick.

I said I'd researched marijuana and wasn't impressed that it was good for non-neuropathic pain. He said it's too hard to get good research in the US on it, but he has a large foreign study that showed it works well.

I've been going to this doctor for many years for a long history of painful conditions. I've needed pain meds for surgeries and injuries. For spine problems I had years of nerve injections and later several ablations, all of which worked at the start then failed, then a few years ago he seemed to give up and started me on just pain meds. I'm dependent and somewhat tolerant, but I don't crave meds, or take any more than prescribed by my PM. I don't expect to be pain-free, just want to be able to function.
Posted 3/13/2019 7:51 PM (GMT 0)
What about reducing what you are taking now ? If you got to a low dose. Would he keep you on them ? I know that does not sound like it could be any help. But I seems like it would be better than MM or Methadone.

I have always been terrified of Methadone, OxyContin and Fentanyl. I have refused them the times it has been suggested. I would also refuse MM. They do not know how it works with prescription medications not related to pain. They do not know what negative effects it could have on certain medical conditions. They do not know about long term mental side effects especially for seniors. They do not have medical evidence it is as safe as many claim.

I pray you find the answer for what is best for you. Please keep us posted. Have you considered changing doctors?
Posted 3/13/2019 9:48 PM (GMT 0)
Alice:
I am sorry to hear that you are bearing the mental weight of uncertainty regarding future dosing of your pain medication.

I think that most people with legitimate chronic pain and who are prescribed opioids hold concerns about what the future may hold in terms of prescribed dosing.

You still have ample time to meet with your pain management physician where you can express your concerns (much as you have articulated in your post here) and arrive at a plan that both you and your MD can agree with. Try to remain positive in your outlook.

I think proposing to your pain MD a few different options, as you have done in this post, seems a valid approach. It shows that you have given thoughtful consideration and are aware of the real and artificial barriers that currently exist in prescribing opoids. In essence, you are bartering with your pain MD. But you are bartering from a position of knowledge and insight. I think most physicians would appreciate the extra work and effort shown.

You have time to reach an place of mutual agreement with your pain MD. Keep faith that you will be OK.
Karen
Posted 3/18/2019 3:19 AM (GMT 0)
Personally, I don't like the psychoactivity of MJ. Rather than relaxing me, it winds me up, especially anxiety. It can help with pain, but the effects for me are very unpleasant.

Why not discuss with your doctor a trial month. Dosages, cannabinoid ratios, terpene profiles, etc are such unknowns you can't realistically move into it without a lot of trial and error.

Also, in my state, there are many pain doctors who allow both opioids and MJ, often with a reduction of the former. Because MJ is a respiratory stimulant, it makes opioids safer, reducing the risk of an overdose caused by respiratory depression.

If you start on this path, start with a 5:1 or 10:1 CBD to THC option.
Posted 3/18/2019 10:19 AM (GMT 0)
Cogito...Or anyone who knows...is a mild (weak) CBD oil something that would be a problem in a drug test by PM? I asked my PM person and they said 'Go ahead and try it...prob just a placebo' which was silly in my opinion. When I asked if it would be a problem showing anything in the urine test he shrugged and said just tell us you tried CBD oil. Is this something that would be a problem in compliance in your opinion (s)?
Posted 3/18/2019 5:42 PM (GMT 0)
CBD products can contain trace THC. Federal law limits it to .3% THC, but even with that, you can test positive for THC. I purchased some federally legal hemp flower last year and vaped it for a while. I bought some THC urine tests and did eventually test positive, just by using it. There are also published studies showing that hemp products can result in positive urinalysis. What is going on is that THC metabolites (which are not psychoactive) end up getting stored in fat cells, build up, and then get release if you lose some weight, exercise, etc..

There are, however, some products that purport to be 100% THC free and can provide you with testing to show that. If you have your doctor's consent, I would suggest buying something where you can get the lab report and show it to your doctor. Nevertheless, from batch to batch, one never knows if some THC will remain.

Perhaps your doctor doesn't know that we have an endocannabinoid system, i.e. natural cannabinoids and receptors that are activated by THC as well as CBD. CBD bonds with the CB2 receptor, which regulates cytokine levels. Cytokines play an important role in inflammation and thus by using CBD, you can reduce inflammation (THC does this too via a related mechanism). Here are a few studies...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578059/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085542/

In short, CBD is not a placebo. It has a well established mechanism of action, one that may or may not benefit you. Note also that CBD has very low oral bioavailability -- between 5-15%. For this reason, I vape it instead of using pills. Another option is sublingual tinctures, but they too aren't great for bioavailability as the liquid usually gets washed away from under your tongue by saliva.
Posted 3/18/2019 7:08 PM (GMT 0)
Thanks, Cogito. The links did not come through but I can look up the articles. I appreciate the information.
Posted 3/18/2019 11:20 PM (GMT 0)
Been researching the efficacy of medicinal marijuana and all I am seeing are positives. I know peeps using it for various conditions, and yes treatment and a reduction med regime for some is showing great efficacy. HT

PS...yes some countries have far more advanced evidenced based research than others....far far away from big pharma that is! HT
Posted 3/19/2019 2:48 AM (GMT 0)
I agree with Cognito and Turtle . . . The use of marijuana has known efficacy and benefits.

Anecdotal stories . . .
My own brother uses MJ for control of epileptic seizures (which have been refractory to almost all prescription medications). My elderly mother uses a CBD liquid for neuropathy. A woman in my condominium complex vapes CBD oil for pain related to an automobile accident a few years back (she fractured several ribs, two thoracic vertebrae, a fractured jaw).

Big Pharmaca in the US has strong lobby efforts against MJ. Success of the MJ cottage growers and dispenciaries would have the effect of dampening Big Pharmaca profits.

Profit motivations and profit maximization are poweful influencers across a range of industries - healthcare, aviation, autombile production, oil drilling, natural gas pipelines, and on and on.

While use of MJ may not bring complete someone with chronic pain complete pain relief, MJ certainly can contribute to an overall lessening of one’s pain experience and thereby lower of the need/dose/frequency for adjunct prescription pain medications for some people.
Karen
Posted 3/19/2019 2:59 AM (GMT 0)
There are no laws regarding prescribing opiates to patients that test positive for THC. If I remember correctly, the CDC recommend doctors stop testing patients they prescribed opiates to for THC. This is something that is up to each doctor.

There are no guarantees if you test negative with a,test you buy. You will test negative with a,test your doctor gives you. The most important thing is to talk to your doctor about his position on THC and prescribing opiates. Do this before you try anything that contains THC. The second most important thing, tell your doctor if/when you try anything that might test positive for THC.
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