How Weed Is Helping Opioid Users Beat Addiction
A growing body of experts and patients say cannabis should be prescribed before painkillers.
This post originally appeared on VICE Canada
Derek Pedro has been in pain for his entire life.
Pedro, 44, suffers from migraines and a form of Ehlers–Danlos syndrome, which affects the collagen in his body, making his joints incredibly loose. Together, the two conditions have caused him pain since the age of six.
Pedro, who lives in Hamilton, Ontario, told VICE he was prescribed demerol, an opioid painkiller, when he was 12 years old. As he grew older, and underwent surgeries for his knees, shoulders, hernias, and spine, he was prescribed other opioids, including fentanyl patches, Percocet, and oxycodone.
He says he expressed concern about getting hooked on Percocet and was told by his doctor: "If you're taking it for pain you won't get addicted." But he did. At the height of his opioid use, he was taking 300-400 Percocets a month, combined with three-to-four 40 milligram doses of oxycodone a day. He even overdosed in the shower from a fentanyl patch.
One day, while about to leave his house for a vacation with his family, he said he had a moment of clarity.
"All of a sudden I can't find my pill bottle... and I was like 'we're not going anywhere until I find my pills'," Pedro said. "There was a feeling that I never want to feel again, it was the feeling of addiction."
Pedro eventually got a medical license to grow weed in Canada and began weaning himself off pills in 2005. By late 2007, he was no longer using any opioids.
"Cannabis hasn't cured me. But it's made my life tolerable when it comes to pain," he said. "I am a productive and engaged father. That is the most important thing in my life."
The Liberal government's Task Force on Cannabis Legalization and Regulation released dozens of recommendations this week on how the legal weed regime in Canada should look. While much of the report focused on recreational use, it also recommended more clinical research about the medical use of cannabis with the aim of bringing cannabis-based drugs onto the market.
But some Canadians, including doctors and patients who deal with pain, are asking why the government hasn't already embraced cannabis as an alternative to opioids—especially with the country in the grips of a deadly overdose crisis.
Canada is the second largest per capita consumer of prescription opioids in the world, according to the Canadian Centre for Substance Abuse. In August, Benedikt Fischer, a scientist with the Centre for Addiction and Mental Health, told a national physicians conference that opioid prescriptions for pain rose 200 percent in the last decade. At 134 milligrams per capita, our morphine consumption alone is almost double America's 73 milligrams per capita.
Meanwhile, overdose-related deaths have soared; 2,500 Ontarians died from prescription opioids from 2011 and 2014, with opioid deaths increasing by 24 percent. Fentanyl—a painkiller up to 100 times stronger than morphine—is responsible for hundreds of deaths across Canada, including 488 in BC from January to August 2016, a 61 percent increase over the same time period the year prior.
Despite its rampant popularity, opioids are actually a poor solution for long term pain, explained Alan Bell, a clinical researcher and professor at the University of Toronto who sits on the medical advisory board for Tweed, one of Canada's largest licensed producers.
Bell told VICE that patients tend to build up a tolerance for opioids after consuming them over time, reducing the efficacy of the drugs. Opioids should be used in acute pain situations—like when a person breaks a bone.
"There is no solid evidence that opioids are particularly effective for long term chronic pain management," said Bell. Likewise, Pedro said that opioids didn't help with his migraines, they just sometimes staved them off.
Bell also explained that with increases in doses due to higher tolerances, the potential for developing a dependence and overdosing goes up. In fact, when some people come off opioids their symptoms return with a vengeance or they have withdrawal symptoms, he says, that can lead them to want to use more, sometimes turning to the street to find the drugs.
So where does weed fit in? Research has shown cannabinoids can be very effective at treating neuropathic pain, Bell explains, and can help reduce the amount of opioids a patient would require. Studies for both families of drugs tend to be short term but Bell says given the choice between a high toxicity drug that can also be highly addictive and a drug with minimal risk of overdose and dependency, "I think I would lean toward a safer drug." In the US, a growing body of research shows states with medical marijuana have fewer painkiller overdoses—and some pharmaceutical companies are even lobbying against pot.
Still, the Canadian Pain Society recommends opioids over cannabinoids. And Bell says many of his physician colleagues "are far more comfortable prescribing opioids, which is completely illogical." Doctors from the BC Centre for Excellence in HIV/AIDS expressed a similar point of view in an editorial in the Canadian Journal of Public Health last year.
Eden Medicinal Society, a chain of dispensaries with locations in Vancouver and Toronto, tried an opioid reduction program in BC through which patients were given cannabis capsules to augment methadone replacement therapy.
In a statement to VICE, the dispensary said informal observation suggested the program was effective in reducing methadone dependency. It is currently being studied further.
Medical marijuana patient Justin Loizos, who has a dispensary in north Toronto, told VICE he advises patients on how they might go about easing off opioids. Loizos, 32, was diagnosed with multiple sclerosis four years ago. He suffers from pain, spasms, dizziness, and is sometimes confined to a wheelchair or hospitalized due to "excruciating pain."
But he has managed to keep from using narcotic painkillers because of his cannabis regime.
He tries to have 1000 milligrams of THC in his system at all times, which he consumes by doing dabs (shatter) in the morning and orally ingesting phoenix tears—an oil extract—in a capsule every four to six hours.
The government task force report did address concentrates like shatter, noting that they contain up to 80 percent THC, but, rather than suggesting an outright ban, it recommended the government proceed with caution when it comes to such products.
Horatio Delbert, a Vancouver-based extractions specialist, claimed that his concentrates, some of them in the form of white powders virtually indistinguishable from a narcotic, are so advanced that they can directly compete with drugs like oxycodone and fentanyl.
"If you can understand certain types of problems well enough, concentrates are opioids, they're just natural," he said, adding cannabis extracts "don't have the downside of pharmaceuticals."
He explained that his clients will pay $135 for half a gram of his extracts—more than three times the street value of cocaine—used to treat everything from insomnia and anxiety to painful conditions like Crohn's disease.
Bell, however, explained that there is no clinical evidence to support the medical use of products like shatter.
Pedro said he currently smokes around 15-20 joints a day, does a couple grams of shatter, and eats homemade edibles, like muffins and cookies. He makes his own concentrates using ethanol, which is currently allowed under Canada's medical marijuana program.
When he was using opioids heavily, he says he was incapacitated, at times dizzy, nauseous, and sweating. He was also 25 pounds heavier.
These days he works as a consultant for several licensed producers. He still has pain, but says he is happy and is helping other opioid users discover the benefits of medicinal cannabis.
"I have my life back," he said. "I had a miracle happen to me and I just wanted to spread it around."
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