Lisa Sheldon has lived with chronic pain for much of her life. The 34-year-old bar manager and mother of two from Mt. Holly, North Carolina (her name has been changed because she lives in a prohibition state), suffers from fibromyalgia, in addition to lingering complications from a past car accident. Drugs like aspirin and ibuprofen didn’t help.
Sheldon describes herself as a go-getter, but trying to parent, work, and attend school, while dealing with severe pain proved nearly impossible. “I was struggling to get through my days,” she said. Nerve pain like what Sheldon experiences is considered some of the most agonizing there is. “The best way to describe it is like you’re being electrocuted," she said. "Or you’re on fire.”
Eventually, her doctor put her on a regimen of opioid painkillers. The term “opioid” can refer to any natural or synthetic compound that binds to the opioid reward centers of the brain, such as morphine, codeine, heroin, oxycodone, hydrocodone, fentanyl, and methadone.
"I could get up, I could function," Sheldon said of the painkillers. At first, it seemed like she had found a solution, but at times she when would go a few days with little or no pain, she began to wonder if the meds were still necessary. That’s when she realized that her body was dependent on pharmaceuticals. So, despite her growing concern, she kept refilling the prescriptions.
Besides the issue of physical dependence, she was plagued with extreme irritability and constipation—two common side effects of opioids. Over time, Sheldon was put on other medications to address those side effects, and when the second tier of medications caused their own cascade of unwanted effects, she was prescribed still another round of drugs to offset those. At a certain point, Sheldon had been prescribed no less than 36 different medications, and her daily routine revolved around pharmaceuticals.
Worst of all, the opioids’ efficacy diminished over time. “Your option at that point isn’t to step down," said Sheldon. "It’s to step up.” Liver damage, persistent GI issues, reduced heart, and compromised lung function, among other conditions, can result from long-term use of painkillers. Fear of overdose lingers in the background, too, for those who depend on these kinds of drugs.
So, Sheldon reconsidered her regimen. Her sister-in-law had had success using cannabis for her own pain condition, and Sheldon wondered whether it would help her, too. It did. She began to transition from opioids to cannabis in May of 2018, and today she lives free from pharmaceuticals. “I don’t feel like cannabis completely deadens my pain,” she said. “It’s still in the background, but manageable. I’m comfortable, but I don’t feel out of control. I don’t feel high.”
Another Success Story
While Sheldon’s success with cannabis may sound miraculous, she’s one of many chronic pain patients making the switch. Mike Robinson, founder of a medical cannabis blog called Mike's Medicines, suffered a catastrophic accident in 1985. In and out of a wheelchair and prescribed multiple pain meds for years afterward, he eventually came to realize he was dependent on opioid drugs like OxyContin. “I didn’t think I was abusing meds. I didn’t refill early. But I had to figure out why I was still using them," Robinson said, after decades of living with chronic pain, and surviving cancer and epilepsy on top of that. He eventually realized that he woke up every morning covered in sweat, head pounding, and in such an elevated state of discomfort that he was no longer taking the meds for pain, but to relieve withdrawal symptoms.
Robinson, now nearing 90 days opioid free with the help of cannabis, told Civilized: “It’s a whole new world. Everything tastes different. Looks different. I used to numb my senses with opioids.” He’s developed a personalized cannabis therapy that he considers a replacement for pharmaceutical pain meds and has started to help others wean off painkillers, too. But, he cautioned that cannabis medicine is not a one-size-fits-all solution and may not even work for everyone. “Cannabis is an awesome natural remedy that so many people are finding relief from,” said Robinson, “but I don’t like to tout it as a cure-all because I don’t see it that way.”
Nationwide Statistics on Cannabis and Opioids
Survey data collected in 2017 from 2,897 medical marijuana patients in legal states showed that 97 percent of respondents were able to reduce or eliminate their opioid use with cannabis. Among them, 81 percent even reported that cannabis alone was more effective for pain relief than cannabis and opioids combined. And a 2018 study from the University of Georgia found a 14.4 percent reduction in prescription opioid use in states with medical marijuana.
Meanwhile, cannabis, as we well know, is on the list of Schedule I drugs—which means that it’s considered by the federal government to have the lowest therapeutic value and the highest risk for abuse: a nonsensical classification, given cannabis’ many medical uses. It’s particularly egregious when compared to pharmaceutical opioids, listed under the purportedly less dangerous Schedule II, which are responsible for 130 deaths in the U.S. per day, or almost 47,450 deaths per year. The drugs responsible for those deaths include both prescription and street opioids, though it’s been documented that the use of prescription painkillers sometimes leads to street drug use. Cannabis does not carry the risk of lethal overdose, unlike opioids, and is just as effective for certain types of pain—in some cases, even more so. Cannabis also has anti-inflammatory properties and can even help alleviate the causes of chronic pain.
A Medical Marijuana Physician’s Perspective
Dr. Bill Code, an anesthesiologist and integrative medicine specialist who’s worked with over 2,000 chronic pain patients in Canada, says that dependence on opioids post-trauma or post-operation is extremely common. People are given a prescription from their doctor to ameliorate short-term pain, but “by the time they’ve done their two weeks, they're hooked,” he told Civilized. Fortunately, he says, cannabis can be extremely effective for pain relief, either alone or in conjunction with the meds. “With a relatively small dose of cannabis, the strength of pain relief from the opioids is improved by four to ten times," he added. Then, patients can wean off pharmaceuticals because they’re not experiencing pain while doing so.
Dr. Code says that depending on multiple factors like the kind of pain experienced, as well as the duration and dosages of pharmaceutical use, some people may be able to taper off drugs like OxyContin or Hydrocodone in a couple of months. The process could require five months to almost a year if the patient is only comfortably able to taper by two and a half percent or five percent a week — but it can still be done.
And while tolerance to cannabis often develops over time, Dr. Code has a few recommendations based on years of working with medical marijuana for pain relief: Change your strain to explore new terpene profiles; and take a tolerance break once a week, or two to three days a month. And as for the question of addiction to cannabis, Dr. Code said that it can happen in about nine percent of those who consume — a small fraction of the number of people who become addicted to pain meds, alcohol, and nicotine. “But the withdrawal from cannabis can be very rapid," he said. "It’s a relatively smoother addiction to solve.”
Even with all the benefits of cannabis over opioids like Oxy and Hydrocodone, Dr. Code cautions against unrealistic expectations. “There isn’t any chronic pain silver bullet that does it all by itself," he said. "What I strive for is what I like to call ‘balanced analgesia,’ which refers to the synergistic effect of different pain relief methods.” A patient may end up using some combination of cannabis, pharmaceuticals, over the counter painkillers, and holistic treatments like acupuncture to get relief. Working with a skilled practitioner is key here.
Strains, Dosages, Delivery Methods
Dr. Code starts pain patients who are struggling with pain on a 1:1 ratio of THC to CBD and observes how they respond. If symptoms don’t abate with that mix, he’ll increase the percentage of THC and often finds that a 4:1 ratio of THC to CBD is “the sweet spot” for pain relief. He recommends oils as an easy delivery method for achieving specific and individualized ratios and dosages, and also encourages people to experiment with terpene profiles to find what works well for them. Terpenes such as d-linalool and sesquiterpenes, he said, may have particular pain-relieving effects.
As the human and economic costs of the opioid epidemic continue to rise in the U.S., and as information about the causes underlying this problem come to light, cannabis’ increasingly widespread legalization could help those who need it. Perhaps one day, medical marijuana — instead of, or adjacent to opioids and other pharmaceuticals — will be considered a first resort for mainstream doctors to prescribe their patients.