Pain medication is the number one reason patients come to me for. Not to prescribe pain medication but for an alternative to it. Something safer. People are tired of opioids, tired of the dependency on them as well as not helping with their pain. Tired of being labeled an addict when they go to get prescriptions refilled at the doctor's office and pharmacy. So that begs the question does cannabis really help decrease prescription opioid use?
In a large prospective study published in the December issue of Pain Med, Philippe Lucas et. al. evaluated 1,145 Canadian patients for this exact question. Patients were evaluated at baseline then at 1, 3 and 6 months. A comprehensive cannabis use inventory and a questionnaire on quality of life were administered each visit. Baseline opioid use was 28% of patients which dropped to 11% at six months! Daily opioid use went from a staggering 152 morphine equivalents per day to 32 in six months! The study suggests that cannabis may play a harm reduction role in the opioid crisis as well as improving quality of life.
Recently I signed up a patient with Sickle Cell Disease. I reflected back to my residency training where the main treatment consisted of hydration, oxygen therapy and pain medications as the pain in sickle cell can be quite painful. With the opioid epidemic most physicians have dramatically pulled back on prescriptions. In a case with Sickle Cell patients can have sudden horrific pain so considering cannabis is very common.
In the Dec 2020 issue of Journal of Clinical Medicine, Donovan A. Argueta et al reviewed clinical articles in Considerations for Cannabis Use to Treat Pain in Sickle Cell Disease. The article reviewed multiple pathways that Sickle Cell patients experience pain and how cannabis can help with specific forms of pain. The review also showed that routine users of cannabis had less hospitalizations than non users per year.
Although just a review of published articles cannabis needs a second look for patients with Sickle Cell Disease and hopefully after federal deregulation large studies can be done to look more at Sickle Cell Patients, but for now I recommend anyone with Sickle Cell Disease to get their medical card.
How do I start using Cannabis? This is probably the number one question I get when helping people get their medical card. From all ages I hear this question although I hear it most with Generation X people. I believe it's because we were raised with Nancy Reagan and this is your brains on drugs commercial. The scare tactics worked on a lot of us, including me, but after seeing cannabis help people get off highly addictive pharmaceuticals it has our generation questioning what we were told. From seeing CBD help the family dog to seeing mom or dad doing a lot better after getting their medical card.
Researching is a good place to start, at least now questioning what we believed. I always recommend people to do research as well as talk to friends or family who have had good success with cannabis. i also tell people to talk with the different dispensaries and to try different dispensaries out because some are there to sell product and some are there to help medicinally. A safe place is to start with an edible 1-2 hours before bedtime. I recommend starting with only 5 mg the first night and adjusting with 5-10mg every third night. With some products containing 250mg this can be tough but most of the gummies will be 100 or 250mg per bag and with 10 gummies that comes out to 10mg or 15mg per gummy. Keep a journal of the brand you buy as well as the strain it includes and the effects both in the night and the following day. Look for effectiveness and any side effects and discuss that with the dispensary bud tenders if you have any. This can help in your next purchase.
With time and your journal you will be able to find what helps you the most with the least side effects. Good luck in your trials!