Chronic Pain Patients Face Medical Marijuana Trouble

Very few doctors are willing to allow opioids and marijuana together
The Lund Report

June 17, 2011 – Christine Mullins was diagnosed two years ago with fibromyalgia, a condition causing complete body-wide pain. The only way she’s found relief has been a regular dose of Oxycontin, an opioid prescribed by her doctor.

The medication, however, causes nausea and Mullins, 38, is allergic to every anti-nausea medication on the market. So for the past year, she’s been using medical marijuana with a prescription from another doctor to relieve the nausea and regain her appetite.

But recently her pain management doctor has said she can’t continue using marijuana if she wants to keep her opioid prescription.

“He told me they don’t recognize it because they get federal funding and that I needed to choose one or the other,” Mullins said. “He said he didn’t care what I used it for. It was an illicit drug and if I continued using it he would no longer fill my pain medication.”

The doctor who prescribed the marijuana, meanwhile, won’t prescribe opioids. Mullins said she’s contacted 150 doctors in the Portland-area and none of them are willing to prescribe both opioids and allow her to use marijuana.

And Mullins isn’t alone.

Paul Stanford, president of The Hemp and Cannabis Foundation headquartered in Oregon with clinics in 11 states, said he’s received thousands of similar complaints from chronic pain patients in Oregon.

“It certainly concerns me,” Stanford said. “We’re trying to help our patients as much as we can. It’s a major problem. It’s terrible that they torture patients this way.”

The issue generally surfaces for patients with severe pain who enter into a “pain contract” with their physician. As one of the stipulations, patients often must take urine tests and stay off any illegal drugs. Although medical marijuana is legal in Oregon with a state issued license, the federal government still treats it as an illegal substance. And thus lies the conflict.

So for the patients that most benefit from medical marijuana, who are perhaps the most legitimate users, they are almost entirely prohibited from using the drug in combination with pharmaceutical pain killers.

“At this point I just feel like the state of Oregon is issuing a card that’s really no good,” Mullins said. “Nobody accepts it. It’s putting us all in danger. If companies find out we lose our job. If our housing finds out we lose our housing. If doctors find out we lose our medical care. It’s basically a useless card that the state is making money off.”

This week, the Oregon Senate approved an Oregon Health Authority budget that includes a doubling of the medical marijuana fee to patients to $200 annually. The program is estimated to raise $7 million in revenue annually that can be transferred to the general fund for other services.

In addition, the dispensaries that supply marijuana in Oregon have recently faced pressure from the U.S. Attorney in Oregon and other law enforcement agencies that their operations could be subject to prosecution. Officers subsequently raided a dispensary in Aloha.

Those who suspect the majority of Oregon’s roughly 40,000 cardholders to not be legitimate pain patients have also criticized the state program in general.

Betsy Boyd-Flynn, deputy executive director of the Oregon Medical Association, said the organization advises doctors to stay away from prescribing medical marijuana because it could endanger their medical license.

“We tell doctors to avoid it, frankly. Because of the interplay between state and federal law, there’s room for significant liability to physicians,” Boyd-Flynn said. “If a patient injures someone and a physician provided the card or was involved in the process of substantiated application, they could potentially be liabile.”

Kathleen Haley, executive director of the Oregon Medical Board, said there are no rules that prohibit a physician from providing both narcotics and a medical marijuana card, but it’s something a physician has to pay close attention to.

“If they violate the pain contract, the physician obviously has to take appropriate steps when they’re managing that pain,” Haley said.

Stanford said he is considering turning his clinics, which currently only prescribe marijuana, into full-service medical clinics. In the meantime, he said, he may ask doctors to consider prescribing opioids in conjunction with cannabis for those patients most in need.

Stanford is also working to promote a ballot measure called the Oregon Cannabis Tax Act that could potentially raise $150 million annually.

Mullins said the current situation puts a blight on the state program.

“To me it’s sickening,” Mullins said. “I’m not seeing anything medical about it. The people in the worst shape are the ones being treated the worst.”

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Comments

No one is going to harm someone on pot...what a joke! You're 100 times more likely to hurt someone taking legal oxycontin or vodka! Wake up FEDS, your scare tactics are beginning to bore us.

I take pain meds for artery and heart desease as have decided not to have the operation suggested. And am a card holder for medical marjuana, now they dare to refuse me my pain medication, it will make me unable to walk. anyone have a suggestion, or recomendation?

Sorry, even though it is not "PC", there is no such disease as fibromyalgia and certainly high dose chronic narcotics are not the answer. In what other country does fibromyalgia exist. 90% of the world's narcotics are perscribed in the United States. That is a far more important and compelling health crisis.

What is the basis of your statement that "there is no such disease as fibromyalgia"? Are you a scientist or doctor? Have you been diagnosed with Fibromyalgia? If you choose to make these type statements then provide information other than your opinion.

So if there is no such thing as fibromyalgia what the hell is causing the severe pain I feel at all times? Are you a Doctor? Where do you get your information?

yeah pain pills are narcotics too and they are more dangerous then marijuana and yes fibromyalgia does to exist your not a doctor or not the specialist so how can you say that it make me sick too here stupid people talk about something that don't even understand. the only way to understand the disease is to have it so i hope god punish you by giving you fibromyalgia and then well see if you think it real or not.

Funny that " there is no such disease as Fibromyalgia", I am currently rated at 40% disabled by the Department of Veterans' Affairs for fibromyalgia which started 10 years ago.

Check out footnotes 4 through 8 here http://bit.ly/1cpp5IY citing articles concerning fibromyalgia prevalence in Canada, Brazil, Mexico,and 5 European countries. The study of the European countries is online at http://www.cnbc.pt/jpmatos/15.%20Branco.pdf But still it could be a widespread PC conspiracy...after living with fibromyalgia for over 20 years, and seeing many research reports of abnormalities of the central nervous system, pain system, etc in fibromyalgia, it seems well established as real to me.

There are several issues with this story. As already mentioned. fibromyalgia is poorly treated with opiate analgesics and Oxycontin is not indicated. Chronic opioid therapy rarely causes nausea. So I find the case study not really compelling.

It's not just fibro patients. This was one woman's story I managed to reach. As the article states, there are thousands of chronic pain patients with the same problem.

Most doctors find cannabis along with the pharmaceutical opiates reduces the amount of opiates needed, offering better quality of life for the patient, and far less damage to the body. Someone needs to educate the doctor,

Tell your Congressional Representatives - It is time to "Change the Schedule of Cannabis, Cannabis Laws, and Drug Czar Laws" Read and Sign the petition at http://www.change.org/petitions/change-the-schedule-of-cannabis-cannabis-laws-and-drug-czar-laws After you sign the petition, email your friendlies, share on facebook, or twitter from the petition page. If you have a website grab the widget so your visitors can sign it without leaving your website. This petition uses laws passed by Congress to point out that by their laws, the laws must change. It begins - It is difficult to understand and believe Congress enacted a law requiring a government official to lie and to ignore science and medical studies. This renders the Office unreliable and a fraud. Though 68 - 84 % of this nation, depending on the poll, wants to legalize the medicinal use of cannabis, and science and medical studies have proven the therapeutic benefits and medicinal value of cannabis, we have been forced to live with outdated Draconian laws. It is time to change this. and continues

It's not about "federal funding;" it's about one's DEA license. Physicians are not eager to risk losing the ability to prescribe controlled substances (which is a federal license) in order to get involved with medical marijuana. This would be particularly true of pain specialist doctors, I'd imagine.

i would have to say, FOR MYSELF, cannabis allowed me to go from bedridden, 360 mg of OXY, (and 13 other prescribed pharmaceuticals) down to ONLY 8.3 mg of intrathecal morphine . And i say ONLY because it it from a pump implanted inside of me for which i have NO control on dosage. Should the goal have some sort of "harm reduction" policy??? glad to be OFF the OXY!!! m.g. illinois cannabis patient

quoted -----> "It's not about "federal funding;" it's about one's DEA license. Physicians are not eager to risk losing the ability to prescribe controlled substances (which is a federal license) in order to get involved with medical marijuana. This would be particularly true of pain specialist doctors, I'd imagine." ---------- I guess that's one reason why they don't have students in law schools imagining things to earn their J.D. Conant v Walters, (9th Cir 2002) 309 F.3d 629, cert denied Oct. 14, 2003) says that the Constitution protects the right to free speech in the 1st Amendment. The decision is binding in the 9th Circuit which includes Oregon. The SCOTUS wasn't interested in hearing the governments appeal. PS within the last couple of months the intention to attempt to strike Conant was broadcast by the arrest of a doctor in Michigan in the 6th Circuit. It's an all or nothing gamble for the Feds, and a pretty stupid bet at that since the 1st Amendment is the one part of the Bill of Rights that the SCOTUS has upheld in almost every case imaginable.

My husband was on Oxycontin for pain before being prescribed Medical Marijuana. He got addicted to them after a week, and ended up getting sick. I urged him to seek Medical Marijuana because I did not want my husband to end up abusing Oxycontin the way that MANY end up doing, and now he has completely stopped taking them, and Marijuana gets rid of his pain with no harmful side effects, none that we know of, at least.

I am 60 years old and I take 40mg of time-release Oxycontin every day for severe neuropathy. It has enabled me to continue working productively. I was disabled from pain before Oxycontin. It's a life saver for me.

At what point is it not ok to feel ok? If this 'substance' should fall into the hands of people that already feel ok and they feel even better, what then? Think about this....what kind of society do we want?

is this coming from an ethical or moral standpoint?whats wrong with society is people who like yourselfs judge others,you know nothing about there medical conditions but throw out your 2 cents judgement and these patients suffer because of your judgement leave the judging to god,your whats wrong with society

I'd be willing to make the switch from Vicodin to Medical Marijuana for Fibromyalgia relief if I knew more success stories in Oregon in particular.

Not only is fibro all-too-real . . . the drugs being used to try and deal with it make the patient, in many cases, very unreliable, ie:stupid, as if the "fog" isn't bad enough.

could you advise how to search for a good dr. that will help with a prescription? i am in such pain and get frustrated just trying. thank you

ive been on the same search for 6 weeks with no anwsers please come to cannabis common sense public broadcast fri @ 730 type into google for address lets ban 2gether and get the resources we need.

The ignorance I see here is horrifying, especially that in the article itself, not just in the comments! First, someone mentioned that her husband had gotten "addicted' to oxycodone. From the way she phrased it, she meant that when he stopped taking it or allowed the drug to clear form his system he got withdrawal symptoms. If I understand that statement accurately, that is NOT an indicator of addiction! Withdrawals are strictly a physiological reaction to abstinence from a medication it has grown accustomed to. It doesn't happen only with opiates either; there are many medications that will cause withdrawal symptoms when they are stopped suddenly. Withdrawals are easily mitigated by titrating down (lowering the dose in small increments instead of cutting it off all at once) instead of suddenly stopping. Addiction is a psychological problem related to obsessive-compulsive disorder INVOLVING usually) a medication. Being an addict does not, however - or SHOULD not - preclude medically correct treatment for pain, even chronic pain. Opioids are considered the "Gold Standard" treatment for chronic pain (per the W.H.O. as well as the Medical Standard of Care in the U.S., though the DEA, ONDCP, DOJ and other agencies that profit from criminalizing pain doctors and refuse to acknowledge the science behind this - or to even attempt to understand it as it would jeopardize their budgets and their nearly unaccountable power). This is because opioids contain the same molecule made by the human body itself specifically for mitigating pain; it's just that in CPPs (Chronic Pain Patients) the pain mitigation system, located in the dorsal horn of the spine, is broken. These drugs are among the safest, best understood most effective and longest-used medications we have. NSAIDs Non-Steroidal Anti-inflammatory drugs), on the other hand (like ibuprofen, aspirin, naproxin and others) kill at least 20,000 Americans every year through bleedouts, strokes and other conditions all caused by bleeding. Their pain-relief is not strong enough to handle CP, and CPPs (mostly, though others as well) tend to take too much vainly trying to control their pain. Pure opioid agonist drugs, like oxycodone, morphine and others, taken correctly, can control almost any level of pain, though as with anything, there are some people who have problems with sensitivities to them. It's also a myth that taking them for pain at high doses will render them useless if a patients ends up needing them for cancer pain later on. THERE IS NO SEVERE UPPER LIMIT TO DOSE. As the World Health Organization wrote: "The right dose is the one that works." Some people have been on regular doses as high as three GRAMS of morphine per day - that's three THOUSAND milligrams - and they did fine. If the doctor titrates up starting from a relatively low dose until the pain is under control and the patient recovers some function, there will be no problem with overdose. The tolerance for the respiratory depression effect that opiates can cause builds so quickly the dose can be doubled roughly every two or three doses. The tolerance for the pain controlling effect, however, builds much more slowly, allowing doses as large as necessary, and that can vary tremendously between patients with the same amount of the same kind of damage. Thus the PDR recommended doses are guidelines, NOT absolutes. There's so much more that the propaganda spread in the Drug War contradicts - wrongly, to the extreme detriment of 116 MILLION people in untreated or under-treated chronic pain. Even many doctors have come to believe the lies, but lies they were and lies they remain. CPPs who are properly treated recover function, start washing dishes again, cooking a decent meal for themselves, they can hold a beloved child again, even go back to work! As Dr. Alex DeLuca says, "They pick up their beds and walk!" To the patients and their families it's a very real miracle. Until the DEA, choosing to be ignorant of the truth, steps in and after a Trial-By-Media in which the doctor is all but hung from a lamp post, a real trial with false evidence begins (true evidence is always withheld, disallowed). Ordinary billing practices become "money laundering," and instead of the Medical Standard of Care being explained, it is also forbidden, and the jury hears about "usual practice" instead. The MSoC is what the experts who do the research and write the textbooks say; "usual practice" is what doctors who are afraid of the DEA and their violent ignorance do - deliberately torture their patients by prescribing far too little. Prosecutors run the show, and it IS a show - a performance. One in which the truth, especially medical science, has little place. The arguments consist of exaggerations, interpreted or simply false statistics, and heartrending, emotional stories, some of which may even be true, are the main fare. Compassionate doctors, who can be fooled by addicts sometimes, and who are also fooled sometimes by doctor-coached DEA agents, can sometimes end up prescribing for an addict who is not a pain patient. This is very much in the minority of any doctor's patient list, but it's unavoidable. And just ONE such incident can get a doctor what amounts to a life sentence, incidentally throwing all of his real patients onto the streets. With doctors mostly too afraid now to prescribe for pain patients and clinics being closed down by entrapment, and 'crimes" that should at most be the business of a Medical Board, not the Justice Department, there are far too many pain patients at any pain clinic, which of course the DEA chooses to interpret as a "Pill Mill," even though they themselves caused the overload! Opiates, by the way, cause NO lasting damage even after many years of regular use, and the problems they cause, like thickened mucus that can cause tooth decay, constipation and "fuzzy headedness" and nausea can all be mitigated fairly easily, often just by switching to another opiate. CPPs have stayed on the same dose for years, and though tolerance can happen, usually when a higher dose is needed, it means that the underlying condition has worsened. Again, there's SO much more about this sick, wrong-headed situation that people, especially doctors and pain patients and their families ALL need very much to understand the truth of. Radley Balko has a number of excellent articles, as does John Tierney of the New York Times, and Payne Hertz. And though a vindictive DOJ Federal Prosecutor together with an ignorant and complicit judge destroyed the advocacy of the Pain Relief Network and its surviving founder Siobhan Reynolds, there are still a few diehard CPPs and a tremendous amount of information at her old blog here: http://www.painreliefnetwork.org/forum/ Learn the truth about chronic pain - it KILLS, despite all the doctors and others who have insisted for a century or more that "Pain never killed anyone." I beg to differ! It causes tremendous amounts of damage to every system and organ in the human body. Read, learn the truth, find out how we've been lied to and ARE being lied to in order to keep the Drug War going, and then get involved! We Baby Boomers are getting older, and many of you reading this will become CPPs (Chronic Pain Patients) as you get older. We're all just one accident, one botched surgery away from a lifetime of pain and, if things don't change, here in America there IS NO TREATMENT FOR IT. None that the cops who are now in charge of Pain Management will allow, anyway. Ian MacLeod

Apologies - in the interest of disclosure: I am a 56 year old CPP, post 6 low back surgeries - 2 within 6 weeks of each other - with "massive arthritis" and "severe nerve damage." I'm a veteran, now disabled (as opposed to a "disabled vet," meaning my disability was incurred during service; my main disability, not the migraines, was not, and I was not sent to Vietnam, though I did join during that conflict. The only war zone I was sent to was East Oakland, at NRMC Oak Knoll, Oakland, CA). When my injury became permanent and never stopped hurting, I lost a) my spouse (more than 90% of us lose the spouse/partner we are with at that time); b)my job; c) my home; d) my vehicle; e) my son (she didn't want him to see me "like that"). All of that is typical, as is the severe loss of self-image/identity crisis. See: http://www.painreliefnetwork.org/forum/viewtopic.php?id=599 "Chronic Pain: The Emotional Journey" CPPs lose everything, sometimes including life itself. 19,000 estimated die by their own hands every year. I've been in pain now for 28 YEARS. Most of that time I was untreated or badly under-treated and severely crippled. The first decade was spent trying to convince doctors I wanted a diagnosis and preferably an operation to repair the damage; the assumption was always that I must be in for opiates though. (Now, after almsot three decades of medical abuse, it's true, but not because of addiction. It's just all that's left). For eight years I was treated fairly well, until my wife went into end-stage COPD. Then the VA blackmailed and tricked me into seeing a "Board Certified Pain Management Specialist." They lied; there is no such thing - he was an internist with one year at a pain clinic. He immediately destroyed the regimen that had allowed me almost normal function for 8 years, crippling me again. Having to care alone for a bed-ridden wife, my weight dropped from 210 lbs at six foot two down to 143 lbs. She and I were about a week away from a mutually agreed upon suicide - both of us I mean - when a new local doctor agreed to help me, just enough that I could care for her; just not myself, the house or anything else. She passed away in my arms June 15th, 2009, having been able to remain, as she wished, in the house she'd grown up in. It was the month after our 13th anniversary. After that I sat in a chair in the living room for most of a year, thinking it had only been a month or two. I just lost the time, and I very nearly died. My hiatus from the VA lasted 35 weeks. but I no longer permit them to handle my pain management. They have limited pain treatment with opioids to 60mg per day of morphine. I was on more than 10 times that, and functioning very well. I found a real specialist, and have begun to recover again, but have just been informed that alterations in the OHP that include a requirement to join, plus limitations on (and a refusal to pay for) opioid prescriptions that would cost more than my Social Security Disability and my VA pension check put together. It may end up a death sentence. If the info I have so far is correct, my choices are 1)leave the country for one that's sane; 2)die here; 3)accept too little medication and spend the short remainder of my life on the couch. Those are more choices than most CPPs have. I just remarried; she's a wonderful, loving lady with six amazing kids. Ian

Apologies for so many, and such long, comments. I suppose you'll just need to choose between them. It ALL seems important to me. As the subject of the article (really, I meant to answer this first!): Opiates and marijuana do not affect each other; they work by totally different mechanisms. There is NO admixture problem, so there is no possible medical reason not to prescribe them together. Where the problem lies is in corporate profits. Once MJ gains any sort of toehold-shadow of legitimacy, it can only go forward from there, and too many industries would suffer. first, the War On Drugs relies on criminalizing this harmless weed and those who use it, for any reason. They provide numbers of busts that look good for promotions or on a resume for politically hopeful judges who need to look "tough on crime," and there's the added benefit that pot smokers are rarely violent. (Busting legitimate doctors has that same advantage, and of course pain patients don't fight back). Then there's the money the Private Prison industry (which includes the Prison Guards Union, which contributed $2.5 million to defeat Prop 8 in California some years ago; they need MORE prisoners to guard, not less). the prisons are paid I forget how much per prisoner by the Federal Government. There's the timber industry, which hemp growers could replace for every thing but lumber; hemp grows MUCH faster than trees, works great for paper, cordage of different sorts, etc, and it grows almsot literally anywhere on very little water and with very little care. Of course there's the money that Big Pharma would lose because they can't patent a natural substance. MJ seeds yield a very high-quality oil and other parts that are good for cooking with,, can be made into all sorts of healthy foods... In short, MJ would lose a lot of very powerful industries a lot of money. This is why it's been illegal for so long, and because corporations an the the politicians they buy are running the country, it will likely stay that way for a long time yet. There are indications that MMJ even cures cancers, and of course it's one of the best if not THE best anti-nausea meds there are - better than anything that big Pharma can make, and unlike most of their meds, it isn't toxic. And the Cancer treatment industry makes billions of dollars every year.They'd lose that as well. Ian

Ok so let me ask, does anyone here know of a compassionate Ommp friendly pain management doctor? I was discharged after being treated for five years beause they started random UA and I am a cardholder but they said the DEA watches them closely. So they termed me and now I'm stuck. They just kicked me off with no meds so I am not looking forward to uncontrolled widthdrawl. I don't use any other drugs. I don't smoke tobacco or even drink. I used the small dose of morphine for my ankylosing spondilitis and cannabis to manage my pain. I have great insurance and paid more out of pocket costs than anyone at their clinic. If the DEA watches them so closely why is it that they blindly prescibe and give meds to some that would cause OD without proper history? I feel like my medical chart is tainted now because if I quit MM I will still have a doctor that distrusts me right from the start because it was in my chart that I had it in my system. So if anyone has any advice or a good doc that understands please electronic mail me at ensjesse@msn.com