Pain Doctors Discriminate Against Medical Marijuana Patients
Starting in 2009, NORML has received a flood of recent complaints from chronic pain patients wrongfully denied treatment by pain clinics for having failed unwarranted drug tests for medical marijuana.
Prop 215 patient Kristin Redeen, who used prescription opiates for severe chronic pain, was surprised when her clinic asked her to submit a urine sample.
“I didn’t think I was doing anything wrong,” says Kristin, who had been treated by the same clinic for seven years. “They already knew about my medical marijuana use.”
When her drug test came back positive for marijuana, Kristin was shocked to be told that the clinic would no longer renew her prescription for the opiate Percocet. Kristin began suffering seizures after her prescription was withdrawn.
Her clinic explained – falsely – that DEA regulations forbid giving prescription narcotics to illegal drug users.
In fact, there is no law requiring pain clinics or doctors to screen out marijuana users, according to legal experts. “It’s BS,” says Washington state attorney Doug Hiatt, who has encountered 25 such complaints this year, "it's Jim Crow medicine." Not a single case is known in which any clinic or doctor has been sued, prosecuted or penalized for allowing medical marijuana.
The root of the problem is that pain clinics are under mounting pressure to monitor patient use of prescription narcotics, especially opiates. Deaths from prescription opiates have reached record levels, leading Drug Czar Gil Kerlikowske to proclaim them as the nation's number one drug abuse problem. Clinics are accordingly being urged to use drug urine testing to stem abuse and diversion of opiates to the illegal market. Although these problems have to do with opiates, not cannabis, many clinics wrongly assume that they are obliged to screen out marijuana users as well.
In fact, there are sound medical reasons for chronic pain patients to medicate with marijuana. A growing body of scientific research – including four published studies by California's own Center for Medicinal Research – shows that marijuana is effective in treating chronic pain. Not only that, but recent studies have shown that marijuana is a useful adjunct to opiates, working along parallel paths to enhance pain relief while actually lowering the required dosage of opiates. Knowledgeable specialists therefore regard medical marijuana as an exit, rather than a gateway, to narcotic abuse.
Unfortunately, many pain clinics remain ignorant of the medical benefits of marijuana, and wrongly assume they are legally obliged to disallow it. Patients who encounter such discrimination are urged to advise their clinics of the facts about medical marijuana and the law. Clinics that persist in discriminating against legal medical marijuana patients should be reported to the state medical board.
In an encouraging development, the Veterans Administration has announced that it will no longer remove veterans with medical marijuana recommendations who test positive for pot from its pain management programs.
In the meantime, California patients are encouraged to report abusive clinics that forbid medical marijuana to complain to the state medical board.
A federal grand jury in Boston is investigating Millennium Laboratories of San Diego, a fast-growing private company selling urine drug testing services to pain clinics across the United States.
Reuters (Nov. 16, 2012)
Cannabinoid–Opioid Interaction in Chronic Pain
D I Abrams, P Couey, S B Shade, M E Kelly and N L Benowitz
Clinical Pharmacology & Therapeutics 90, 844-851 (December 2011)
Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook a study to answer these questions. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2–4, and in the morning of day 5. Blood sampling was performed at 12-h intervals on days 1 and 5. The extent of chronic pain was also assessed daily. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration–time curves for either morphine or oxycodone after exposure to cannabis. Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.