Pain Management Community

I don't use cannabis for pain as I found it did not work for me.

That said, I read in the newspaper within the last couple of days that the VA in some areas will not count urine with marijuana in it as dirty if the person is taking it for pain as instructed by their civilian doctor in a state where medical use is legal, and that it is up to the VA doctor if he wishes to prescribe opiates to those patients. Before it said that patients with marijuana showing in their urine would NOT be given RXs for opiates as a matter of policy.

You might show your doctor's group an article like this and see if it sways them at all.

However, VA doctors are not required to have DEA numbers to prescribe opiates, according to a VA doctor I know who has worked at the VA for many years and does not have one. You could search the DEA website and see if they have a rule like that. It might be true.

There is some controversy about giving a patient opiates if he is also a cannabis user, but I don't know if it is valid or not. They may or may not mix well according to where you read about it.

I don't know that actual evidence based, medical research has shown a "wonderful synergy between opiates and cannabis" or not. Research in the US regarding cannabis has not been allowed for many years in great quantity. What research are you talking about? Where was it done? Printing it out if it is valid research might also be useful to take to your doctor's group.

I would opt to use one of the drugs for now, in accordance to your doctor's policy, and pursue changing the policy of this medical group. That is just my opinion, we all have one.

Take care, Annette

I find that marijuana works extremely well in combination with my opiate medication. if u cant get it perscribed, and it truely works for you... than just suck it up and continue to get it the good ole fashioned way.

A lot of pain management doctors do random urine screens and include marijuana in that screen. If you come up positive for pot, the doctors are within their rights to cut off your RX for opiates and even discharge you as a patient.

If your pot does more for you than the opiates, do and you are willing to risk losing the opiates, go for it. I would keep enough opiates stashed to taper yourself off so you don't have to go through withdrawal.

Take care, Annette

Hi Annette! I failed to attribute my source, being too sore to hunt it down... but I don't think it will matter at all to my docs -- they're not concerned with the validity of cannabis, but only that the DEA will come down on them.

My last group of docs sent me for a urine test, and when I realised that it's only intent was to drug test me, I went back to them and said that I didn't want to do it because of the cannabis use. They said "We don't want a positive for that..." and tossed the lab test request.

As for opiates and cannabinoids, there is ample evidence of cannabinoid interaction with endogenous opiate systems.

from a rather lengthy but interesting article at http://www.letfreedomgrow.com/articles/can030828.htm

4) Cannabinoids represent an important parallel system to the endogenous opioid system of pain modulation, and administration of cannabinoids can effectively synergize opioid responses while mitigating side effects. Cannabinoids show unique promise in treatment of neuropathic pain.



Research is beginning to show that there is a synergy between cannabinoids and opioids and thus, a patient could decrease the amount of opioids necessary to manage pain due to the opioid sparing effect of cannabis.


I can't get to the original study as Elsevier owns just about anything published in a peer-reviewed journal. But I did read it when it first hit the news.

I'm so glad it works for you
I have no trouble obtaining either in the Golden State -- it's legal here for medical use. But the DEA has apparently told docs everywhere that they will be hit and hit hard if they prescribe opiates to those using cannabis -- and it isn't a safety issue; if anything cannabis allows a person to use *less* opiate pain medication. It certainly works that way for me, but only part time -- I only smoked once or twice a day because more than that and I was concerned that my short-term memory would be compromised.

Think I'll do what Annette suggested and verify that this is in fact a DEA rule!

http://www.medicalcannabis.com/Cannabis-Science/opioid-sparing

This page has papers on opiates and cannabis, and what might be useful resources on the site.

I really think that the prohibition against pot is silly. I don't think it is any worse than alcohol and it actually does have some medicinal value, unlike alcohol. I think the laws need to change in order for decent research to be done in the US.

I suggested evidence based research to try and convince your doctors, but if you feel it is hopeless, that is up to you.

As far as using pot so I could reduce the amount of opiates I use, I don't really see the point. Perhaps when I am taking so high a dose of opiates that doctors do not want to give it to me, it might help. I prefer to take the least amount of drugs I can, and adding one to decrease the dose of another wouldn't be as good for me as adding pot, and being able to eliminate opiates completely. I tried pot for pain many years ago, back before I was on a long acting opiate, and it did no good for my pain at all.

Years before that, I spoke personally to a neurologist in Idaho who had written papers about pot and migraines, and he gave me some suggestions. I tried what he suggested too and it didn't help my migraines either.

I guess everyone has to decide for themselves.

Take care, Annette

I followed the link on this page to a lecture by Sandra Welch who participated in studies with Marinol (not marijuana) and opiates and she found this effect. However, she only used mice and rats in her studies, not people. I think it will be better once we have clinical trials with humans.

Marinol is available now in the US and I am familiar with some folks who have used it for pain, with varying results. If your doctor wants to give it a try, he is free to do so.

Take care, Annette

At my Pain Clinic they do have contracts to do Random Urine or Hair tests but i have been there 3 years and never have been picked. But in the initial Interview you are asked to disclose wether you smoke cigarettes, Pot and what drugs you have used or tried.

For me i have never tried the illegal's , and had no problem, I did find out however those that admitted to a pot smoking habit got rejected as canidates for Pain Med's,and where instead only offered a living with your pain program "teaching" biofeedback and meditation and excercise regimes to replace the med's.

Long term pot use was considered a warning sign of a potential addict and someone who did'nt mind breaking the law,as in buy and selling any med's that may have been prescribed for them. No its not right i agree but thats what Doctors out here in the East are thinking.

The thing about pot and pain is that one variety is mucvh better for pain than the other. Indica is best for pain, sativa is better for unleashing the creative force, etc. If you were given a sativa, you may not have had any benefit for that reason. I've been told that the best for pain is 80% indica 20% sativa, but unless you live somewhere with a larger number of competing dispensaries (like California) this might prove a difficult task. These days most of the pot around is likely to be a hybrid of the two. Right now it's the sativas that are in fashion, however, meaning indicas may be harder to find.

Personally I wouldn't touch Marinol, it's all THC! What about the *other* 300 active cannabinoids?

Hi Annette: Just so you know, I was kicked off pain medication by Kaiser. They kept coming up with things I had to comply with until they came up with one they knew I wouldn't do, and they booted me.

And my therapist there said that the reason I wasn't testing positive for benzos (I take clonazepam) was that I wasn't actually taking them. As if! Getting that stuff made me such a suspect in Kaiser eyes -- I had to have it preascribed by an old doc because they wouldn't do it, even though I was tapering off and had already reduced my dose to .75 mg.

(I didn't tell her I'd been smoking pot the whole time and never tested pos. for that either...)

Additionally I went into metabolic acidosis after losing my pain medication and being unable to prepare food (or eat), and I lost a LOT of muscle tissue. They did absolutely nothing to try to diagnose what was wrong -- I had to figure it out on my own!

Anyway, I am away from Kaiser now, and I am SO GLAD!!!

(If you have chronic pain, an HMO is probably not for you.)

I actually got to talk to Dr. Russo on the phone. I called his office and he answered the phone and spent 20-30 minutes discussing pot and migraines with me. He was very informative.

Thanks for the link.

Take care, Annette