What’s Missing In the Opioid Crisis Conversation

Tennessee lawmakers believe that an elaborate gift card scam is fueling the state’s opioid epidemic.

New York State Senator, Martin Golden claims that opioids aren’t a “ghetto drug,” because even “doctor’s kids” are gaining access to them.

Former Democratic Rep. Patrick Kennedy blasts the bipartisan opioid commission of which he was a member, calling it a sham, because nothing has been done since Trump declared a 90-day public health emergency in October.

These are only a small sampling of the stories that flood the daily reporting about the crisis, which has been responsible for more than 500,000 deaths since 2000. Despite effusive promises to fight the epidemic during his campaign, President Trump is doing nothing effective to combat the crisis, and opioid overdose deaths continue to climb in areas that supported him in the election. In West Virginia, a state that favored Trump by 40 percentage points in 2016, topped the list for having the most overdose deaths that year.

Another state that voted 51 percent for Trump, Ohio, saw a 39 percent increase in overdose deaths from mid-2016 to mid-2017, almost three times higher than the increase in deaths nationally. In Kentucky, a state that favored Trump 63 percent in the election, is now suing a drug distributor for illegally saturating the state with opioids and fueling overdose deaths. Meanwhile, Attorney General Jeff Sessions recently addressed the crisis, praising Trump’s response, adding that patients should “tough it out” and take an aspirin.

As a chronic pain patient, I know well the stigma surrounding prescription pain medication, and how difficult it can be to obtain relief. I took low-dose opioids as prescribed for several years before moving to Florida, which was experiencing a “pill mill” epidemic. While I was able to find a doctor to prescribe me my low-dose pain and anxiety medication, I quickly realized that most physicians in Florida were facing scrutiny for providing such prescriptions.

A recent crackdown required physicians to report prescriptions for controlled substances to a database, and the law was changing to make it more difficult for doctors to prescribe. Because of this, when the doctor I was seeing found that another patient was abusing pain medication, he abruptly stopped prescribing controlled substances altogether. This left me with no opportunity to safely taper off my medications, and I was frantic to find an alternative.

Through trial and error, I was able to find holistic alternatives, eventually finding cannabidiol, or CBD. CBD is the naturally occurring part of the cannabis plant but doesn’t have any psychoactive or addictive properties. Even after being off pharmaceutical pain and anxiety medication for several years, doctors didn’t take note of the alternatives that were relieving my symptoms, and most didn’t take them seriously.

When I last visited my gastroenterologist about a new source of severe pain, he asked what I was using to manage symptoms of my Crohn’s Disease. I started telling him about the CBD when he cut me off. “I’m more concerned with you smoking pot than any other medication I could prescribe,” he said. Before I could defend myself and explain that CBD wasn’t the same as smoking cannabis, he told me that I would have to go on biologic drugs.

The stigma surrounding CBD stems from lack of research and knowledge about the many benefits. More and more medical professionals are realizing the wide range of benefits cannabis can offer and are approaching health care in a more holistic way. One of those people is Dr. Shivani Amin, who owns and operates Green Health Docs, cannabis evaluation centers located in Maryland.

“I believe the key here is through better understanding of the plant itself. Cannabis has over 400 different chemical compounds. When people think of marijuana they automatically associate it with THC and the negative stigma that it is used for the typical “high.” It is not only the THC that is a great pain controller but many other chemical compounds, such as CBD found in marijuana are great pain controllers that do not produce a euphoric feeling.”

In addition to lack of research, big pharmaceutical companies influence both medical professionals and politicians who shape drug policy. The manufacturer of the biologic drug my doctor recommended, a drug that comes with a black box warning and has caused Lupus and other fatalities, for example, has contributed over $4 million to one of the biggest supporters of anti-cannabis legalization. Purdue Pharma, the makers of Oxycontin, has contributed over $1 million to the same lobbying group, and financially supported other anti-legalization initiatives.

Back in October of 2017, on the same day Trump declared a public health crisis regarding opioid use, John Kapoor of Insys Therapeutics was arrested for bribing doctors to prescribe the company’s fentanyl spray. Insys Therapeutics gave $500,000 to anti-cannabis legalization efforts in Arizona, and lobbied the DEA not to move cannabis to Schedule III back in 2011, when the Department of Health and Human Services requested the change. In 2016, Insys received approval from the FDA for their synthetic cannabis drug, Syndros, to be placed on Schedule II.

Pharmaceutical drugs can make you feel as though control is an illusion, to which Oregon Medical Marijuana and chronic pain patient Stephanie Kerns can attest. Kerns left her pain clinic after 14 years in search of a better alternative to the pharmaceuticals she felt were killing her, and found CBD after becoming a medical marijuana patient. After trying every available pharmaceutical on the market for pain and nausea, she found that CBD was able to treat both quickly, in a way she considers miraculous.

“The first time I had a chance to try CBD anything, it was some homemade BHO (Butane Hash Oil, often used in vape pens) with a great deal of CBD in it. We knew it was almost pure CBD because it was tested by one of the first labs in Portland. I vaporized a small amount of extract of it and in seconds I felt relief that was overwhelming. I felt like a jellyfish. My muscle spasms stopped, my mind was not racing from the panic of being in pain all the time, and it seemed to me impossible to vomit if I had CBD in my body. I kept kicking myself: Why didn’t I try this sooner? I never knew it was an option.”

With cannabis remaining on Schedule I, even medical professionals who include it as part of their practice are facing challenges. Jessie Gill, a registered nurse with expertise in pain management who is also a medical cannabis patient, explains some of those limitations:

“As medical professionals, we vow to do no harm, but the schedule I status of cannabis forces healthcare providers to choose between recommending deadly pharmaceuticals or breaking the law by encouraging use of an ‘illicit’ but much safer alternative. The lack of education prevents many healthcare providers from recommending cannabis and the stigma stops even more. Yet, even the providers who overcome the stigma and educational barriers still face legal and ethical implications because of the legal status.”

In addition to legal concerns and big pharmaceutical control, insurance companies are making it more difficult for patients to pursue safer options. A recent collaboration between the New York Times and ProPublica found that large insurers were making it difficult for patients to obtain coverage for safer pain medications because opioids are cheaper. Because of its federal legal status, rehabs offering cannabis to overcome opioid addiction must be paid out-of-pocket, because insurance won’t cover treatment.

Despite mounting evidence that patients with chronic illness are finding a dramatic change in quality of life because of cannabis, mainstream medicine still rejects it as a serious alternative. Since 1976, when John Bonica called for an increase in education about pain to be included in all health science schools, not much has changed. In 2000, the American Academy of Pain Medicine issued a call for medical schools to expand required curriculum to include chronic pain, palliative, and end of life care, but little changed. A 2011 study showed that 80 percent of American medical schools didn’t include formal pain curriculum, with only 16 percent offering electives.

Jessie Gill didn’t consider medical cannabis a viable alternative for pain management until she suffered a severe spinal injury on the job. After years of excruciating pain that didn’t subside with pharmaceuticals, she turned to medical cannabis out of desperation and found a much better quality of life. Additionally, she became a cannabis specialist and devotes her time to educating the public about the benefits of this treatment.

“As a hospice nurse, I was an expert in pain management. Back then I would have told you that pain control comes with unpleasant side effects, like constipation, nausea, vomiting, anxiety, fatigue, and depression. These side effects are expected during opiate treatment. But as a cannabis specialist, I now realize that it doesn’t have to be like that. Many patients can achieve pain control with just medical marijuana and, of course cannabis does have side effects, but they aren’t nearly as serious or detrimental as those from most pharmaceuticals.”

With a background in pain management, Dr. Amin witnessed an opportunity for patients to have a better quality of life, without the debilitating side effects of pharmaceutical medicine or risk of death. She strongly believes cannabis can heal many chronic conditions, and advocates for more research, education, and continued activism for legalization.

“I definitely believe with the removal of cannabis as a schedule I under the controlled substance act we will see a decrease in the usage of opioids. Recent studies have shown that ever since legalization of marijuana in Colorado opioid-related deaths decreased significantly. This is most likely because patients have more access to cannabis. Cannabis provides tremendous pain relief due to THC and the anti-inflammatory properties of CBD. With legalization, there would be easier access and less stigma to cannabis resulting in pain relief and decreasing the need for opioids. “

Some pharmaceuticals are necessary for survival–consider the life-saving properties of penicillin or vaccines–but we must continue to call out those who are fueling the crisis and making it more difficult to access the natural form of cannabis. The conversation needs to include the patients who are only looking for relief, who aren’t addicted, who can’t access alternative medicine. With more education, medical professionals and caretakers can offer a comprehensive and better approach to pain relief.