NY: Seeking Relief – Patients Fearful Of Opioids Want Medical Marijuana For Pain

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Furtys couldn’t get any more opioids.

His prescriptions dried up in 2012 when he went to rehab.

His street supply ended in 2016 when he was arrested and learned about a detox program while in jail.

But his pain didn’t stop.

While in jail, Furtys read that New York state added post-traumatic stress disorder and chronic pain to the list of debilitating and life-threatening conditions allowed to be treated with medical marijuana.

“I have both of those,” said the 34-year-old Rochester man. “There was no way I wasn’t going to go that avenue.”

There’s more than anecdotal evidence that individuals being treated for pain are at least considering if not outright choosing medical marijuana over opioids.

Nearly twice as many new patients at Columbia Care from 2017 to 2018 said they want to reduce their use of opioids, according to the company that manufactures and dispenses medical marijuana at Eastman Business Park.

Dr. Rob Horowitz, chief of the Palliative Care Division at Strong Memorial Hospital, said some patients look horrified when he suggests a fentanyl patch for their pain.

“They go, ‘Isn’t that the one that kills everybody?’” Horowitz said.

According to Horowitz, seven clinicians in URMC’s outpatient palliative care unit who are registered with the state to recommend medical marijuana have certified about 200 patients over the past two years. He said the number has steadily increased, showing “more of the willingness among our team to offer it with recognition that opioids carry a legion of side effects.”

The addictive properties of opioids, the overdoses and less drastic but still real problems such as constipation are well-documented.

Horowitz acknowledged that medical marijuana has risks, but not to the extent of an opioid. Horowitz said he is clear about potential side effects and problems, but patients are adamant. “I’m having patients say ‘I want to be off the damned opioids,’ or ‘I want to be on less of the opioids,’ or I’m feeling cloudy and I’d rather feel cloudy on medical marijuana.’”

Opioid prescriptions flowed

Furtys started on opioids in 2009 after a back injury while working as a carpenter. He continued on opioids after throat surgery in 2009. He was living with his parents and his mother noticed that in 2012, he still was getting prescriptions.

“Shortly thereafter, I was in rehab,” Furtys said.

He was prescribed suboxone, but his drug use continued until June 13, 2016, when he was arrested.

After his release, he said it took him nearly three months to find a provider to certify that his history of PTSD and chronic pain made him eligible for medical marijuana.

Furtys is on the board of ROCNorml, a local chapter of the national organization that advocates for the reform of marijuana laws. He is back in school, taking classes at Monroe Community College to be a flight paramedic.

He said that was not possible when he was taking opioids.

“Within a couple of weeks of my spirits lifted and my focus more correct, I was able to sign up for school. … I feel like I have a purpose now.”

More cannabis, fewer opioids

Medical marijuana is legal in about half the states. New York has among the most restrictive law, with providers having to take a state-approved course and register in order to certify patients.

Individuals can qualify for medical marijuana if they have been diagnosed with one of 12 debilitating or life-threating conditions.

As of March, more than 49,000 individuals were certified to receive medical marijuana. The top five diagnoses were:

• chronic pain (62.1 percent)

• cancer (12.8 percent)

• neuropathies (8.7 percent)

• multiple sclerosis (3.4 percent)

• inflammatory bowel disease (3 percent)

In states with medical marijuana laws, prescriptions for opioids from 2010 through 2015 dropped by about 2 million daily doses per year, according to an analysis of Medicare Part D data reported in the April 2, 2018 issue of JAMA Internal Medicine. The data did not cover private insurance and in New York, medical marijuana is not covered.

Medical marijuana became available in New York in January 2016. Opioid prescriptions in Monroe County dropped by about 24,000 from 2014 through 2016. But it’s hard to know what role marijuana played in the decrease.

Excellus BlueCross BlueShield did not have information about trends in opioid prescriptions for its subscribers readily available.

Patricia Kendall, a family nurse practitioner in Brockport, started her own practice and registered to offer medical marijuana after working for years with people in chronic pain.

“The amount of opioids they’re on, it would blow your mind,” she said. “It bothered me. These patients knew they were on a lot of medications. They didn’t have alternatives when I was working with them.”

Kendall added her name to the list of practitioners on a public webpage of the state Department of Health. The roster is a fraction of providers who are registered to certify patients. A more robust list of the 1,529 registered providers is on a health department webpage available only to health care practitioners.

Kendall said people who’ve called have not expressly asked to get off opioids, but she expects those questions. “Some patients are not aware there is a better alternative than opioids that the provider is offering them.”

Dr. Bridgette Wiefling is senior vice president of the Primary Care and Ambulatory Speciality Institute at Rochester Regional Health. She said the system does not have a stand on whether its providers should certify their patients for medical marijuana.

“We’re not encouraging or discouraging people at this point,” she said, adding that those who are registered with the state are not breaking any rules.

Wiefling could not quantify how many patients are asking about medical marijuana instead of opioids, but she said they are not coming in droves. “I think some of the people who suffer some of those conditions are looking for the safest, best answer. As medical marijuana becomes a little more in the public eye and people are reading about it more, I think there’s more comfort in people asking about it.”

Fool me twice …

The cannabis plant is best known for THC, which brings on euphoria. But that plant has many properties and Wiefling, like other physicians, said it’s essential to get more research on how THC and the cannabidiols (CBD) work on pain.

“I want to be careful we’re not making a mistake like was made with opiates,” she said. “It takes time to understand the pros and cons fully.”

In 2017, the National Academies of Medicine released a report on the health effects of cannabis. The report found substantial evidence that compounds in the plant can help with chronic pain in adults, chemo-induced nausea and vomiting and patient-reported spasticity associated with multiple sclerosis.

Dr. Rosemary Mazanet of Columbia Care practiced oncology. She said the purposed of medical marijuana is not to substitute one high for another. “I think the people who are talking about the high THC are sort of missing the point of what the cannabinoid can offer.”

Mazanet said that as of March 2017, about 40 percent of new patients to Columbia Care who were using opioids said they wanted to reduce those drugs. In March 2018, about 70 percent of new Columbia Care patients who were using opioids wanted to cut that medication.

Columbia Care, one of 10 licensed companies in New York, is not in states that have legalized recreational marijuana. Its medical products include capsules, tinctures and vapor. New York does not allow smoking.

“The challenge here is that because you can sell it like candy in some states, people are out there capitalizing on the headlines rather than focus on the fine print. It the fine print where we’re going to find the answer.”