The news has been filled lately with the severity of the “Opioid Epidemic” and every day we see patients new to medical marijuana. The common phrase is ‘My doctor has had me on Norco for years, and he/she cut me off completely last visit’ followed closely by ‘you are my last hope’. Other patients are weaned off so rapidly and and in such large increments they go into opioid withdrawal. Still more go to their doctor/surgeon with a very legitimate complaint of pain, easily treatable with very low doses of medications to be denied- ”You have to go to a pain clinic for that”. Here is a phone book, find a pain clinic, and deal with it for up to 1 year to get an appointment on your own, even with great insurance and a very clear indication.
An example of this effort to reduce the use of opioids in a patient we’ll call ‘Chloe’ who underwent a painful surgery to remove stones in her bladder. Think about that for a moment, her abdomen was cut, her bladder opened, and stones were taken out. Then she was expertly put back together. Understandably, she was expected to have some post op pain. Her doctor addressed this under the new ‘guidelines’ he said. She was given the seizure medicine Neurontin. No Vicodin, no Motrin, not even Tylenol- A SEIZURE MEDICINE which has been helpful for pain in conditions like fibromyalgia. Have another look at the photo for this article- those are the three stones removed from Chloe.
The Origins of the Opioid Epidemic
When I was a resident in the 1990’s the big deal was ‘Pain is the 4th Vital Sign’ and ‘If you use narcotics for real pain, you won’t become addicted’. As a result, any recorded pain on your patient’s chart was a mark against your care, and we handed out Percocets like jelly beans. This was absurd. People with osteoarthritis were being put on Norco so they had no recorded pain, Dentists routinely gave a month worth of narcotics for uncomplicated extractions and root canals. We doctors created the opioid epidemic.
This went on for years until it became painfully obvious we were all idiots and had done a very, very bad thing. Grandmothers were addicted to heroin, in 2014 there were 744,000,000 doses of controlled substances delivered to the 10.5 million citizens of Michigan.
The Overreaction to the Opioid Epidemic
To it’s credit, the State of Michigan Acted. It created a ‘blue ribbon panel’ in 2014 to study the opioid problem in 2015. This panel consisted of 21 members. 2 were doctors that didn’t do pain management. 2 were pharmacists that didn’t deal with chronic pain management. The rest were law enforcement, the MSP, the prosecutors, and one of the two working groups was headed by the AG. Hardly a ‘public health and treatment’ oriented group. Their first mission? Send fake patients into the office of Dr. Bob, who dared to use cannabis and low doses of pain medication/suboxone to treat chronic pain and addiction three years before Dr. Gupta came on TV to say what a great and effective idea that was. Despite screening out multiple patients (who had falsified licenses and state MAPS reports), one managed to get 45 norcos and they took his license for 6 months. Meanwhile doctors right down the street were prescribing hundreds of morphine tablets and combining it with Xanax. Go figure.
With this and other examples of severe punishments of doctors- some bad, others absolutely doing right by their patients, a chill was felt throughout the medical community. Non-medical managers sent out the word. NO MORE OPIOIDS. The result of this was to take a poorly managed pain control system and turn it into a withdrawal nightmare as patients were inappropriately weaned or even abruptly cut off of their long term pain medicine. Patients like Chloe, with clear indications for even short term narcotic pain management were put on drugs not designed for primary pain management. (In fairness, Neurontin is a very good add on for pain management- it makes the pain meds work better- but it is NOT a pain medication for most conditions on its own.)
Why is Grandma turning to Cannabis?
One result of this is that patients are calling our office at 989-339-4464 for help. People that never considered cannabis are looking to us to find relief from their well documented pain. We are happy to report that the vast majority ARE getting help, and improvements in their quality of life. Thoughtful and Caring PHYSICIANS are quietly sending their patients our way, because they are seeing the benefits even if they can’t write the certs themselves. We are happy to help, reducing the use of narcotics is the primary reason Denali Healthcare was started in the first place. When we were able to use suboxone, we helped people get off narcotics completely. Even with our pain management in full swing before the undercover patients two years ago, our use of opioids averaged 1/4 of what our patients came to us taking, and they got better pain management.
In addition to our certifications for cannabis, we are using a pulsed laser to help with pain. We added this after Dr. Bob used it on his own rotator cuff tear- after 4 treatments his pain was reduced 90% and that level of comfort has been maintained for 18 months. No drugs, no injections, just pain relief.
What should we do?
Physicians that do pain management should accept the responsibility of dealing with the consequences of their treatments. They should understand the physiology of the opioid epidemic and the treatments available- Suboxone used properly and weaned off in a year or so is very effective- to use it is simply an 8 hour course and an application. The use of cannabis can EASILY cut the use of narcotics in half- Can you imagine the effect on the opioid epidemic if practically overnight we could cut the use of narcotics by 50%? If practices don’t allow their doctors to certify, allow them to refer. We stand by to help.
Perhaps the most alarming effect of the opioid epidemic is the refusal of physicians to treat pain when the indication is obvious, as it was with Chloe. Now because her doctor is afraid to treat it, she suffers expected pain. She is just a little thing, the dose of Norco is just a couple of milligrams for someone that weighs only 14 pounds. He chance of abusing that little bit of medication, or sneaking off to shoot up heroin is non-existent. Other than howling and hissing, she does little to complain. Chloe is my daughter’s cat. And the Neurontin is just not cutting her post surgical pain.
We in medicine need to stand up for our patients and keep in mind the goal of pain management is to reduce unnecessary suffering in a balanced way. Michigan has a pain patient bill of rights. 1/ All patients deserve to have their complaint of pain taken seriously. 2/ Patients with chronic pain should not be treated as drug addicts 3/ Pain needs to be addressed in a reasonable and appropriate fashion. We as physicians need to start doing this, or our patients will start suing us for failure to do so. Given the sheer number of people affected by this absurd and overreaching reaction to the opioid crisis, I am not willing to put my fate in the hands of a malpractice jury- given the near certainty they have either been directly affected by this opioid epidemic policy of cutting people off or they have a close friend or family member that is. They would have my butt.