Ask Dr. Dave: How to Deal with Chronic Pain and Opiate Phobia

Dear Dr. Dave,

My husband and I both have severe chronic back and leg pain. Dur to medication cutbacks we are struggling to find alternatives. I have had a stroke as well. What would you suggest for us?

Thank you,

Sharon in South Carolina

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Dear Sharon,

People with chronic pain are really suffering because of the government’s criminal justice approach to pain management. I have written two or three lengthy letters to the Los Angeles Times trying to get them to address this problem. Because pain is the number one reason that patients see a physician, this crackdown on opiates is preventing legitimate chronic pain patients from receiving appropriate medical care. It is a counterproductive intrusion of the government into the practice of medicine. I have written about this, as have many others, quite extensively.

Ok, now that the rant is out of the way, here is the answer to your question.

You are probably already aware that cannabis, and particularly CBD and THC (two of the 113 cannabinoids, or 21-carbon molecules that either stimulate or blocks the body’s CB1 and CB2 receptors) are effective analgesics. This is the number one reason for cannabinoid medicine specialists to recommend cannabis for the treatment of pain.

In most cases, the patient is able to decrease their opiate dose by 30-50% by incorporating cannabis. The dose of THC on the cannabis should exceed 10mg. For many patients, 15mg of THC and 15mg of CBD is effective. Numerous studies on the 1:1 ratio of THC to CBD (through clinical trials of the whole plant cannabis extract Sativex, by GW Pharmaceuticals) show that this ratio is effective as an analgesic. GW’s product, which is currently undergoing clinical trials, has an equal amount of THC and CBD, 25mg per dose. A study done in the 1970s on isolated THC showed that 20mg of the cannabinoid was equal to four Tylenol. So, it won’t be as effective as say, morphine, but will take the edge off your pain.

Several of my patients have recommended turmeric as having modest analgesic properties, ginger as well, when used on regular regimens (here is a good example).

Some researchers have begun to discuss the use of the plant Kratom as a possible safer painkiller than opiates. This is an unregulated product, so be diligent in verifying the safety and efficacy of your source if you choose this route.

You note also that you have had a stroke, and you will be happy to hear that cannabis is a neuroprotective. Dr. Raphael Mechoulam, the Israeli scientist who is the godfather of modern cannabis research, work with Pharmos Pharmaceuticals to develop Dexabinol as a medication to limit the neuronal damage that can accompany a stroke or traumatic brain injury. If a person has exogenous cannabinoids circulating at the time of a stroke or TBI, or is given it in the hour or two immediately follow that event, they will have less nerve tissue damage than if not.

 

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About the Author
David Bearman, M.D.

David Bearman, M.D.

Dr. Bearman is one of the most clinically knowledgeable physicians in the U.S. in the field of medicinal marijuana. He has spent 40 years working in substance and drug abuse treatment and prevention programs. Dr. Bearman was a pioneer in the free and community clinic movement. His career includes public health, administrative medicine, provision of primary care, pain management and cannabinology.

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