Anonymous wrote:How come Opiates are ok for treating neuropathy, but cannabis is not? I can not think of any way that derivatives of cannabis are less dangerous than derivates of Opiates. I have neuropathic pain from nerve damage, and have been prescribed Oxy, but decided not to because of the risk of addiction.

I can not try Cannibis, even thought it has fewer side effect, is less dangerous, and less addicting than opium based products. I can not risk it, because I could lose my security clearance. So, I endure the pain.

Because our government sucks balls.

I dont have a clearance and have found that cannabis has saved my life. I've always suffered from insomnia, but then a few years ago it got unbearable. Noting helped. Doctors threw all kinds of anti depressants and highly addictive benzos at me. Out of desperation I started taking edibles. Holy fu%k. Literally turned my life around. My insomnia was making me suicidal and non functional.

Fuc% the government. A bunch of sh*tbags running this country. Amazing its legal to prescribe opioids which are wrecking this country and marijuana is illegal. Gtfo.

My response is to the PP directly above and is in the interest of helping others understand why some medications really are necessary for a reasonable quality of life.

At the risk of beating this topic to death but in light of the developments around fentanyl's history, so to speak, the *in*ability of patients with chronic and/or end-stage pain to access opiates for legitimate and controlled use is also horrific. Increasingly, I am seeing this lack of access, like so much else, linked to socioeconomic factors. To receive opiates or other medications for chronic pain typically involves monthly visits to pain clinics or pain management specialists, who require referrals and have waiting lists as well as high price tags; the time to visit these doctors, most of whom do not have evening or weekend hours, thus requiring sick leave; psychological testing and appointments regularly; urine screening at least 4 times a year (my last bill for this was $1600, btw); and the cost of the medicines themselves (generally not terribly expensive but some are far more than others). Other drugs that are sometimes prescribed instead of opiates can be far more expensive, incidentally, such as Nucynta (which is now increasingly considered dangerous vis a vis addiction but formerly used as an alternative) or a Butrans patch (which can result in side effects that can be life-threatening).

I am one of the 'lucky' ones who can and does access daily pain medication including opiates. I have good insurance; disposable income to afford the co-pays etc before our deductible and out of pocket maxes are met; a strong relationship with my physicians who know that I am not a 'seeker,' as well as the fact that I am not working so I never have to cancel appointments (were I an hourly employee somewhere, I'd lose money every time I scheduled an appointment for between 8 and 3:30 M-Th); the ability to self-advocate and to get second opinions, which is generally required as part of the merry-go-round of diagnosing complex and chronic illnesses; and an education that's let me be and remain self-informed about the dangers of addiction as well as dependence -- including spending LOTS of time and out-of-pocket money talking with psychiatrists about addiction vs dependence vs alternatives for managing chronic pain and multiple co-morbid conditions.

If I didn't have 'all this,' I can imagine a couple of different scenarios, both very ugly. I could remain at/in a level of pain that renders me barely functional (even with medications, therapies, etc., I am visibly impacted ranging from atrophying muscles to disproportionate swelling/malformed hands and feet to simply looking like hell because of pain-related insomnia and the anguish of intractable pain). It's not pretty physically or psychologically since when you are in this level of chronic pain your functionality takes emotional energy as well, and at least in my case, leaves my grumpy on good days and downright nasty on my worst days -- including and especially because I hate EVERY SECOND of feeling unable to enjoy life with my husband and daughter.

The second scenario is worse, though, and I suspect is at least part of why we see death attributed to opiates -- if one cannot access pain medications legally or affordably, there are certainly illegal ways that cost lives, ranging from street drugs that can contain/be cut with life-threatening substances; prescriptions obtained over the internet (again, no quality control); the ability to 'mix' drugs without medical attention, resulting in toxicity and death; addiction stemming from a complete lack of oversight and medical review; contraindications or mixing meds again because no one knows that a patient's taking two drugs that, together, mean death: I could go on, and I still wouldn't capture all of the dangers, again and in part because I am one of the lucky ones. My knowledge of illegal access comes only from research; my awareness of life without responsible pain management is minimal because those years are long behind me, although they were hell on earth when I was in them.

There are no easy answers to any of this. To return to this thread's subject line, many people live in states without legal access to cannabis. Others will tell you that legal or not, cannabis alone cannot touch the pain in the way that opiates can, when prescribed legally. Some patients, even with the best of intentions, end up addicted to opiates as opposed to dependent, meaning that for whatever reason, they ramp up and amp up their use to the point where they are killing themselves figuratively and literally. Other patients take their own lives because of the levels of pain they endure, even with carefully controlled medication.

I can tell you, though, that blanket statements about opiates and assertions that no one should take them ever are as much of a danger and a threat as anything else. I know this from seeing and talking with many patients who are terrified that their slender grasp on a manageable life will disappear. I've lived this as someone who worked as long as she could while taking medications in the evenings, knowing that there was NO way I could have continued as long as I did had I not been on controlled pain management (and even then, since I would not take medicines while on the job, my performance was so sub-par for me that I ultimately had to retire early. And yes, on the other side, I have also watched those close to me die from addiction even as I've watched my best friend suffering from end-stage cancer go through withdrawal because of irresponsible physicians who failed to titrate her off the Dilaudid that managed her post-op pain. There may be no easy answers and there may be worlds of contradictions, but there is no world without pain: to deny pain relief to those who need it to navigate that world is almost as cruel as the pain, itself. Please, please don't let ignorance or fear or all-encompassing statements make a living hell that much worse for those patients who struggle mightily already.

Anonymous wrote:Agree with PPs and go on neuroleptics first. See a pain specialist or neurologist if you aren’t already. Stay away from opiates.

This. Stay FAR away from opiates.
They are killing 130 Americans every day.
Every single day.

Anonymous wrote:I have neuropathy as well as a chronic pain condition and am treated with Gabapentin for the neuropathy and opiates for the chronic pain condition. Other posters are absolutely right. If you have straight-up neuropathy with no other conditions, then you should be treated with Gabapentin or Lyrica as a first-step remedy.

Additionally, OP, I respect your concern about addiction and opiates; I have had the same fear and have discussed it with multiple physicians, especially since my mom was addicted to benzos and alcohol.

However, if opiates truly ARE the best way to treat a condition (and I agree that they're not for neuropathy), then you CAN take them, even long-term, without addiction. To be sure, you need to work with a doctor to wean off of the medication if/when you're able to come off (some conditions really do end up requiring years of dosing, especially if you're not able to use a pain pump or a spinal cord stimulator). Dependence and addiction are two different issues and are managed entirely differently.

I'm posting this because I am among those suffering from long-term chronic pain or cancer whose ability to have a reasonable quality of life can be compromised by the restrictive approach to opiates. We absolutely need better regulation -- there is no question about that -- but there is also a danger in making access nearly impossible for some patients. I'm lucky because I have an excellent pain management team, but not everyone is in this position.

One note: typically, pain management physicians will not prescribe both medical marijuana and opiates and I am presuming Gabapentin/Lyrica -- it's a 'one or the other.'

My aunt is on opiates for chronic pain, and her doctor routinely urine tests her for use of other drugs. Use of cannabis, which persists in urine for weeks rather than the couple of days like most drugs, would result in removal of her opiates.

I have neuropathy as well as a chronic pain condition and am treated with Gabapentin for the neuropathy and opiates for the chronic pain condition. Other posters are absolutely right. If you have straight-up neuropathy with no other conditions, then you should be treated with Gabapentin or Lyrica as a first-step remedy.

Additionally, OP, I respect your concern about addiction and opiates; I have had the same fear and have discussed it with multiple physicians, especially since my mom was addicted to benzos and alcohol.

However, if opiates truly ARE the best way to treat a condition (and I agree that they're not for neuropathy), then you CAN take them, even long-term, without addiction. To be sure, you need to work with a doctor to wean off of the medication if/when you're able to come off (some conditions really do end up requiring years of dosing, especially if you're not able to use a pain pump or a spinal cord stimulator). Dependence and addiction are two different issues and are managed entirely differently.

I'm posting this because I am among those suffering from long-term chronic pain or cancer whose ability to have a reasonable quality of life can be compromised by the restrictive approach to opiates. We absolutely need better regulation -- there is no question about that -- but there is also a danger in making access nearly impossible for some patients. I'm lucky because I have an excellent pain management team, but not everyone is in this position.

One note: typically, pain management physicians will not prescribe both medical marijuana and opiates and I am presuming Gabapentin/Lyrica -- it's a 'one or the other.'

Agree with PPs and go on neuroleptics first. See a pain specialist or neurologist if you aren’t already. Stay away from opiates.

Opiates are not a good first line therapy for neuropathy. You should try gabapentin or lyrica

The bigger problem with medical marijuana is that it is illegal at the federal level. That means anyone with a clearance (common in this area) is risking their job to use it.

The funny thing is Opiates are not particularly effective for neuropathic pain. What worked for me was lidocaine patches.

It was criminalized in 1970 by Nixon.

Why... Here is a quote why...

We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities.

Cannabidiol and opium can treat different types of pains: weed is better for chronic and bone pains, meanwhile opium is appropriate for hard pains for dying cancer patients .. but I am sure we will witness legalize soon, as medical marijuana is being approved at more and more states, and cannabis oil is available almost everywhere (mostly online, but it is still a fact).

Yeah, stay the hell away from Oxy. Go the Lyrica route. Also try "cold laser" treatments, which certainly helped me. You'll have to call around and most people won't know what you're talking about, but it's worth it.

Move to the District. Short of that see if your doctor will prescribe Marinol, a legal form of THC.

We live in DC and I have a family member with a condition that marijuana alleviates often better than prescribed meds. This has been relayed to treating doctors at Johns Hopkins in Maryland. The doctors have written Marinol on the medication record, which is a stand in for the DC medically prescribed marijuana.

Combo of things...yes pharma has something to do with it. But in order for cannabis to be at the same level as opiates, they would have have to be regulated. Grown under regulations, harvested, made into sellable goods, and sold all under the strict FDA regulations. Frankly, the amount of time and money needed to do this isn't something that they likely want to do.

Then there is the whole issue of how do you regulate between the FDA approved cannabis and the street one which can be more potent and harmful.

All that said, I do agree that medical cannabis should be legal. I'm just not sure if it's realistic.

I suspect Big Pharma has something to do with this.

How come Opiates are ok for treating neuropathy, but cannabis is not? I can not think of any way that derivatives of cannabis are less dangerous than derivates of Opiates. I have neuropathic pain from nerve damage, and have been prescribed Oxy, but decided not to because of the risk of addiction.

I can not try Cannibis, even thought it has fewer side effect, is less dangerous, and less addicting than opium based products. I can not risk it, because I could lose my security clearance. So, I endure the pain.