Our guest blogger this week is emergency-medicine specialist James Li, M.D. After nearly a quarter-century as an ER physician, Dr. Li has witnessed firsthand the devastation that opiates can cause to individuals, families, and communities. Here, he shares his perspective on medical cannabis, Maine’s opiate crisis, and the potential for therapeutic use of marijuana to “bring… reality to hope” for many who struggle with opiate addiction. -BDK
I’ve been in practice as an emergency physician for over 20 years. Like CNN’s Dr. Sanjay Gupta (producer of the CNN special “Weed”) I had serious doubts about marijuana’s medical value since being taught that it was addictive, illegal, and used primarily as an intoxicant.
Like most doctors, my solution for treating pain in my emergency room patients was a prescription for an opioid like Vicodin or Percocet. I considered patients with long-standing pain syndromes from things like fibromyalgia, post-herpetic neuralgia, or sciatica to be hopeless cases, since I knew of no therapies or medicines that could help them.
Then about three years ago, I started seeing ER patients who had gotten certified for legal use of marijuana for many of the same conditions I considered hopeless. Amazingly, they didn’t seem to be high or stoned or addicts. Indeed, all of them had been able to stop their other pain medicines, including their opioids, because the marijuana was a more effective painkiller than any of the traditional pain medicines their doctors had been prescribing them for many years.
About the same time, I learned that opioid prescriptions in Maine were responsible for an epidemic of overdose deaths. Indeed, beginning in 2010 and continuing through the present, oxycodone and hydrocodone prescriptions have caused more accidental deaths in Maine than car accidents, a fact that astonished my entire group of emergency physician partners.
These two realizations — that patients could safely find relief of pain with marijuana and that the traditional medicines we were prescribing were truly dangerous — prompted me to go back to the medical literature to see if marijuana had credibility as a medicine for chronic pain.
I was surprised by the answer I found. In numerous human studies of patients with long-standing pain syndromes, marijuana had pain-relieving effects that surpassed the effects of traditional pain medicines. Unlike the opioids that so many doctors were prescribing, marijuana was also safe. It killed no one.
In addition, marijuana did not cause tolerance. In other words, patients could get pain relief with small doses of marijuana and trust that those same small doses would remain effective in the future. In contrast, opioids cause rapid tolerance (something we call tachyphylaxis in medicine). No one who has ever been on opioids for long can escape this phenomenon. Most patients must rapidly escalate their dosing of opioids to maintain the same degree of pain relief, while at the same time suffering from ever increasing toxic side effects. Thus, the longer a patient stays on opioids, the higher the risk of overdose and death.
Not so with marijuana.
Two years ago, owing to hospital and federal restrictions on any medical practice involving marijuana, I started to see eligible patients in a part-time clinic outside of my primary practice in emergency medicine. My first patient, a senior Maine guide with advanced arthritis, had just completed a through-hike of the Appalachian Trail, fulfilling a lifelong dream. However, the experience was bittersweet because of the additional strain it put on his already worn joints. Once the hike was complete, he found he could barely walk. The pain was so great that most days it was a struggle for him to just to get out of bed.
Both of us were skeptical about whether marijuana would do anything for his pain. But he was in desperate straits. Having known him well for many years, I decided marijuana was worth a try and certified him.
The day after he went to the dispensary, he called to tell me that he not only was able to get out of bed without pain but also had gone out after getting up and completed a two-mile walk. Until that day, he’d not been able to walk even a single block since returning from the Appalachian Trail. The following day he was able to walk a full five miles without pain. He and I were both amazed.
Since that time, I’ve listened to a multitude of patients who have benefited from medical marijuana. Their stories are similar. They tried many other therapies without success. They were discouraged and desperate. They came to our clinic with many reservations. After being certified, they cautiously tried a small amount of medical marijuana usually purchased from one of Maine’s eight state-licensed dispensaries.
In most cases, unbelievably, their pain was significantly diminished.
In most cases, unbelievably, they were able to function again.
In most cases, unbelievably, they were able to stop their other prescription pain medicines because the marijuana worked so much better and, unlike the other medicines, had few if any side effects.
Over the past two years, I’ve watched patients become people again, filled with more life than they’ve had in years because once again they can function, interact, and even work. That’s why I keep doing this, certifying patients.
Marijuana really works. It’s truly a medicine that brings reality to hope.
James Li MD
Maine MMJ Physician Services