“The pills made everything feel better, but over six months had gone by and I didn’t feel like I was making sustainable progress,” recounts 52 year-old Bob of Portland, Oregon, who requested his last name not be shared.
Three years ago, Bob fell and hurt his back. As part of his treatment plan, he was prescribed a number of different opioid pain medications, including Oxycontin and oxycodone. Over time, he felt he was becoming dependent on the medications, and wanted a change.
Eventually, Bob discovered that cannabis helped relieve his pain without the risky side effects of opioid medications. He used cannabis to taper down his use over time, despite his doctor explicitly asking him not to use it.
“The doctor asked me to sign a document giving him permission to test me for marijuana,” Bob explains. “Although I had dabbled in weed before, the doctor specifically banning me using it – while at the same time writing a new pain pill script each month – made me sit down and do some research into whether the weed could help with my pain.”
Bob used cannabis to taper off his opioid pain pills.
“It was kind of like a light bulb went off and I decided that I would try to extend my pain pills by supplementing [them with] weed.”
“Like, I would wait longer in between taking the pills and smoke if I was just in moderate pain instead of taking a pill. I only had 30 days left but was able to stretch that to over 60 days and by the time I had ran out, I didn’t need them anymore.”
Bob credits cannabis with helping him get off the opioids while managing his pain effectively, and he feels angry that his doctor tried to keep him from it. He believes he would still be dependent on opioid pain medications today if it weren’t for cannabis.
When it comes to opioid dependence, stories like Bob’s are more and more common these days. The National Initiative for the Care of the Elderly released a report recently which focused on the opioid crisis among older adults. The report found that older adults are prescribed the most opioids – in part, because they are more likely to experience pain. They also found that older adults are at a higher risk of addiction and overdose, because of changes in metabolism as we age.
Opioids are a double-edged sword. They’re effective, but risky medications. Not only are they potentially addictive, they’re easy to overdose on because tolerance grows fast. Shockingly, 30 per cent of opioid-related deaths occur in adults over 50. And adults 65+ have the highest rates of hospitalization for opioid poisoning, according to the August 2018 report.
Could access to legal cannabis help mitigate the opioid crisis among older adults?
Natural Care nurse practitioner Lynn Haslam thinks so.
“I think that we, as health care providers, strive to provide good pain control. But with the opioid crisis, there is increasing hesitancy to provide opioid prescriptions to anyone. This presents a difficult situation for any healthcare provider,” Haslam explains.
“Opioids are indeed effective at mitigating pain, but the time has come where we have to circle back to ensure that all other [options] have been tried. [This certainly] include[s] cannabis, especially the higher CBD or balanced THC-to-CBD options.” CBD is a non-intoxicating cannabinoid found in cannabis, with pain-relieving properties. Many healthcare providers are more comfortable with the idea of CBD because it doesn’t create a high, and tends to have fewer side effects than THC, although THC is a potent analgesic in its own right, and may improve the efficacy of CBD.
Current research suggests there is a beneficial synergy between cannabis and opioids. Cannabis is an effective pain treatment by itself, but when patients are also taking opioids, cannabis may reduce the need for opioid pain medication. Other research suggests it could even help users manage withdrawal.
However, the older population presents a challenge for healthcare providers. Haslam warns: “We must approach use of cannabis in the older adult with caution and respect that it is still a drug. Many studies involve younger participants, and as we age, our ability to metabolize medications changes.”
“A recent Canadian study – with an average [participant] age of 45 – demonstrated a very low rate of adverse events. I would recommend that older adult patients work closely with their prescriber to [find] a balanced THC-to-CBD mix, with slow titration and close observation for optimal pain management.”
Haslam recommends a “start low and go slow” approach when using cannabis to treat pain, especially when the patient is also taking other medications. “There is always the risk of falls, dizziness, and drowsiness, especially with co-morbidities [aka, other conditions] requiring multiple medications.”
Overall, Haslam is “excited for the future” of medical cannabis for the treatment of pain. She is hopeful that increased access to cannabis could reduce the negative impact of opioid use, especially in older adults.
A growing body of evidence suggests that cannabis might be useful as an adjunct treatment for pain with fewer risky side effects than opioid pain medications. In particular, cannabis treatment for pain appears to benefit the older adult population, who are at higher risk of complications from opioid treatment. Healthcare providers remain cautiously optimistic, carefully titrating patients’ doses of cannabis to help them reduce their opioid use. In the future, studies focusing on cannabis and opioids in older adult populations specifically could help healthcare providers make better-informed decisions. For now, it’s up to doctors and patients to work together to find solutions that optimize pain management and minimize risk.