Opioid Addiction

One of the more popular lectures given at Cann Med was by a physician by the name of Dustin Sulak, DO. He is the owner and medical director of a couple of practices in Maine that treats about 14,000 patients – with the focus being on chronic pain treatment and opioid addiction. There is a sister practice in Massachusetts that is seeing about 5,000 patients. His presentation posed the question whether or not cannabis can be a viable alternative and treatment option for both chronic pain and opioid addiction. Wouldn’t that be amazing?!?!?!? Have you heard of the opioid addiction crisis we are in the middle of? Are you aware that the US uses over 80% of the world’s opioid supply?? Some statistics he provided:

• about 44 people in the US die EVERY DAY from prescription pain killer overdose. This does not include heroin OD, which would bump that number to 80!!
• over 7,000 people are seen in the ER every day, seeking opioids for non-medical use.
• 1/20 people (over age 12) in the US used prescription pain killers non-medically at least once in 2010
• between 2000 – 2010 the number of SALES of prescription drugs AND the number of overdoses have nearly QUADRUPLED.
• nearly 50% of patients who take opioids for more than 30 days will CONTINUE to take them for 3+ years (yes, this is an addictive drug).
• 79.5% of heroin users report using prescription opioids before seeking heroin.

Most of these numbers came from http://www.cdc.gov by the way………

See the pattern here?? How about this question – does it HELP with chronic pain?? Do we even have any evidence that it does?? Nope. Why is it prescribed so much?? This is another topic entirely, but I can tell you from personal experience working as a nurse for 15 years, that the pressure is HIGH for doctors to ‘fix’ people’s pain. As Americans we want fast results! We want to pop a pill, feel good and get on with our day! If you don’t fix me, you are going to get a horrible yelp review, doctor! Your satisfaction scores are going down, stupid hospital! Reimbursement? Forget it!! OK – clearly we need to chat about this laters.

Dr. Sulak has discovered a huge need and is staying busy all day, every day helping those that want to move away from their addiction. He explained to us how both opioid and cannabinoid receptors are present in the pain signaling areas of the brain and CNS, and when administered together they create a greater than additive antinociceptive effect.  He presented multiple studies that were made up of patients that incorporated cannabis into their pain regiments and were able to either reduce or completely discontinue opioid use. This is a study that his practice is currently working on publishing:

Because there is essentially NO lethal dose of cannabis, it is more than ok to prescribe it WITH opioid prescriptions. This is actually ideal, if the goal is to wean down (or off) the opioid pain killer. One thing that chronic pain patients report is that with cannabis, the pain doesn’t totally go away, but it becomes less of a distraction. It allows them to stay engaged with the people around them and continue activities of daily living. An important element of recovery is to be AWARE of what your body is doing. If numbing all of the pain is the goal, what happens when you overuse an injured area and then the drug wears off?? How does that help in the long run?? I realize we are covering TWO very different topics here….. Using cannabis for opioid addiction in a setting of non-medical use (no chronic pain) and then addiction because of severe chronic pain. Something else to consider is that opioids can, arguably INCREASE chronic pain over time. Whaaat?!?!??

Another great aspect of combining these 2 medications is that cannabis supports upregulation of opioid receptor proteins in the spinal cord and prevents tolerance build up of the opioid. Yay!! Win win. Patients are able to manage pain without having to double the dose every office visit. OK – I have an opioid addiction. How do I get started?? Dr. Sulak would be a great place to start. His website actually talks about how to integrate small doses of tincture or vaping type cannabis. He suggests taking small doses WITH each pain killer you take. Ideally reducing that dose over time.

I can’t possibly tell people how to treat their addiction on a website. Professional support is required! Counseling is required. Taking care of injuries with therapy – necessary! There is NO pharmacological cure all. It does NOT exist. Ok? Ok. Go get it.