Mary Lou Smart www.medicalcannabisart.com
Stephen (who requested anonymity) has been through the ringer. His particular condition made its first appearance in 2004, with a jolt of incredible pain in his testicles.
With no rhyme or reason, the random pain might appear if he was walking or lying still. It ranged between crushing and piercing.
Initially, the 18-year-old was sent from his primary physician to a urol-ogist, who could not find anything wrong, but quickly ramped up the pain meds, from one 750-mg Vicodin every eight hours to five 5/325-mg Percocet every six hours in addition to a 2-mg hydromorphone (Dilaudid) every six hours or as needed daily.
Instead of subsiding, the pain spread. He visited another urologist, who ran every test under the sun but couldn’t pinpoint anything. A diagnosis of kidney stones led to more pain killers, but no kidney stones were found.
By 2006, his employer made it known that lying in a fetal position on the floor while calling in pain meds was not acceptable, and he left retail management. He then pursued a degree in computer drafting and design at ITT Technical Institute.
While his physicians were unable to uncover anything, a lab technician taking blood for a routine test noted that he had seen pain move south from the bowels to the testes, and that Stephen might want to visit a gastrointestinal doctor, which he did. Finally,
in 2009, at age 23, he had a colonoscopy, which found chronic active colitis. An endoscopy found acute erosive gastritis and duodenitis. An exam of his liver and surrounding area discovered pancreatitis.
Stephen worried that the opiates might be addicting. When he woke up one morning in a cold sweat and shivering, he knew that he’d become reliant on the Dilaudids. He put them away in his sock drawer for a week before taking another. When he told his doctor what had happened, she stopped prescribing hydromorphone and upped the Percocet dosage.
By this point, the pain, which had never left his testicles, was also in his stomach. “Food entering my stomach felt like hot glass shards,” he said. “It never changed consistency either, only temperature, as it moved through the rest of my intestines.” Because eating made him vomit, he quit eating. After he went from 285 to 150 pounds in three months, his doctor told him he was dying.
“It was a sobering moment, because I knew that if I didn’t do something I probably wasn’t going to see 24,” he said. “She sat me down and said, ‘Look, we need to figure out some-thing quick or I need to hospitalize you because you are starving. You are wasting away.’”
While Stephen had smoked marijua-na as a teenager, it had never appealed to him. Smoking was not a regular pastime. Faced with starving to death in pain, he toked again. Cannabis worked, both by improving his appetite and helping him forget the pain. Within a few weeks he’d gained 10 pounds, and his condition was stable.
As in many medical marijuana sto-ries, the federal government found a way to prevent the care of a seriously ill patient. A variety of things might have been occurring to draw atten-tion to his situation. For one, he’d been honest with his doctor and told her that he was smoking cannabis to improve his appetite. She, in turn, had noted in his medical records that along with the opiate medications, he was smoking historical medicine when necessary. In addition, when stopping in to pick up his prescrip-tion refills, he noticed that several doctors, and not just his primary physician, were signing off on his refills. All of this could have drawn attention to his situation. For what-ever reason, a second “doctor”– Stephen doubts that he was a doctor – began sitting in on his meetings with his physician.
“He wore the lab coat, but his stetho-scope seemed like a prop to me,” he said. “He was some kind of hospital administrator.”
With no warning, Stephen was taken off all pain medications. The reason given was cannabis use.
Unethical Pain Treatment Care of the United States Government
For any doctor to withhold treatment for anything other than medical rea-sons is something that has received attention in the courts. In 2003, in Conant v. Walter, by refusing to hear the case, the U.S. Supreme Court upheld a lower court’s decision (Ninth Circuit Court of Appeals affecting nine states) ruling that a Bush Administration plan to strip doctors of their licenses if they were caught talking to patients about the medical use of marijuana was a clear violation of First Amendment rights.
Not that Stephen was ever given any kind of pain contract to sign, because he was not, but shutting off pain medication because of cannabis use, which prompted the above-men-tioned action, concerns an outdated prohibition and has absolutely noth-ing to do with medical care.
While signing a treatment attestation
for pain management would require a patient to acknowledge who he or she is and
have that person agree to not misrepresent medical history, the standard pain
contracts currently in use throughout the United States are something
altogether different. Because of the federal government’s stance in placing
marijuana in Schedule I of the Controlled Substances Act, seriously ill
patients that depend on the therapeutic bene-fit of cannabis are thrown under
the bus. Because of Schedule I’s require-ment that a drug have no currently
accepted medical use in the United States, the plant that’s never killed anyone
can cause pain patients that have been honest with their doctors to lose their
medical care. The inap-propriate placement has been noted by landmark rulings
by two Drug Enforcement Administration (DEA) administrative law judges (Mary
Ellen Bittner 2007 and Francis L. Young, 1988), both of whom strong-ly favored
more access for research and rescheduling in rulings that were ignored by the
Even the federal government’s Veterans Administration (VA) is changing with the times. In July 2010, the Department of Veterans Affairs, through the Veterans Health Administration (VHA), issued Directive 2010-035, the first of sever-al on the same topic, outlining guid-ance on access to and use of medical marijuana by veteran patients. The directive acknowledges that laws in states authorizing the use of medical marijuana are contrary to federal law, that veteran physicians recom-mending marijuana can lose the abil-ity to prescribe controlled substances and be subject to criminal charges, and that marijuana cannot be used on VA property even in states that allow medical marijuana. The direc-tive states that VHA policy does not prohibit veterans in programs of states that authorize medical marijua-na from participating in VHA sub-stance abuse programs, pain control programs, or other clinical programs.
The VA directive is a clear case of a federal authority deferring to state law, according to Michael Krawitz, founding director of Veterans for Medical Cannabis Access. A letter to Krawitz from Department of Veteran Affairs Under Secretary for Health Dr. Robert Petzel stated that “stan-dard pain management agreements should draw a clear distinction between the use of illegal drugs and legal medical marijuana.”
“It’s a recognition of validity of state law,” said Krawitz. “There’s no fed-eral law or rule or anything else requiring a doctor take a patient off of pain treatment, should that patient be using legal medical marijuana.”
When told of Stephen’s treatment, Krawitz was clear. “The notion that anyone would threaten a patient with denial of care is an absolute, outra-geous violation of every standard that we hold dear in our society,” he said. “Whether he signed a contract or not, taking away someone’s success-ful pain treatment is a violation of basic human rights. It is a violation of medical ethics and of the standards of medical care.”
Fighting Prohibition with Schedule III Medicine
When faced with a firewall prevent-ing her patient from having opiates because he’d admitted to using cannabis, Stephen’s doctor came up with an alternative plan. By now, they were both aware of the total dis-connect between the federal govern-ment and the medical profession regarding cannabis and health care. While cannabis might have saved his life, its status as a Schedule I drug was creating problems with the law. She prescribed Marinol, synthetic THC classified as a Schedule III (medically beneficial!) drug, which would always explain away any cannabis components in his system.
A funny thing happened when Stephen was yanked off opiates. His health improved, and his stomach didn’t hurt as much.
“The research confirms that cannabis has a synergistic, beneficial relation-ship with opiates,” said Mary Lynn Mathre, president and cofounder, Patients Out of Time. “Most patients taking cannabis for pain will either get off of opiates entirely or really reduce the dose, and they do not need the stool softeners, antiemetics, or antidepressants usually prescribed for opiate side effects.” His new regimen is Prilosec for stom-ach acid, Zofran for nausea and Tramadol when he does have severe pain, maybe once a week. He uses the Marinol, which works during his
most severe pain times, when he wakes up in the morning and when he goes to sleep at night. Cannabis is a mainstay in his medicinal war chest. A whole-plant advocate, he prefers a vaporizer for the fast action and also likes edibles because they last longer and seem to help with his physical pain.
“The cannabis helped with the pain in my intestines,” he said. “It defi-nitely helps with appetite and nau-sea. I have not vomited since I start-ed medicinally using cannabis, which has done wonders for my esophagus and stomach. Cannabis doesn’t have any of the side effects of any of the other medications that they give me.”
Pushing for Reform in Virginia
Stephen’s experience turned him into an advocate for others. Like many who realize that marijuana is more than a recreational drug, he is push-ing for a more compassionate med-ical cannabis program in his home state.
Virginia’s possession law for a first offense is a small fine and under a month in jail. Cultivation of 10 plants can be considered a personal possession misdemeanor. Selling marijuana to a friend can be adjudi-cated as an accommodation, with the same weight as a possession charge. Virginia does have a medical cannabis law that covers patients with cancer and glaucoma.
Stephen is drafting more comprehen-sive medical cannabis legislation, meeting legislators, and working with advocacy groups such as Patients Out of Time.
“The problem with medications handed out for pain is that many of them are more addictive than effec-tive,” he said. “Cannabis saved my life by stabilizing the weight loss. It’s been extremely beneficial in other ways, including pain management. There is no other way to put it; cannabis has been a blessing in my life.”