Marie Jones (whose name we’ve changed to protect her identity) is a 33-year-old bar manager and mother of two living in Mount Holly, North Carolina. Years ago, she was diagnosed with fibromyalgia as well as joint-related complications from a past car accident.
Over-the-counter medicines did little for her pain. “I was having more and more health issues, and it was very debilitating,” she told Carolina Cannabis News.
Jones described herself as a person who’s always had a lot of drive, but trying to parent, work and go to school while dealing with severe pain proved too much to handle. “I was struggling to get through my days,” she says.
Nerve pain like what Jones experiences is understood by the medical community as some of the most intense. “The best way to describe it,” she said, “is like you’re being electrocuted. Or you’re on fire.”
The words “opiates” and “opioids” are sometimes confused. “Opiates” refer to a class of painkilling drugs derived from the opium poppy, such as morphine, codeine and heroin.
The broader term, “opioid,” can refer to any synthetic or naturally-derived drug that binds to the opioid reward centers of the brain, including the aforementioned drugs as well as hydrocodone (Vicodin), oxycodone (OxyContin), fentanyl and methadone.
“The best way to describe it,” she said, “is like you’re being electrocuted. Or you’re on fire.”
Eventually, her doctor put her on a regimen of opioids. “With hydrocodone, I could get up, I could function. I was mobile,” Jones said. At first, it seemed like the right solution.
Jones said she’d have a couple of good days with little or no pain, and then wonder whether she really needed the medication anymore. That’s when she realized her body was dependent on pharmaceuticals. Despite her growing unease, she continued taking hydrocodone as prescribed.
Extreme irritability and constipation were two of the most debilitating side effects from taking opioids, Jones said, and over time, she was put on other medications to address those effects. The second tier of medications caused their own suite of side effects, and Jones was prescribed still another round of drugs to offset those.
At one point, Jones was prescribed 36 different medications. Her daily routine centered around pharmaceuticals.
Worst of all, the opioids had lost some of their effectiveness over time. “Your option at that point isn’t to step down,” Jones said. “It’s to step up.”
She was already taking 40 to 50 mg of hydrocodone a day, putting herself at risk for a whole host of potentially detrimental conditions, including liver damage, heart arrhythmia, sexual dysfunction, depression and more.
While we prefer to use our source’s real names, given the topic there are times when the need to protect our source is paramount. We believe this is one of those times. For the record, “Marie Jones” is a friend of a friend; as soon as Carolina Cannabis News was launched, in Sept. 2018, our mutual friend urged us to tell her story.
A New Way — But With Fewer Side Effects
In May 2018 — after learning her sister-in-law in Las Vegas had some success using cannabis to treat her own pain condition — Jones began transitioning from opioids to cannabis. Today, she lives free from pharmaceuticals.
“I don’t feel like cannabis completely deadens my pain,” Jones said. “It’s still in the background, but manageable. I’m comfortable, but I don’t feel out of control. I don’t feel high.”
To date, 33 states allow access to medical marijuana, but North Carolina is not yet one of them. Jones prefers cannabis-based oils to smoking — but in whatever form she takes it, she must turn to a private supplier. “Cannabis has been so demonized,” she said. “I have to take an illegal approach to obtain this natural thing with few side effects. And that breaks my heart.”
While Jones’s success with cannabis may sound miraculous, she’s not alone. In a 2017 study, 97 percent of a sample of 2,897 medical marijuana patients in legal states reported reducing or eliminating their opioid use with cannabis. Meanwhile, 81 percent said that cannabis alone was more effective in relieving their pain than cannabis and opioids combined.
Another study published last year from the University of Georgia found a 14.4 percent reduction in prescription opioid use in states with legalized medical cannabis.
“I have to take an illegal approach to obtain this natural thing with few side effects. And that breaks my heart.”
The Doctor’s Perspective
Dr. Rav Ivker, an osteopath at Fully Alive Medical Center in Boulder, Colorado, and author of the 2018 book Cannabis for Chronic Pain, has treated more than 8,000 patients with medical marijuana. Most were on opioids prior to seeing him. Dr. Rav, as he is known to his patients, told CCN that cannabis has helped a large number of them taper down or eliminate their opioid use.
Dr. Rav said a ratio of equal parts tetrahydrocannabinol (THC) to cannabidiol (CBD) — better known as a 1:1 THC to CBD formula — is particularly helpful for pain relief, and people with neuropathic pain — such as what Jones experiences, as well as patients with multiple sclerosis, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, osteoarthritis and rheumatoid arthritis — respond most successfully.
[Video: CNN’s Dr. Sanjay Gupta talks about the possible connection between marijuana and opioid addiction and CBD. He also explains that much of the research on this topic in the U.S. was “designed to look for harm,” whereas international studies paint a different picture entirely. April 2018.]
The 1:1 ratio works because THC activates or enhances the pain-relieving effects of CBD, and in turn, CBD modulates the psychoactive effect of THC. It’s a synergistic interplay between different cannabinoids often called “the entourage effect.”
Dr. Rav added that some of his patients also supplement on top of that formula with additional CBD. “I haven’t seen anyone, even with the most severe pain, fail to relieve the pain with that combination,” he said.
In 2015, Dr. Rav experienced first-hand how effective cannabis is for managing medical conditions: He developed a case of shingles that left him in excruciating pain. Without cannabis, he said, he’s not sure how he would have coped.
“I had seen my patients relieve their pain and get off opioids with cannabis, and I was very impressed,” he said. “But after I had the problem myself with shingles … I became a real believer.”
Of course, there are some risks associated with cannabis. Dr. Rav cautions against concentrates such as shatter, resin and wax, among others, that can contain up to 95 percent THC. It’s not needed for pain relief and can become addictive, he said.
Further, there appears to be an association between heavy-THC use among young people and the risk of developing schizophrenia.
Nevertheless, Dr. Rav said he hopes to see cannabis removed from the list of Schedule 1 drugs at the federal level because, at least for certain types of pain, cannabis is just as effective or more effective than opioids (listed as Schedule 2). Cannabis has known anti-inflammatory properties.
Unlike with opioids, Dr. Rav said, “you can also treat the causes of the chronic pain, not just the symptoms.
Approximately 130 people in the U.S. die each day from opioid overdoses. That staggering number adds up to 42,000 Americans per year — surpassing even car accidents as the leading cause of death among Americans under 50.
The drugs responsible for those deaths are a mix of prescription opioids and street drugs, though the pathway from prescription painkillers to opioid street drugs has been clearly documented.
By contrast, cannabis is not associated with fatalities, even in very high doses, according to the U.S. Drug Enforcement Administration — at least until the Trump administration removed that information from the agency’s website last year. There are also far fewer side effects with cannabis use than in opioid use.
Marie Jones can attest to that. That’s why she’s comfortable with her choice to use cannabis for pain relief. She is, however, uncomfortable about breaking the law to do what she feels is best for her health.
“I hope we see a change,” she said. “I do think it would make a huge difference to a lot of people.”
Danielle Simone Brand
Danielle Simone Brand, an independent journalist based in California, writes about cannabis, homesteading and parenting. Her work appears on TheWeek.com, Kveller.com and ChopraCenter.com. She is writing for Carolina Cannabis News as Part of our "Voices from the Green Side" series.