About Pain Meds and MJ

After my mother gave birth to my sister and me (or, removing grammatical convention, me and my sister--I was born 10 minutes before she was), she went into cardiovascular collapse after the administration of percocet, a combination of acetaminophen and oxycodone.  My mother has long contended that she has a dangerous allergy to this medicine; she experienced the classic near-death experience, and her heart had to be restarted with paddles.  A brand new nurse broke down in tears.  The truth is that my mother probably is not allergic.  Instead, she was a very tiny woman and was not narcotic-tolerant: oxycodone should never be administered to a non-opiate tolerant patient (60 mg. of hydrocodone daily, for example), nor should it be used for short-term pain. Doing so creates the risk of breathing problems and cardiovascular collapse such as my mother's; it also carries a strong risk for addiction.  I should say that my own dose of pain medicine comes nowhere near close to qualifying me for using oxycodone, and I would be more than hesitant to use it because of the risks, whatever the benefits.  I can attest to the risks of another drug with similar effects; I had fentanyl post-surgically, and while it ameliorated temporarily agonizing pain (gas pressure on an already badly painful spine), it depressed my breathing greatly despite my regular low-dose use of narcotics.

Given such considerations, I was highly surprised when an ER doctor gave a relative a small prescription of oxycodone for an acute injury, especially since three ibuprofen (600 mg., standard for an injury) take her pain away and a much milder pain medicine should work if higher doses of ibuprofen need to be avoided. Frankly, I am worried and concerned from this single incident that ER doctors are giving pain medicines like this routinely.  Are we to believe that the recommendations of pharmacists and reference books are just fluff, or are we to look to individual cases like my mother's and see that the dangers are real? I have warned my sister, but I believe that to her the prescription legitimizes her pain, as I think often happens with other patients post-injury or post-surgically.  Do most people really need hydrocodone or percocet after wisdom tooth removal?  I don't think so.  I threw ours out!

Why do physicians often overtreat acute pain and undertreat chronic pain?  Do people believe that acute pain is a given, that chronic pain is imagined?  I feel fortunate to receive the pain medicine that I do and feel that I do receive it from my self-advocacy. While my pain is at times undertreated, most of the time I can manage with it, the wheelchair, and a combination of activity and rest that takes into account pain flares and related individual capability.

Physically, I wonder if I would be better off trying medical marijuana, at least at night to control breakthrough pain, and I have considered moving states if I am able to in order to acquire it. While some might laugh about my over-prudence in this regard, I have children and not only would potential arrest have an impact on them, but I believe that I could easily be denied access to my regular medications, as has happened to other patients who have used marijuana illegally in a state where doing so is not legal.  After the death this week of an employee at a California dispensary, I think that perhaps general legalization is the only way.  Otherwise both providers and patients are at risk for violence and break-ins.  The history of marijuana prohibition parallels and coincides with alcohol prohibition, except that marijuana prohibition was rooted in racism and classism. Thus when alcohol prohibition was repealed, anti-marijuana laws never were.  I don't know that I could or would want to use it regularly--as with any medicine, I'd have to see how my body responded.

Cannabinoids work even where opiod receptors have been destroyed by nerve damage. While the synthetic drug Marinol is available and legal, it is as expensive as ultra-sleek disesase modifying drugs (up to $15,000 a year), and patients report it is not as effective and produces more rather than less psychologic side effects.  Certainly it is cost-prohibitive for many. 

It is odd to me that a drug that is so dangerous and addictive as oxycodone can be legally prescribed and yet a much milder one (cannabis) cannot be in most states.  And the form that is legal creates more psychologic side effects that people worry about than the illegal one. How much sense does that make?

Though I have long believed marijuana should be legal for cancer, glaucoma, arthritis, and other chronic pain patients, I have shied away from the topic, even though others have recommended that I move to another state or try it illegally.  Severe bouts of lichen plano planarius (I can barely disguise a hand-sized bald spot), an unusually extreme bout of shoulder/cervical pain, migraines from both of these, and these in conjunction with the usual arthritis rendered my pain medicine inadequate for several weeks, especially overnight.  This has convinced me I need to speak up more, and not just for myself, that I've been selfish not to do so.  I am lucky that with more continuous pain I could move in with family or friends in one of a few states where medical marijuana is legal, though that would disrupt my household.  Would I have shied away if I lived in another state or country?  Probably not.  But when people have been rounded up--even recently in Canada--then I have to speak up. Even where it is legal, local municipalities often put in place such strict regulations as to limit patient access.

To me, the same legal defense used for Roe v. Wade should apply to medical marijuana (the Ninth Amendment), but this defense has thus far failed.