Pubdate: Sun, 07 Sep 2014 Source: Washington Post (DC) Copyright: 2014 The Washington Post Company Contact: http://mapinc.org/url/mUgeOPdZ Website: http://www.washingtonpost.com/ Details: http://www.mapinc.org/media/491 Author: Janice Lynch Schuster Page: C4 A PAINFULLY LONG WAIT FOR MEDICAL MARIJUANA For 18 months, I have lived with chronic pain - burning mouth syndrome - triggered by oral surgery and nerve damage. On my worst days, it creates the constant sensation of having scalded my tongue and palate. On good days, it feels as though a binder clip was snapped on the tip of my tongue. It has been a miserable experience, and I try my best to manage the pain. Opioids, once hard to get, now are widely prescribed for an array of conditions, including mine. Americans consume about 99 percent of the world's supply of one such opioid, hydrocodone. Widespread abuse of prescription painkillers has led to addiction and, too often, overdose deaths. Despite convincing evidence that people who live with chronic pain need help from interdisciplinary pain management teams, which could offer help with physical and occupational therapy, social supports and more, most pain patients do not receive it. Instead, tens of millions of us find our way to pain experts who, almost without fail, prescribe opioids. Once on the opioid train, we live with constant scrutiny from its conductors - our own fears of dependence and addiction and the suspicion of physicians, their office staff, pharmacists and families and friends who try but cannot understand our experience. I have tried many pharmaceutical treatments and complementary therapies. Because my pain is centralized - it is really coming from my brain, not my tongue - it seems to be tamped down by exercise or a full night's sleep. I still rely on painkillers, though, to make it through days when pain makes it hurt to eat or talk or breathe. I almost felt relieved this April when I heard that Maryland, my home for most of my 52 years, had legalized medical marijuana. Medical marijuana could never replace opiates, one pain expert told me, but it could very well reduce opioid doses and frequency. A study in the Journal of the American Medical Association finds that states that have legalized medical marijuana experienced an almost 25 percent mean reduction in opioid overdose deaths. The authors acknowledge that they do not know the interaction of policy with use, but some correlation seems likely. I see my pain doctor every month. I dutifully follow all recommendations. I exercise often. I've worked on relaxation and meditation and stress reduction - and still, my pain persists, and so, too, my need for medicine. These monthly visits invariably include enduring being chastised by a pharmacist who might or might not fill my prescription. Some pharmacists do not have an adequate supply of my medication, and some refuse to call other pharmacies to ask what they have in stock because all pharmacies, it seems, fear robbery. At one point, staff at my doctor's office suggested I "drive around" until I found a pharmacy to fill it. I have talked to pain experts about the chance of medical marijuana helping me, and I decided to broach the subject with my pain doctor. I planned to ask for a time-limited trial, to see whether THC, the active ingredient in marijuana, would have any salutary effect on me. I worried about how it would be dispensed, knowing that, with my mouth pain, I could hardly smoke it. I was anxious about how the pain doctor would respond. Those questions were almost irrelevant. It turns out Maryland has just begun a lengthy process in which the Medical Marijuana Commission has invited public comment on proposed regulations. Leaders want to launch a safe and effective program, but by some estimates, patients will not be able to try marijuana until late 2015 or early 2016. The full document, more than 80 pages, details the very specific circumstances in which it can be prescribed and by whom and a process for licensing up to 15 dispensaries. I asked my doctor what would happen if I went to another state and bought some to try. He assured me that a urinalysis would reveal this and that I would be removed from his pain practice. That seemed too great a risk for me to take, especially not knowing whether marijuana would work. I am all for patient safety, and I have no desire to be a guinea pig for pain management. But a year or more with no real alternatives? At least I can live with my pain; it will not kill me (although some days, it does rob me of my joy). But for patients with severe and near-constant seizures, medical marijuana promises to be a lifesaver. Why deny them access to treatment? Much of the debate over medical marijuana smacks of the moralizing and stigmatizing that pain patients experience as we try to find better ways to function. And while insurers cover medications and procedures, they are less willing to pay for the "soft" treatments that might really make a difference. If medical marijuana opens some sort of third way, I'd take it. What do I have to lose - other than pain? Janice Lynch Schuster Riva, MD - --- MAP posted-by: Jay Bergstrom