A ‘lose-lose situation’
He fought to get off opioids. Now he has to choose between food and medicine
SASKATCHEWAN - Aaron Unger says his decision to use medical cannabis instead of opioids to manage his chronic pain is forcing him to go hungry.
The 31-year-old had been taking opioids since age 12 to manage the pain caused by Crohn’s Disease until three years ago, when a physician authorized him to use medical cannabis.
Unlike prescription opioids, Health Canada doesn’t recognize cannabis as a therapeutic, so it’s not covered under any provincial or territorial drug plans. Unger has to pay out of pocket.
His income source is the province’s disability program, and with the cost of the cannabis plants and products he uses to manage his pain, he can’t afford food and other necessities, he says.
“My biggest problem today is I have to choose between ‘do I buy my food or do I buy my medicine?’ That’s why this is my breakfast today,” Unger said, holding up a bottle of meal replacement drink.
“Because Ensure is covered if the doctor prescribes it.”
Unger says the pain caused by Crohn’s Disease can leave him curled in a ball, screaming. He took opioids throughout high school. The dose gradually grew as he developed a tolerance, until he was prescribed multiple 8 mg doses of Dilaudid each day, plus 175 micrograms of fentanyl every three days, he says.
He found himself craving his next dose, or wanting to take an extra, and worried he would overdose.
“I thought, I’m going to crack eventually, because I’ve got 180 pills at a time that are 8 mgs each. That’s enough to kill several people on my street … it’s insane that amount of drugs was sent home with a teenager.”
A report by Saskatewan’s Auditor General in 2019 found 98,947 people received opioid prescriptions from Saskatchewan pharmacies in the 2018-19 fiscal year, down from a peak of 107,626 in 2015-16.
Unger said he feels “100 times better” since making the switch: he sleeps easier, his mental health has improved and he’s happier.
But patients in his predicament struggle to afford their medication.
Dr. M-J Milloy, a University of British Columbia assistant professor and British Columbia Centre for Substance Use research scientist, was part of a study in Vancouver’s Downtown Eastside that found people who use drugs are less likely to use fentanyl if they use cannabis.
Overall, there’s not enough hard, clinical evidence for the medical community, Milloy said.
“The problem we run into is that we haven’t been able to conduct the sort of clinical trial that we would need for physicians and other care providers to confidently say ‘this will work.’ “
“For some people it’s a very pleasurable experience to take cannabis; for other people it’s an instant panic attack.”
U of S professor Dr. Radhika Marwah started Saskatchewan’s first chronic pain clinic. She’s recommended cannabis to only a handful of patients, but it can be effective in rare instances, she said.
“If a patient comes to me and says that he or she benefits with cannabis, then I would say continue using it. If it’s helping you, use it, but I would still do all the screening and assessments to make sure the patient is not misusing it, or they are using it in a way that’s going to reduce the harms.”
Unger said he’s been given a lose-lose situation.
“I as a Canadian citizen have to choose between ‘do I risk overdosing and dying on opioids in order to be able to pay for food? Or do I keep with the cannabis and keep starving myself?’ Why is it acceptable in Canada that I have to make either of those choices?”