When cannabis is an ally in pain fight
Pot has helped Gillian FitzGibbon find relief and kick opioid use
When Gillian FitzGibbon’s doctor suggested she try cannabis to reduce her chronic knee, hip and ankle pain, she figured anything was better than the cocktail of opioids she had been prescribed for years, medication that she said left her in an “abyss”.
As health-care providers sound the alarm over rising opioid addiction and the lack of available pain management alternatives, some patients like FitzGibbon — along with their physicians — are turning to cannabis derivatives for relief.
Ottawa physician Hillel Finestone co-authored an article published on June 14 in the journal Canadian Family Physician that calls opioid use in Canada an epidemic and links it to the lack of options offered by doctors for pain management. The authors say this is happening, in part, because nonmedical pain management services — like physiotherapy to address physical tension and psychologists and social workers to address stress — are not covered by government health insurance plans, and therefore typically not considered part of a pain management plan.
And while Finestone says medical marijuana may have a role to play in the holistic approach to pain management, he cautioned it shouldn’t be considered a “silver bullet.”
“Cannabis is definitely used by some people for pain but it is still a small aspect of the multidisciplinary approach (of how) we want physicians to treat it, and the way we want people to think about it,” said Finestone, who is director of stroke rehabilitation research at Élisabeth Bruyère Hospital and a professor of physical medicine and rehabilitation at the University of Ottawa. “No one is going to say that marijuana is a one-stop pain treatment.”
Nevertheless, FitzGibbon, 56, whose pain stems from multiple sports injuries and recent falls, was willing to take that chance. She had been on a cocktail of pharmaceuticals, including opioids, to treat anxiety, depression and osteoarthritis. Her inactivity contributed to weight gain and her family doctor suggested she undergo bariatric surgery — an operation to reduce the size of her stomach — so she would eat less. While reluctant, she was considering it because she was desperate to regain her health and mobility.
“I found myself lying in my hospital bed (after a serious knee injury two years ago) in my living room, where I lived for six months, wondering why I was still alive,” FitzGibbon said. “I had no idea that there were such severe side- effects (from the drugs). You get so trapped in the abyss of opioid side-effects that you just can’t (see) your way out of it.”
According to the Centers for Disease Control and Prevention in the United States, regular opioid use can lead to addiction or overdose. Deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescription drugs. From 1999 to 2014, more than 165,000 people died in the U.S. from overdoses related to prescription opioids.
There are currently no nationallevel data for prescription opioid-related mortality in Canada. However, the Canadian Centre on Substance Abuse has provincial data that shows the overall rate of opioid-related mortality increased by 242 per cent between 1991 (12.2 per 1,000,000) and 2010 (41.6 per 1,000,000). In 2010, 12.1 per cent of all deaths among those ages 25 to 34 in Ontario were opioid-related, an increase from 5.5 per cent in 2001
Dr. Mary Lynch, a pain specialist and professor at Dalhousie University in Halifax, is currently researching the use of medical marijuana in pain management. While she acknowledges there is a role for opioids in certain cases, her research has found that 25 of 30 randomized controlled trials done as part of her study in Canada have shown that cannabinoids have “a significant analgesic effect” and are safe in the management of chronic pain. She admits the research is still in its infancy and more research needs to be done. Until then, she says, the government needs to address the problem of long wait times to get into pain clinics.
“We have a terrible situation across the country where people with chronic pain conditions wait for very long periods of time to get into pain clinics,” said Lynch. “Many have absolutely no access because there are no pain clinics in vast areas of Canada. They are mostly in the urban centres.”
FitzGibbon waited a couple of years after her knee injury to get into the Chronic Pain Management clinic, part of the AIM Medical Group at the Trainyards. When she met with Dr. Marc Engfield for the first time, he told her he was open to cannabinoids to help control her pain.
“I really just sat and bawled my eyes out, saying please help me,” said FitzGibbon, who admits she had been struggling with suicidal thoughts. “I said I am so tired of being prescribed medication with such severe side-effects.”
The doctor suggested she try synthetic cannabis, along with a strain of cannabis oil that helps her address all her ailments at once. One dose of oil is the size of a piece of rice, which she puts under her tongue. She also went to National Access Cannabis, a for-profit, membership-based consultation centre in Hintonburg where she learned about strains and the many ways — including cooking — cannabinoids can be ingested. When she walked into the clinic last fall, she was 100 pounds overweight and barely mobile. Since then she been able to manage her pain, get off four medications and become mobile. Another byproduct of better health is more than a 100-pound weight loss.
“I can do the stairs better, I’m moving better, my blood pressure went down,” said FitzGibbon “All I’ve ever wanted to do is emerge out of hibernation a healthier person and this is my year.”
All I’ve ever wanted to do is emerge out of hibernation a healthier person and this is my year.