Friday, March 30, 2012

Chronic pain, the "chronic" and right ways/wrong ways

Composing, performing and producing music doesn't necessarily go in hand with use of  mood altering substances. I don't smoke anything, I used to drink occasionally but I have some issues with reflux as well as being on some medication that doesn't permit that.

I am on medication for chronic pain. I am fairly happy with this medication, it is a patch that I apply once a week, it keeps a constant level of this medication running into my system, and it works well. My life is miserable without it, because I have issues with the bones and discs in my back and neck as well as with arthritis in my knees. I have to "work against it" a little because it can cause me to be a little lethargic, but not terribly so.

The manufacturers of medicines are not infallible, of course, and they are part of a profit making industry of significant proportions. But I know they are constrained by laws and by scientific processes that are mandated by law that they must follow to ensure the quality, purity and strength of their products. They know how much of a particular substance is in their medicines because they are intimately familiar with the molecular structure and weights, and apply sophisticated technology that is carefully calibrated in order to perform the various tests required. They are liable for product defects, and they are regularly held accountable if their practices are found to be injurious.

Now, to compare this to what is emerging as the "medical marijuana industry", we see that there are a lot of differences. Frankly, bluntly (find a pun there if you like), for the longest time the people that have been cultivating marijuana have been doing so primarily for the purpose of producing plants that can get a person more high, stoned, baked, fucked up, etc.. Only fairly recently has the cultivation of this product been geared towards pain control. It does so happen that the two go hand in hand with respect to cannabis, the molecules that make people feel better make them feel less pain, so this is not a condemnation. But it is true majority of this substance that is purveyed on the black market and consumed, is consumed for the purpose of mood alteration.

The cannabis equivalent to "opium dens" far outnumber the cannabis equivalent to "pain clinics". To arrive at this conclusion doesn't require extensive research and study. Again, it is only recently that some forms of legitimacy are being afforded cannabis for medical purposes for modern populations. It is the case that, historically, it has always been used for this purpose, but as a whole natural remedy and not as much within the matrix of modern medicine..

Now, it is easier to draw a parallel between legitimate modern pain medicine and medical marijuana than one might think. Because, of course, most of that meticulously tested, regulated, controlled and molecularly well understood medicine has it's basis in opium. The patch that I apply each week is a derived from opium, and almost all of the pain medicines that really work well are opiates. And, just as cannabis is associated with shady stoners and bohemian dreamers, so is opium, and it doesn't take rigrous research to know that fact either.

The arguments that most people who want to get high off of pot like to raise start to come up now "cannabis is not as addictive, it is not as toxic in long term use, it is not as expensive to produce" etc.. But they make these arguments, of course, because they want to get high.  The will argue and argue because they like how it feels to be stoned, just like a child will argue because they want something sweet instead of their veggies. And this is not good for two reasons.

Reason one is, objectively and scientifically, it's a little different than the sweet thing versus veggies. Because there are real issues with opiate pain medicines, high rates of addiction for one. Opiates can make you feel good, euphoric, and there are synthetic opiates that eliminate a fair amount of that. So they are prone to abuse. Also, just like there is "pot" and medical cannabis, there is "heroin/opium" and opiate pain medicines: there is the black market and the legitimate market for both.

Now, just for the purposes of this writing, let's say that the plusses and minuses of opiates vs. cannabis are a wash: fast forward a bit along a possible alternate future line where cannabis is used in the same way as opium as a basis for pain medicines, and the raw form of cannabis is also adjudged as acceptable for medicinal use. based on sound scientific study and given that the method of administration is not injurious (that is, it doesn't involve inhaling smoke that contains various particulate matter and toxins).

Doctors would have another tool that they could apply in the adminstration of chronic pain. Chronic pain is a huge issue, you know when you are in just a little pain it takes effort to deal with it, and if you have substantial pain all the time then you end up getting a treatment like mine which I have to say has transformed my life very positively.

Now, would I prefer to be high all the time to the de-euphoricized opiate patch I use now? Truthfully, honestly, no I wouldn't. I like euphoria just as much as the next person, but you really do have negative feelings for a reason, they are part of your information flow, your ability to react, excel and interface effectively. If I was told by my doctor, "ok there is the cannabis based patch that you can use just like your current one" I would be intrigued, but also a little daunted, because I know what's working for me now is working well enough. If my doctor said "now, you know that the treatment you are on will cause you to build up a tolerance, and you will need stronger and stronger dosages to have the same effect, eventually. But this new medicine is less prone to that" then this would be a plus, or if my doctor said "this new treatment would have less risk because of [some scientific reason]" then that would be a plus.

But the bottom line is that for me to want to change the treatment there would be some level of advantage, and the assumption would be that the same amount of certaintly about what was in the patch and how it worked and all the tests and regulations were in place to ensure that the providers were producing just as known a quantity and quality of the cannabis based treatment as they are the opiate based one.
Because that's how the market works, that's what people with my level of chronic pain want in their medicine. I'm not talking about people with terminal or life threatening cancer, or degenerative diseases, that's a different level of pain and also a different level of willingness to accept risks and less convenient methods of administration.
My market it huge, however, it is huge and growing and it is in need of more medicines without the downsides of opiates. But for that market it's important that all of the same assurances that are applied to current medicince are applied across the board.
And. having said all of that, it is always an experiment to some extent even after all of the testing, trials, and production controls. We hear about medicines that have side effects that were not observed in the smaller populations first using them. Late night TV runs adds for lawyers looking for people treated with medicines that were later found to be problematic.
I guess what I'm saying is that the use of anything shouldn't outpace the science that supports its application. I'm actually happy to hear that people are able to relieve very very bad pain caused by really bad diseases and conditions by using cannabis. I do have a general feeling that they are not risking unduly given their more dire conditions. I'm mainly hoping that the science is learning from these people's experiences, in a harsher light, they are a cohort in an experiment and their data needs to be gathered and correlated. I'm not sure if there is a way to know just how many milligrams of what molecules were in each dose, or what the rate in micrograms per hour was absorbed given the way that things are currently being done.
I'm definitely not wanting people in dire pain and circumstances to be denied relief, but to ensure that medicines that work aren't relegated to only being "last resorts" simply because the proliferation of the use in that scenario outpaces the science that needs to be applied to understand these medicines, in order to make better medicine for more common, widely experienced conditions.

As far as legalizing social use, it should be regarded as a different subject and not at all linked to medical use. As it stands, people getting intoxicated for fun often experience much less fun than anticipated, and it is a different realm of discourse.

Finally, one thing that is definitely a plus with regard to cannabis based pain medicine vs. opiate: far less likelihood of fatal overdose.


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