Last December, the Star Tribune reported that in Minnesota deaths from prescription and illegal opioids had risen sixfold since 2000, with 317 lives claimed in 2014 alone. Chronic pain doesn’t discriminate — prescription opiates and heroin both metabolize to morphine in our bodies. Rich, poor, unknown or superstar: All are vulnerable to these risks when escalating doses of prescription opiate medication are their bridge to temporary relief.
When I was trained as a doctor in the 1990s, opiate painkillers like OxyContin, Percocet and Vicodin were paraded in front of us as potential good treatments for pain. We didn’t foresee the beginning of the terrible opiate crisis we find ourselves in now.
None of us thought we’d effectively be pushing heroin, but from the body’s viewpoint, this is what we were inadvertently doing by normalizing prescription opiate use.
Now, as an emergency room physician, I witness the devastation caused by prescription opioid overuse and abuse in Minnesota. Perhaps you know someone in this trap. One of our state’s greatest artists, Prince, may have fallen victim to the same pattern of chronic pain, escalating opioid use and accidental overdose experienced by so many others. This wasn’t a moral misjudgment or a suicidal gesture — it was the tragic outcome of what can happen when your body learns to need opiates to numb chronic pain. There is a risk that the same opiate level may one day stop your breathing — the potentially deadly spiral of prescription opiate use for chronic pain.
I have hope that physicians and patients are at a turning point — seeking an alternative to these potentially deadly painkillers. On July 1, the Minnesota Department of Health will add “intractable pain” to the list of conditions that qualify a patient for access to medical cannabis — making this safe, alternative remedy available to many more Minnesotans.
Opioid-related overdoses and deaths continue to rise because healing professionals, trained to prescribe these medicines, recognize few other choices. Many physicians and patients carry opinions about medical cannabis based on the rhetoric of fear and the connotation of moral impairment rather than learning the truth. Our training didn’t include centuries of forgotten experience with cannabis. We didn’t learn that our bodies have a whole system of compounds — like those found in the cannabis plant.
Medical cannabis potentially could save lives that might otherwise be lost to chronic opioid use. A 2014 study in the Journal of the American Medical Association Internal Medicine found that states with laws allowing access to medical cannabis had almost 25 percent fewer incidences of opioid-overdose deaths than those without.
These opioid medications that allow patients with chronic pain to get by day by day are also putting them at mortal risk. I could not stand by and watch this twisted paradox. Dr. Andrew Bachman and I cofounded LeafLine Labs as mounting evidence showed how effective medical cannabis could be for many patients — while remaining much safer and less addictive than opiate painkillers used today.
A week from now, physicians willing to have this conversation with patients may begin certifying Minnesotans with intractable pain for participation in the state’s medical cannabis program. Current observational data from the state Health Department show that a majority of patients are benefiting from medical cannabis. It can effectively treat pain — without risk of death from respiratory arrest. It is far less addictive than opiate medications, and it has been shown to reduce the severity of opiate withdrawal for those attempting to quit an opiate painkiller addiction. One patient at LeafLine Labs started opiate painkillers to treat painful and unrelenting muscle spasms from a motorcycle accident. Certified for medical cannabis as an alternative in 2015, he now is free of opiate painkillers. “I’m more functional,” he says. “It’s a very clean product that works better than the opiates that were prescribed to me before.”
Our state is at a crossroads. The Health Department has recognized the potential of medical cannabis for intractable pain. Now it’s time for physicians and patients to move toward medical cannabis as a valuable, tightly regulated alternative to opiates. For Prince, it comes too late. But for thousands of others, there’s a better way to help those in chronic pain — without risking tragedy.
Dr. Gary Starr is chief medical officer and co-founder of LeafLine Labs, one of two companies authorized to grow and sell medical cannabis in Minnesota.