Patients and Providers Say Cannabis Helps Reduce Opioid Use

By Crystal Lindell

More than half the pain patients certified in New York state’s medical cannabis program say they’re using cannabis as an alternative to opioid medication. 

That’s great news for patients who see real benefits from cannabis, but we have to be careful to avoid further demonizing opioids when data like this is released. Using something as an alternative doesn’t show that it’s necessarily more effective or more helpful. Often, it just means that something is more accessible. 

The data comes from the New York State Office of Cannabis Management’s 2023 Patient and Provider Survey Report, which was recently released. This was a large survey that collected responses from 10,781 patients and 265 providers enrolled in the state’s medical cannabis program. 

“Findings from both the patient and provider surveys demonstrate that medical cannabis is effective for pain management and has the potential to reduce the use of opioids,” the report found.

About 57% of the patients were pain sufferers, making pain the top condition for using cannabis, followed by post-traumatic stress disorder (24%), neuropathy (19%), spasticity (11%), rheumatoid arthritis (11%), inflammatory bowel disease (10%) and cancer (8%).

The survey found that 66% of patients think medical cannabis helped reduce their use of opioids for pain management.

The providers were largely in agreement, with 83% saying “medical cannabis should be used to reduce the use of opioids for pain management” and 75% saying cannabis poses less risk than opioids. 

However, this is where I start to raise my eyebrow a bit. 

It makes me nervous that so many providers see cannabis as being safer than opioids. The fact that 25% of them don’t is also a telling statistic. It means the data on this is unclear.

All substances have side effects. Both patients and providers understand this. In a just world, patients should be able to make the choice about which substances or medications they use, after factoring in their own preferences for what side effects are acceptable as a tradeoff for pain relief. 

Even if it was proven that cannabis is significantly safer than opioids for managing pain, that doesn’t mean it’s just as effective as opioids. Personally, I don’t find cannabis to be very effective at all for treating my pain. I also really dislike how sleepy it makes me. For my life and my needs, opioids remain a much better option. 

I’m lucky enough to have a recurring prescription for opioid medication. But for patients who can’t get an opioid prescription, they don’t truly get a choice or “alternative.” Cannabis may be their only legal option. 

The New York State report also shows me that it’s long past time to make cannabis legal at the federal level. It’s clear now that classifying cannabis as an illegal controlled substance never had any foundation in health concerns. Clearly, cannabis can help treat a large number of medical conditions. And many people get health benefits from using it. 

A lot of drugs that are classified as harmful controlled substances can still be obtained by prescription. And some that are not “controlled” are potentially more dangerous than cannabis. That doesn’t make any sense, but that’s how the system is set up under the Controlled Substance Act. 

The way that cannabis has been slowly legalized across the country should make us take a long look at all of our drug laws. There are many illegal substances, such as psychedelics, that could potentially help people manage health conditions – but only if they had access to them in the same way most Americans can now access medical or recreational cannabis. 

If nothing else though, cannabis’ slow legalization has given me some hope. I can remember even 25 years ago, being in college, listening to guys in dorm rooms ramble on about how cannabis would be legalized someday. I confess I didn’t believe them. At the time, it felt impossible. 

Turns out, I was wrong. Now I just hope we don’t stop at cannabis. 

In Memory of Two Pain Warriors

By Pat Anson, PNN Editor

The pain community is mourning the loss of two of its most dedicated advocates this Memorial Day weekend: Terri Lewis and Jeffrey Fudin.

Dr. Fudin was a clinical pharmacist who specialized in pain management at the Stratton VA Medical Center in Albany, New York. He was also a prolific researcher, blogger and mentor to other clinicians. Fudin died Friday at the age of 63 after a lengthy battle with Stage 4 colon cancer.

Fudin spent much of the past year visiting with family and friends, displaying an extraordinary amount of courage, grace and humor as his prognosis worsened. He even managed to work a few laughs into his own obituary, which he penned himself.

“Seriously, you thought I was going to leave you all without a final post from the grave? If you’re reading this, I am now resting comfortably and hopefully watching over those I most cherished while on earth,” Fudin wrote.

“Someplace there is a lemon tree that will bear fruit from the earth. That sour fruit will provide joy and perhaps lemonade to those I leave behind.”

JEFFREY FUDIN

Terri Lewis’ battle with cancer was shorter and her passing unexpected. She died Saturday at the age of 70 from complications caused by chemotherapy for metastatic melanoma. 

Dr. Lewis was a rehabilitation specialist and educator who specialized in disabilities and mental health. She traveled regularly to Taiwan, where she was an Assistant Professor at National Changhua University of Education.

Lewis was a prolific researcher on issues affecting the pain community, which she shared freely with other advocates and reporters. She and Fudin helped me understand many complex issues when I first started covering pain management a decade ago.

“Terri was one of the most staggeringly intelligent people I have ever met. I remain in awe of her ability to identify and wrangle large data sets and to discern meaningful trends and relationships in healthcare processes with levels of complexity which overwhelm me,” said patient advocate Rose Bigham.

“She was generous with her time, coached and collaborated with many other pain patients and advocates, and was a fierce defender of her adult son who had been neglected and abused by multiple healthcare systems and providers due to his complex health conditions. She was relentless. She taught so many of us to never give up, and to be unafraid of tackling the big problems.”

TERRI LEWIS

“Terri Lewis was a force; her enthusiasm was inspiring, and I think that enthusiasm helped struggling patients keep hope alive and continue to fight, myself included. I am so grateful for all she taught me,” said Anne Fuqua. “There was one day where I was worried sick about a friend with muscular dystrophy who was on a ventilator. His physician had decided to take advantage of having him admitted for IV antibiotics and use this as an opportunity to taper his opioids and he planned to do this over the period of one week. Terri knew exactly who to ask for – and in less than 2 hours the taper was aborted.

“The very best those of us who loved Terri can do is to use what she taught us to help fellow patients as well as ourselves. I hope we can do a tenth the good she did in her lifetime.”

‘They Were Heroes’

It’s an overused expression, but Lewis and Fudin really were “pain warriors” who worked hard to dispel the many myths that surround the use of opioid medication. They risked their careers and reputations while opioid hysteria gripped the nation, patients were abandoned, and doctors were prosecuted for treating pain. When others looked away, Lewis and Fudin stood up to defend them.   

“They were heroes,” says Dr. Mark Ibsen, who fought to regain his medical license after he was suspended by the Montana medical board for “overprescribing” opioids.  

“Terri was a tireless and relentless advocate and teacher. She understood the malfeasance of targeting doctors by the abuse of dating mining,” Ibsen told PNN. “They use these data banks to predict diversion and prescribing ‘outside the usual course of medical practice’ even though nothing of the sort is proven.” 

Much of Fudin’s advocacy was focused on ending the “pseudoscience” of using morphine milligram equivalents (MME) to measure the risks and effectiveness of an opioid – which illogically presumes that every patient and every opioid are identical.

“Jeffrey Fudin debunked the false equivalency of MME levels, noting the bogus assertion that ‘one size fits all’ does not apply to the complexities of human biochemistry and pharmacology,” said Ibsen.  

Fudin’s funeral will be held on June 1 in Albany. In lieu of flowers, it was Fudin’s wish that any memorial tributes be made in the form of a tax deductible donation to the Dr. Jeffrey Fudin Memorial Foundation. 

A Terri Lewis Memorial has also been established at the Arachnoiditis & Chronic Meningitis Collaborative Research Network (ACMCRN), a non-profit that Lewis helped found and where she was VP of Research..

RIP Terri and Jeff.