Good Samaritan makes a Bad Policy decision in forcing Patients to choose between Opiates and Cannabis. In essence, Good(?) Sam is Punishing Patients for being cured with Cannabis. And Why? Was somebody harmed by concurrent use? Did they end up overdosing on Opiates or other negative consequnces? No, in fact opiate use is typically decreased when used in conjunction with cannabis. So what's the problem? Well, as one of my elders once told me, when it don't make sense, follow the money. Thus We can imagine that who ever is getting paid for the opiate use is Not Happy about any decrease in use. We just hope that this isn't a case of Good Sam or the Doctors having stock in the Opiate company, or something like that. In addition, the specter of Politics raises it's ugly head. Has the DEA come thru and told Good Sam to do this or all of it's Doctors Controlled Substance licenses will suddenly need to be re-inspected?

Policy means Many Medical Cannabis Patients Experience Discrimination From Their Physicians

Cannabis activists, particularly those that have worked in medical cannabis clinics, have heard more and more stories regarding patients experiencing severe discrimination from their physicians due to their use of medical marijuana, even when allowed under state law. Published stories regarding patients being denied transplants have surfaced, and even some signs of hope that such a policy, with no scientific basis, is starting to be reformed. Many patients are now reporting that they are being forced to choose between medical marijuana and pain medication, with doctors threatening to stop prescribing pharmaceutical pain killers if the patients continue using medical cannabis. Many patients anecdotally have reported using fewer pain killers such as OxyContin due to using medical cannabis. Scientific research now backs up these anecdotal claims.

Pain Patients, Pain Contracts, and the War on Drugs

Pain contracts. Pain management contracts. Medication contracts. Opioid contracts. Pain agreements. They go by different names, but they all mean the same thing: A signed agreement between doctor and patient that lays out the conditions under which the patient will be prescribed opioid pain medications for the relief of chronic pain. (To see a standard pain contract, see below ) For some of the tens of millions of Americans suffering from chronic pain, opioid pain medications, such as Oxycontin or methadone, provide the only relief from a life of agony and disability. But with the Office of National Drug Control Policy's ongoing campaign against prescription drug abuse and the Drug Enforcement Administration's (DEA) ongoing crackdown on physicians it believes are prescribing opiates outside the bounds of accepted medical practice, the medical establishment is increasingly wary of pain patients and adequate treatment of pain is a very real issue for countless Americans.

In recent years, doctors and hospitals have turned increasingly to pain contracts as a means of negotiating the clashing imperatives of pain treatment and law enforcement. Such contracts typically include provisions requiring patients to promise to take the drugs only as directed, not seek early refills or replacements for lost or stolen drugs, not to use illegal drugs, and to agree to drug testing. And as the contract linked to above puts it, "I understand that this provider may stop prescribing the medications listed if... my behavior is inconsistent with the responsibilities outlined above, which may also result in being prevented from receiving further care from this clinic." "Pain agreements are part of what we call informed consent," said Northern Virginia pain management and addiction treatment specialist Dr. Howard Heit. "They establish before I write the first prescription what I will do for you and what your responsibilities are as a patient. They are an agreement in order to start a successful relationship that defines the mutual responsibilities of both parties. More and more states are suggesting we use agreements as part of the treatment plan with scheduled medications. Such agreements are not punitive; they protect both sides in functional way."

If Heit sees a cooperative arrangement, others disagree. "This is really an indication of how the current DEA enforcement regime has created an adversarial relationship between patients and physicians where the doctors feel the need to resort to contracts instead of working cooperatively with patients," said Kathryn Serkes, spokesperson for the Association of American Physicians and Surgeons (AAPS), which has been a fierce critic of criminalizing doctors over their prescribing practices. "The pain contracts are a tool to protect physicians from prosecution. He can say 'I treated in good faith, here's the contract the patient signed, and he violated it.' It's too bad we live in such a dangerous environment for physicians that they feel compelled to resort to that," she told the Chronicle. "Patients aren't asked to sign contracts to get treatment for other medical conditions," Serkes noted. "We don't do cancer contracts. It is a really unfortunate situation, but it is understandable. While I am sympathetic to the patients, I can see both sides on this," she said.

"There is no evidence these pain contracts do any good for any patients," said Dr. Frank Fisher, a California physician once charged with murder for prescribing opioid pain medications. He was completely exonerated after years of legal skirmishing over the progressively less and less serious charges to which prosecutors had been forced to downgrade their case. "The reason doctors are using them is to protect themselves from regulatory authorities, and now it's become a convention to do it. They will say it is a sort of informed consent document, but that's essentially a lie. They are an artifact of an overzealous regulatory system," he told the Chronicle. "When this first started, it was doctors using them with problem patients, but now more and more doctors and hospitals are doing it routinely," Fisher added. "But the idea that patients should have to sign a contract like that or submit to forced drug testing is an abrogation of medical ethics. Nothing in the relationship allows for coercion, and that is really what this is."

The pain contracts may not even protect doctors, Fisher noted. "When they prosecute doctors, they can use the pain contract to show that he didn't comply with this or that provision, like throwing out patients who were out of compliance. The whole thing is a mess."

Q: DEA has a Medical license so NO pain patients are allowed opiate medications? ER doc refuses to even examine or evaluate pain due to history of chronic pain.

I tried to explain that this is new acute pain and was handed a printed message stating that their hospital would not give injections or oral narcotics to pain patients due to DEA pressure. This has been going on for months now, I have been told by some physicians that I truely need pain medications, but they don't write scripts for those due to their clinics directives from DEA. I can barely walk due to pain and have been to previous pain clinic and told to go to pool therapy..that is now finished. Pain is still increasing. Went to new Pain Program and was told I needed eval by their PT, psychologist, neurologist, MRI of lumbar spine and pelvis x-ray, and releases signed for medical history. PT at pain clinic told me they could only partly help me as my scans and lab tests show significant painful conditions. I am still waiting for a decision by the pain clinic if they will agree to treat me.

I was told if I got all these screenings done he would see me as soon as possible as it was obvious I was in a lot of pain. I called his nurse AGAIN today and was told that next opening to see doctor was April 5th-2 months from now still! Then I was told he could possibly fit me in sooner, my information was on his desk, but he will not be back in that office until next week. My GP angrily told me that opiates were only for dying patients. I feel so guilty and weak and ashamed by all these reactions to my request for a modest amount of medicine to help me tolerate the pain. Don't tell me to find another doctor unless you know someone who will prescribe to a new patient! No one does in this area, I can't even get an exam!

Maybe I should try to find one of the "lonely street drug dealers" that the DEA has told us about through ADS on TV saying everyone gets high on prescriptions for narcotics from doctors, so Dealers don't have any business. Maybe they should advertise on TV so someone decides my need for medication besides the DEA! Has anyone else seen these "public service announcements"? I would go and get drunk but I went through the self-medication phase and have chosen sobriety for a year and a half so my mind would remain clear, I have no history of problems following prescription medication. My mind is not clear due to severe pain. I became an RN because I respected the medical profession and wanted to be a part of it. Now if I want to practice medicine I have to work for DEA or an Insurance

Increased Access To Therapeutic Cannabis Likely To Reduce Patients' Use Of Opiates, Other Addictive Drugs

Regulating cannabis access would provide patients with an effective treatment for chronic pain and likely reduce morbidity associated with the use of prescription opiates and other pharmaceuticals, according to a review published in the Journal of Psychoactive Drugs. A researcher with the Centre for Addictions Research of British Columbia reports that cannabis may be useful in the treatment of chronic pain as well as certain substance abuse disorders, and that it poses fewer risks to health than many conventional alternatives. He writes: "When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective. Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates."

The author continues: "Since both the potential harms of pharmaceutical opiates and the relative safety of cannabis are well established, research on substitution effect suggests that cannabis may be effective in reducing the use and dependence of other substances of abuse such as illicit opiates, stimulants and alcohol. As such, there is reason to believe that a strategy aiming to maximize the therapeutic potential benefits of both cannabis and pharmaceutical cannabinoids by expanding their availability and use could potentially lead to a reduction in the prescription use of opiates, as well as other potentially dangerous pharmaceutical analgesics, licit and illicit substances, and thus a reduction in associated harms." For more on this Action item, Contact organizer Ed Julia Glick via FaceBook: Corvallis Cannabis Support Group - www.facebook.com/corvalliscanabisgroup, phone: 541-224-4039 -or- email: glicke@live.com *