I must assume that everyone reading this article is well aware of our country’s struggle with opioid addiction. There are a number of pharmaceutical companies, physicians, and even pharmacists that contribute to this national epidemic. The pharmaceutical companies continue to manufacture narcotics that are stronger and more addictive, while encouraging physicians to prescribe them. As narcotics can help to treat pain, depression, and other mood disorders, doctors dole out prescriptions for them much too quickly and readily, almost habitually. Finally, pharmacists in many cities receive thousands of narcotic pills to fill these prescriptions, which immediately sends up a red flag and should make them question why so many of these drugs are prescribed in such high numbers.


So, why do some patients fall into the opioid trap, while most patients never do? I honestly believe that addiction is considerably more likely in patients who struggle with an element of depression. In fact, I think most prescriptions end up being abused when the patient suffers from a combination of pain and depression, both of which are often improved by narcotics. With depression frequently linked to pain, it is reasonable to expect that a patient suffering from both will have a strong chance of developing a dependency on opioids. Often their physical pain resolves but their depression persists. In this situation, some patients may even “create” pain in order to receive pain pills.


If a physician knows for certain that a patient is in severe pain, whether clinically depressed or not, they tend to open their prescription pads and recommend narcotics relatively freely. After all, if a patient has cancer, for instance, it is common to experience acute pain and related depression. The doctor will then recommend whichever narcotics they believe are necessary in order to control the pain the patient claims they have. Often however, it is difficult for the the patient to differentiate between the pain and the mood disorder. I have rarely met a patient in severe pain who is not depressed.


With opiate addiction, depression is a very critical risk factor. When the patient receives their first pill (potentially one of many narcotics,) their pain will improve, and in turn, to a greater extent their depression improves. I speak from experience not only treating hundreds of patients in pain, but from my own personal experience as well. Twenty five years ago I had undergone back surgery, and received my very first narcotics. Almost predictably, due to my discomfort and infirmity, depression accompanied my pain. This led to a very difficult year struggling with addiction, and ultimately contributed to the loss of my marriage. In the end, although my experience was dreadful, I am one of the fortunate ones who not only survived, but because of this personal awareness, have the ability to treat numerous patients with added empathy and compassion.


As research and development progress in the science of cannabis, we’re discovering that similar effects and benefits can be achieved with some of the newer complex tincture formulations, without the addictive nature of narcotics. The combination of CBD + THC + THC-V shows great promise in the treatment of pain. Although at present THC-V is not consistently available, we are quite certain that that soon will be changing. By utilizing various ratios of these molecules, we anticipate the ability to treat pain and mood issues to a far greater degree of efficacy than ever before. We foresee THC-V to be the “anti-depressant” cannabinoid, and because CBD and THC target pain, when all are combined, they’ll make a powerful and efficacious remedy. Additionally, by adding THC-A (the raw form of THC,) it will address some anti-inflammatory issues as well.  In other words, we have every reason to believe that we will treat pain quite successfully with cannabis.  The future looks bright indeed.


So, what is the point of all of this? Why is this article about treating pain around the time of surgery?  I have had a number of patients who have come into my office for “pre-op” visits. Many were orthopedic surgeries, but there are similar stories for other types of surgeries as well.


The vast majority of my patients have either never tried cannabis, or they tried it when they were in college. Some hated it and some enjoyed it, but that was the extent of it. These patients, in general, tend to have a very low tolerance for THC, however, THC is very important in treating pain.


So, what is the solution? Many patients do very well with a blend of CBD:THC. If they cannot tolerate the psychoactivity (or “stony” feeling) they may be experiencing, we will recommend a higher degree of CBD in the formula. Over time, generally a THC sensitive patient will acclimate to this “stony” feeling, and we will then adjust the formula and/or dosage accordingly.


As an example, if the physician begins with a recommendation for a 1:1 CBD:THC ratio, it’s to be expected that most patients would be unable to tolerate the amount of THC in the formula. CBD decreases the “stony” feeling of THC, which is helpful, but it might not provide quite enough pain relief. Despite that, if the patient is going in for surgery in a few weeks and is concerned about needing narcotics post-op, starting with a 1:1 tincture just at night over the three pre-op weeks, and then slowly increasing the dosage, they will likely be able to use the 1:1 without any issues by the time of their surgery.


Then, if the 1:1 formula is still not enough to keep the patient comfortable post-op, the patient can take a few mg of a pure THC formula. Adding some THC to the regimen on occasion when the pain is severe will be a big help. Yes, it will cause some psychoactivity, but it is certainly better than enduring severe pain.


In summary, building up tolerance by taking a tincture with some THC pre-op is a simple way for patients to prepare use CBD and THC to quell their pain post-op, thereby avoiding an introduction to narcotics, which can potentially be devastating if they are struggling with depression or have a tendency towards addiction.

Allan Frankel, MD Dr Allan Frankel is one of the few physicians in the US who truly understands Cannabis as a medicine. All treatments suggested have been well studied. Every patient seen by Dr Frankel is given a personally created Treatment Plan created with the patient's specific issues defined. Plant medicine requires "tuning" of the dosing. Dr Frankel works with his patients thru a messaging portal. The use of this portal, allows quick and simple follow up contact with Dr Frankel. Patients are not charged for these messages, as this is how Dr Frankel has learned what he has learned. Follow up appointments in person or by phone/video are also available when needed

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