We are all aware of the epidemic of narcotic related overdoses and deaths. The rate has been increasing and there is a national movement to find alternative methods of therapy.
The patients I see that are having issues with narcotics generally fall into two groups:
- Patients with narcotic addiction, which often starts with a prescription related to an injury and becomes an addiction. The injury is now the minor issue and narcotic use/abuse has become the main issue.
- Patients with illnesses whose issues may include pain, depression and/or insomnia. They suffer from multiple symptoms where narcotic use might be reasonable, but the side effects and/or the efficacy has dwindled.
Let’s begin with the second group. In general, they have little difficulty getting off narcotics if their issues are handled with an alternative means. A typical patient may have cancer, perhaps with bony metastases who’s symptoms include anxiety, insomnia and uncontrolled pain. Often the dose of narcotics has been increased over time and the side effects have become difficult to deal with.
A patient such as this should be fully assessed and a modest dosed cannabis regimen can be determined. If the patient tolerates THC, I would include THC in the regimen. If they don’t, I would of course start with a high CBD:THC ratio medicine. This can be delivered sublingually with dosed sprays and orally with capsules. Once the patient’s side effects are controlled with cannabinoid therapy, the patients can work with their physician to titrate their narcotics until they are no longer using them. I encourage them to stay on a low dose of their opiates for some weeks until their pain has been stable and controlled and then have them stop the balance of the narcotics.
With the first group, patient withdrawal symptoms are significantly minimized with a consistent dosage of CBD:THC in the ratio best suited for each patient. In many of these cases, we find the patients also suffer from additional issues such as depression. So a key component to helping the patient is to try to identify what “feeling” the patient is craving from the narcotics and try duplicate it with various combinations of cannabinoids and terpenes. This does not work for everyone, but for the patients who reach my office, we have a solid response and success rate. We have some early statistics, but not ready for publication.
Suffice it to say, these are reasonable and rational approaches to consider.
In addition to a consistent cannabis regimen, the patient needs a support structure and motivation. This is a family issue, as all are affected. I would encourage those close to the patient to be involved with the physician meetings and help monitor the cannabis regimen.