Opioid Insanity

Let me begin with several presumed facts:

1) There is an opioid problem, crisis, epidemic in the United States.

2) I personally use an opioid for a pain issue I have been treating for over fifty years.

3) I have at various times in the past 5+ decades had acupuncture, acupressure, chiropractic manipulation, cortisone injections, prolo-therapy, massage and literally scores of salves, balms, lotions, tinctures, pill, capsules, powders, back braces, straps, devices including electric stimulation, both light and laser therapy. Most of these interventions have been legal according to the FDA.

4) I hold a Ph.D. degree in psychology and as such claim to have a fairly well-rounded understanding of the roles of pain, pain management and the medical establishment.

Hence, begins my story.

Last week, I had my semi-annual appointment with the pain-management physician. After consultation, he renewed my medication. The new order was transmitted to my pharmacy and I shortly received the text notification that my prescription was delayed pending a insurance review. This was expected.

Within 48 hours a new message informed me my prescription was available. When I got to the pharmacy I was asked if my insurance company has informed me of the one week limit they were willing to pay for. I had not been thusly informed. The pharmacy technician said a lot of patients were running into this new insurance edict.

I was informed that I was considered "opioid naïve" and that the insurance would only pay for 14 pills for one week. Then I would be required to see my physician again (and pay the $40 co-pay again) for another prescription.

Here is the math. I currently get 30 capsules every 6 months. The insurance company wants to pay for 14 pills every 7 days. 

In the midst of an opioid crisis (see #1 above) the insurance company believes I and my physician are not intelligent enough (see #4 above) to correctly manage my pain. The insurance company wants me to take MORE drugs than I am taking by a factor of nearly twelve times more.

Crazy? Ridiculous? Counter-intuitive . . .

But wait there's more. My pain doc also requested that before I my next visit I should take one pill the night before and one the morning of my appointment, so that I will test positive for the opioid. It seems the government needs proof that I am taking my pain meds and not selling them on the street. So once every six months, whether I need them or not on my appointment day I have to take medication to satisfy big brother.

Not one but two instances where during this 'crisis" (#1 above) a well-managed pain patient (#2 above) is required to take pain medication to satisfy medical bureaucracy. Who might a rational person ask should be making such decisions? The patient (#3 & #4 above); the patient and their physician; the insurance company; the government?

Perhaps the problem is I am just too naïve.

Prolotherapy

I've had a pain in my lower back for fifty-two years. Tried many therapeutic approaches to deal with the pain and chased dozens of potential cures. Belts, needles, pills, ointments, manipulations, machinery, prayer, anger and offerings to both light and dark deities. Then back in September I went to see a new cannabis doctor to renew my medical card. He gave me a diagnosis I had never heard before and referred to a therapy also new to me. Because I was days away from hitting the road for 3+ months, I didn't pursue this avenue until I returned last month. On December 29th, I had my first in a series of Prolotherapy treatments.

Prolotherapy involves the injection of a irritant solution into either joint space, or into a weakened ligament or tendon. Dextrose is the most common solution used with some local anesthetic and other additives. The injection is administered at joints or tendons where there is connection to bone, in my case vertebrae. In addition, I also had platelets injected into the tears and holes in the lower back/spine structures. The process involves taking blood I donate and then spin it down in a centrifuge to extract only the platelets.

Because I am having both forms of therapy my interval between treatments is eight weeks. I am not due for a second treatment until late next month. The anticipated course of treatment is based on decades of evidence. I am not and should not expect any changes that rise to the level of 'healing' until after the second treatment. So as of now I am where I have been for five decades. But with a degree of cautious hope.

I will say that extensive research prior to going under the needles leads me to believe I am in the prime category for having prolotherapy be effective. More reports will follow. My fingers, toes and vertebrae are crossed and I am doing the other work (physical therapy, aqua-aerobics and extensive walking) to compliment the treatments. Please remember me and my sacroiliac in your offerings and supplications to deities of all persuasions.

Class Action Lawsuits

I guess today's message is that common knowledge is not always quite as widespread as you might think. Fairly sure I have mused in the past about just how litigious our society has become when several firms can run national tv spots to buy out your structured settlement. I mean everybody sues everybody else for anything and everything and apparently there are tens if not hundreds of thousands of people being paid off over time on court ordered awards.

Then there are the class action lawsuits. A whole bunch of people ban together and sue one company, corporation or a whole slew of them. Sort of sanctioned gang on gang thing with everyone in suits. A legal donkey of a very different color.

I was at a party recently where a man was talking about being part of one of these classes in a legal action. In fact, he was just about to sign the papers to join the lawsuit and several other men were telling it was a lawyer's scam and he would never see any reasonable compensation. The gentleman was not interested in hearing such words and the discussion slowly degenerated in alcohol-fueled boy talk.  I had zero interest in offering up my two cents worth of knowledge and/or opinion, however later I was introduced to the gentleman's wife and she was still apologizing to anyone who had been in earshot of the earlier heated boyz quarrel.

I asked if she were comfortable with being part of the class action and she said she really didn't know enough about it. I made a recommendation to her then and I will make it to you now should you ever be in such a situation. Here it is:

I am not a John Grisham fan, if you like him read Scott Turow he's a much better author. But that is not my advice - if you are anywhere near a class action lawsuit or know someone who is then read The King of Torts by Grisham. It is an easy read and an honest indictment of the legal scam that attorneys have made of the class action lawsuit. At least you will know the species of snake you are getting into bed with.

Medical Marijuana (4): Botanical Chemistry

I am going to guess that just about everyone knows the active ingredient in marijuana is THC (tetrahydrocannabinol). That's what gets you high. But like so many other plants, chemical compounds, prescription medications, herbal remedies and drugs -- that's not all that's going on chemically when we introduce marijuana into our system.

I have already written about the two sub-species of marijuana (indica and sativa) but there are other properties to be considered. The one I want to discuss today is CBD or cannabidiol. Often the strength of pot is measured by its THC percentage but that is only one of several cannabanoids that are present in most marijuana. CBD is one of those 'others' and has some remarkable qualities including reducing what some refer to as the social isolation or 'anti-social' qualities of prolonged marijuana use. 

CBD has also been shown to be a primary factor in treating nausea, anxiety and inflammation. Even more interesting is that as some growers hybridize for more CBD, they are discovering pot that provides various medical benefits while inhibiting the typical marijuana high.

High CBD extractions have also shown early promise in lowering the aggressiveness of breast cancer cells and limiting their invasiveness. Note to dispensaries, labeling that includes CBD testing results will draw customers.

As entrepreneurial growers are given more and more incentives to produce a wider range of products, the trend towards unique blends should provide higher and higher CBD potent strains, which may provide easily stoned patients like myself the ability to gain the medical benefits of marijuana without the associated intoxication.

PRODUCT REPORT: Suckers & Hard Candy

I will preface this report with the stipulation that I am not a big hard candy guy. In addition, it is very difficult to regulate your consumption when you are sucking on a marijuana lollipop. I suppose if you want to sit at your desk and get high with a piece of candy this would work, but as a delivery vehicle for a medically titrated dose, well these suck. Also, it amazes me with all the sweet sticky sugar base used in these treats, candy makers seem unable to make them taste like anything but a vaguely disguised garden compose heap. My advice, go with cookies, pies, cakes; they easily cover the bitter green flavor of the plant, particularly the chocolate based products.

That being said - the Lolle-zing suckers can and do deliver a large dose of THC (56 mg) per pop. They are publicly unobtrusive if that is an issue for you. However, despite the alleged flavors (I tried lemon and pomegranate) they taste like old, moldy grass.

Previous posts in this series:

Medical Marijuana (1): An Inquiry

Medical Marijuana (2): The Dispensary

Medical Marijuana (3): Human Experimentation