Treating Pain with Medical Cannabis as an Alternative to Opioids

 

This is the transcript for the above video, in which Matthew Wilson interviews Dr. Andrew Medvedovsky about medical marijuana and cannabis as alternative medicines for treating chronic pain instead of opioids…

Matthew: Hello everyone. We are here with Dr. Andrew Medvedovsky, and he is going to take us through a new area of medicine today, that I think some of you may already be familiar with. The doctor is a board certified expert in both the field of neurology and pain management, but the doctor has branched off into a new area of pain management, and Dr., if you could just introduce our audience to the nature of your practice.

Andrew: Thank you, Matt Wilson, for having me here. So I’m a neurologist and a pain management special. My new adventure started a couple years ago when I decided to explore medical cannabis as an option for my patients, that lead to a new career, new direction for me. And currently I operate four clinics, which are called New Jersey Alternative Medicine, and we focus on medical cannabis, patient consultations and education.

Matthew: Now before you went into medical cannabis, you had a traditional pain management practice.

Andrew: Correct. I was part of a traditional pain management practice, which I’m still part of a practice independently of the medical cannabis.

Matthew: So let me start off with a question that’s on most people’s minds. Which is why cannabis, what is the basis for cannabis as an alternative treatment approach for pain management in lieu of opiods?

Andrew: Okay. It’s funny that we use cannabis as alternative medicine, it’s probably the oldest medicine in existence. It’s been used for thousands of years to teat every ailment from headaches, to pain, to cancer, to skin conditions.

Matthew: And what is it about cannabis that makes it an appropriate alternative?

Andrew: Cannabis is a plant that contains many phytocannabinoids, which are compounds that our body makes. Our body has an endocannabinoid system which we are learning more about each day. And the system is involved in every aspect of our daily living, from balance to pain control to motor activities, to development, to immune functions. So by using cannabis, we’re not taking anything foreign, we’re actually taking in a natural compound that our body produces and needs for various ailments.

Matthew: So explain to the audience, in particularly our judges, as to why they should consider cannabis as a reasonable and necessary medical alternative to the use of opiods. What’s the benefit?

Andrew: So in order to really understand the benefits of medical cannabis, we have to look at really how both work independently. Opiods are synthetic medications that are used for pain. When someone takes an opiod, they are targeting the opiate receptors. Over time, what happens, the natural production of endorphins is suppressed, the person will become dependent on the ongoing supply of outside opiods, and over time there’s dependency. There will be potential for addiction and also side effects.

Matthew: And how is cannabis different?

Andrew: Cannabis is a natural plant. Our bodies make these endocannabinoids, so by using cannabis, you’re essentially supplying natural compounds.

Matthew: And what kind of medical benefit or what kind of medical conditions respond to the use of cannabis?

Andrew: There are over 100 conditions that we know will respond to cannabis, but since we’re talking about chronic pain and this current time, I want to focus on that. When we look at chronic pain patients, most of the time chronic pain is not the only problem. With chronic pain comes anxiety, insomnia, opiod side effects, frustration, stress. And many patients end up being on multiple medications for sleep, for anxiety. The opiods will call constipation, essentially, they’ll need to be on a constipation medication. And over time, you have patients who are on five, six, seven medications. And over time, that’s a major burden on their health, on their bodies, and financially.

Matthew: So we do frequently see there where our patients are using opiods, our clients are also taking a benzodiazapine at night to sleep. They’re taking an anti-depressant or an anti-anxiety drug, or maybe taking a pain receptor drug like a Neurontin. How does cannabis play a role in replacing that collection?

Andrew: When we look at the pharmaceuticals that you mentioned, especially opiods and the benzodiazapines have a synergistic effect to suppress respiration. It’s very dangerous. And they’re also habit forming, and they can result in withdrawal symptoms and addiction. Cannabis can help with sleep, with anxiety, with pain, with energy. Replacing, essentially, multiple medications, which will help the patients feel better, less burdened of poly-pharmacy, and less risk of side effects.

Matthew: So help us understand how you take an opiod patient and help them convert to alternative medicine or cannabis? What are the steps you go through?

Andrew: So the most important step is for the patient to understand the value of cannabis, and how cannabis can be a tool in their well being and the treatment. If, for example, someone is with chronic back pain and they’re insomnia and spasms, and multiple medications, I would recommend starting with night time use of cannabis to help with the sleep regulation. To help them get…

Matthew: Nighttime. Nighttime first.

Andrew: Nighttime first. It’s safe, they’re not driving, they’re home, they’re not worried about going out of the house, and they’ll be able to appreciate immediate benefits of better sleep. Better sleep means better energy, more activity throughout the daytime, and an ability to reduce their nighttime opiod doses.

Matthew: Now most of these patients come to you already in a treatment protocol that includes a range of traditional drugs.

Andrew: Yes.

Matthew: Is this an alternative that is just an immediate switch? What’s the process?

Andrew: It’s not. It takes education, understanding, and it takes follow up. Patients need to be guided on how to best wean off of opiods. I always recommend let’s start at nighttime and reduce the benzodiazapines first. If we can get the sleep to be better, patients feel better. They don’t need as much medicine, and they’re able to reduce the nighttime pain pill. Once they reduce that, I tell them let’s get you on a regiment to start using cannabis in the daytime. It could be a topical, it could be a daytime strain. And they feel their pain is better managed, and then it would begin to prolong the interdose duration, we’ll begin to reduce the doses of their breakthrough medications. And over time we see a significant reduction in medications, not just opiods.

Matthew: Now is there an expectation that cannabis therapy becomes a complete substitute for all traditional medicines?

Andrew: No. I look at cannabis as a valuable tool. It’s part of a comprehensive treatment plan. Maybe patients who are on cannabis still report small or lower doses of opiods for times when they travel out of the state. When they have to attend some function or just the flexibility of taking a medication. We also know that opiods and cannabis are synergistic together. Cannabis…

Matthew: When you say synergistic together, what do you mean? How do they work together?

Andrew: Well opiods work on the opiate receptors, and cannabis works on different receptors in our brain, spinal cord, throughout the body. And both have pain and [inaudible 00:08:07] properties. So by combining an opiod and cannabis in low doses, you’re targeting pain control through different pathways.

Matthew: Now a significant portion of audience either is representing the insurance industry or a part of the insurance industry. Give them your best argument as to why cannabis is a cost-effective and reasonable alternative to paying for opiods.

Andrew: When we look at many pain patients, the typical treatment plan, most pain patients who are chronic opiods have a monthly doctor visit, which in our cases would include a urine drug test. Some ancillary services, doctor visits, and medications. The cost of pharmaceuticals are extremely expensive, and you have the cost of a urine drug test, which can be close to $1,000, maybe a little bit more, maybe a little bit less. And then injections and the ongoing services. It’s extremely expensive.

Matthew: So let’s talk about the average cannabis patient. The monthly cost of the purchasing of either, well, we’ll go into this in a second, but the average monthly cost is what?

Andrew: Average monthly cost for cannabis patients, I would say, is around $200, a little bit less than $200.

Matthew: And how does that compare to the average opiod patient?

Andrew: It’s not even close. Average opiod, long acting medication, I would assume on average probably cost over $1,000.

Matthew: So help me dispel a myth, because the image here is that my clients are sitting around at home firing up a joint and that’s the treatment. Is that an accurate characterization?

Andrew: It’s not, and that’s the biggest misconception. Cannabis comes in various forms. We discourage patients from smoking, so first thing we tell them, please, do not smoke cannabis. There are various forms, including lozenges, topicals, oils, various strains that could be vaporized. And in my practice, we have classes, patients are educated on the safest use of cannabis, patients oftentimes combine various forms. They might use an edible or a lozenge at night time for a longer relief, they may use a vaporizer for daytime, breakthrough pain for a daytime strain, to really focus on the pain relief properties and not effect their ability to function and their cognition.

Matthew: You also began to educate me when we were talking before about the different organic components, and that THC, which is the part we all associate with a cognitive or psychological effect, isn’t the only effective component in cannabis.

Andrew: It’s not. Cannabis flower, in the actual form, has over 100 cannabinoids, phytocannabinoids. We know really of about five of them, the main ones are THC and the CBD. THC is associated…

Matthew: C…

Andrew: BD.

Matthew: CBD.

Andrew: Cannabidiol.

Matthew: And what is CBD?

Andrew: CBD is one of the major cannibinoids, which has significant anti-inflammatory properties. THC is the most well-known, well-recognized cannabinoid, which binds to the CB1 receptor, which is responsible for the psychoactive effect.

Matthew: That’s the, quote, getting stoned part?

Andrew: Exactly.

Matthew: I just had to add that.

Andrew: Of course. I often tell my patients who come in and tell me, “I don’t want to be high.” I ask them, “What does high mean? What does it mean to be high?” I explain to them that if you’re really depressed and you’re miserable, and you’re in pain, and you’re happy and elevated, that’s a good thing. High essentially means you’re going to be in a better mood, you’re happier. So when you go to a doctor, and you’re getting a anti-depressant because you’re depressed, essentially it’s making you high, it’s making you happier. So I think it’s the concept of you’re gonna be stoned smoking a joint on the couch, high laughing. It’s not really the way, really medicinal cannabis works.

Matthew: And the CBD doesn’t result in a quote, highness, correct?

Andrew: Correct. CBD is primarily for pain, inflammation, and effect of body.

Matthew: So is there a blend or balance that you use?

Andrew: There is. You know, the most important factors that define a strain, for it’s ability to treat various elements, is the combination of CBD and THC, and now they’re cannabinoids. The natural plant is very unique. It contains terpenes, which are oils, compounds, flavonoids, which all interact together to be able to have this effect. They’re called entourage effect, it’s like an orchestra. Every instrument by itself sounds nice, but when you combine all the instruments in synchrony, it’s even better.

Matthew: So when is the right time for me to refer a patient to you to explore cannabis as an alternative?

Andrew: I think that when a patient is in treatment, and they are suffering with chronic pain and insomnia and anxiety, their treatment leads to pharmaceutical management, which doctors believe will be a long term plan. It’s not going to be acute pain, a week of pain medications and you’re done. If they’re leading toward a long term pharmaceutical management, it’s a good idea to consider cannabis as a viable option because I’m taking a lot of patients who are already on five, six, pharmaceutical medications. Then we’re working backwards, I’m weaning them off. So if we were able to offer this patients earlier in their treatment, I think it would really minimize their risk of poly…

Matthew: So give our audience an idea of how effective cannabis can be at reducing the use of multiple other medications, including opiates. What kind of success have you seen?

Andrew: Based on my patients, and the data we collected, I can say that about 75 to 80% of patients who are on cannabis for chronic pain are able to reduce their opiate usage.

Matthew: How significantly?

Andrew: I would say 50% of patients reduced it by at least half. And I would say 70% of patients are on some lower forms of cannabis.

Matthew: So ultimately the net result of this should be reduction of opiod use, but not potentially complete elimination of it?

Andrew: That’s the goal.