Case 1
Even after typical cancer treatments (ex: chemotherapy, radiation therapy, and immunotherapy) have eradicated the disease and patients become cancer-free, pain can be a significant burden and can impact one’s quality of life. One particular patient stands out in my practice. Luis is a 54-year-old man who has survived Multiple Myeloma, a cancer of the bone marrow. Bone pain is a very common symptom in this cancer, as this cancer can destroy bones throughout the body, and can be quite difficult to manage effectively. Luis came to me years after his cancer treatments had concluded and he was in remission, but with continued crippling back pain.
Luis had been treated for years with an Oxycodone-based regimen for pain control. Oxycodone is an opiate medication similar to morphine. Despite its short-term effectiveness at controlling pain, long-term use of Oxycodone (and other similar drugs) exposes patients to significant risks. This is especially true as the medication progressively loses its effectiveness and patients require increasing dosages to maintain a similar effect, a concept known as tolerance. As doses increase to maintain a therapeutic effect, the risk of side effects increases significantly.
When Luis came to see me, his suffering was evident. He suffered not only from the constant and uncontrolled pain but also from a feeling of helplessness he experienced from depending on a prescribed substance. As his dosing requirements increased, Luis found himself trying to find a new doctor every month to obtain a prescription for a treatment that was not significantly improving his quality of life and was taking away his dignity. At this point, the prescription of medical marijuana was legal in our state, with chronic pain a qualifying condition. As we started to work together, we decided to try medical marijuana.
Luis was started on the following regimen: an oral form of equal parts CBD and THC, to be taken every day twice per day, as well as a high-THC/low-CBD inhaled formulation to be used up to four times per day for breakthrough pain. His previous opiate-based regimen was changed to a long-acting formulation to make down-titration easier. He was encouraged to resume physical therapy as well.
Over the next few months, his opioid requirements were quickly cut by a third and were eventually discontinued by the end of the third month of his treatment with medical marijuana. Since then, he has used marijuana intermittently with good effect for pain control.
Take Home Messages
This case demonstrates how the appropriate use of medical marijuana can effectively manage chronic pain in cancer survivors and help to detoxify from chronic opioid regimens. Furthermore, for those who have social hardship as the result of opioid regimens, medical marijuana can help regain dignity through effective, non-opioid pain management.
The names on this reported case have been changed in order to protect patient confidentiality.
Stay tuned for two more cases!
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