Eyes Wide Open
So Much I Don’t Know
The New York Times article by Alex Berenson, “What Advocates of Legalizing Pot Don’t Want You to Know,” reminds me of Sabrina Carpenter’s song, “Eyes Wide Open,” that includes these lyrics: “Better keep my eyes wide open/There’s so much I don’t know.”
There may be “so much I don’t know” residing within everyone — even those of us who are passionate about our beliefs. Science, or the lack thereof, may not alter our opinions.
I was in college during the hippy days of the late 60s and early 70s when hallucinogens were rampant and socially accepted by the liberal sects of society. In fact, recreational drugs were a polarizing symbol of the anti-war vs. pro-war crowds.
Societal attitudes have changed. Now, the vast majority of Americans, and an even larger percentage of Canadians and Europeans, favor the legislation of marijuana even though only a small minority of people use it.
Truth Lies Between Extreme Views
Members of the scientific community and media have often demonized opioids, even if they have had to manipulate statistics or present out-of-context facts. By contrast, others often hold up marijuana as the solution to everything from opioid addiction to mental health disorders.
Some of those who oppose opioids often let their zeal to prevent harm cloud their logic. To them, anyone who suggests that an opioid may have a place as a therapeutic option is either a shill for opioid manufacturers or a legalized drug pusher.
Even doctors sometimes buy into the theory that physicians who prescribe opioids to treat pain are drug pushers. Here is a recent example. Lawrence Kelmenson, who practices psychiatry, wrote a “Mad in America” blog titled “How Doctors Became Such Prolific Drug Dealers.” In it, he claims that “There are no good intentions in dispensing daily opioids.” This psychiatrist’s presumption that physicians would be mercenaries at the expense of sick people is an affront to all physicians who have devoted their lives to helping people.
On the other hand, when people suggest that marijuana or even cannabidiol (CBD) may have adverse consequences for a subset of individuals, they are at risk of being pummeled verbally and discredited as ignorant.
The truth usually lies somewhere between the extreme views. That is probably the case with both marijuana and with opioids.
The Times article by Berenson cites a recent report that using cannabis is correlated with an increased risk of schizophrenia. This may be true but, it has been difficult to research marijuana’s effects because of its status as a schedule 1 drug. Therefore, we lack the science to determine the extent of marijuana’s efficacy and safety in different populations.
Marijuana’s Risks Are Scientifically Unclear
Of course, psychosis is only one serious, albeit uncommon, consequence of marijuana. As with an opioid or any drug, we must conduct a risk/benefit analysis of marijuana before we decide whether or not it would be appropriate for medicinal use. This needs to be done on an individual basis.
It may be that the risk is low with almost everyone, but this is not as clear scientifically as it needs to be. Granted, many of my peers used the plant in the 60s, and many of them seem to have done so with impunity. However, now, the concentration of THC in marijuana can be between 2 and 10 times higher than it was back then. Marijuana hasn’t been regulated, and the chemical composition of the street drugs is anybody’s guess.
Many people may not be aware that even the newly FDA-approved CBD product, Epidiolex, showed signs of potential liver damage in the data the manufacturer submitted to the FDA to get approval for their drug. There was only a slight signal, but it was there, nevertheless.
Why wouldn’t some people be sensitive to a high doses of a drug that is metabolized by the liver? It remains to be seen how safe marijuana and CBD are when, while legalizing them, we have placed no constraints on dose or frequency of use.
Until that data becomes available, we would all be prudent to keep our eyes wide open ’cause there is so much we don’t know.
Thank you for staying on top of these issues
As a chronic pain patient, I agree. There is a sweet spot between extremes where all CPPs get opiods & NO CPPs get opiods! There is also the same spot for marijuana. It will work for some but not for all. One of the problems I see is that even with medicinal MJ scientific control studies, you are going to have people with adverse side effects in any population or demographic. We have a ton of (non-scientific) empirical data that shows that those who don’t have severe adverse effects, will certainly “survive” the treatment – even if it doesn’t alleviate their chronic pain. The second problem that I see is that, as a patient, I would prefer that MJ not be legalized as a prescription medicine that would require regulation by our bloated, over-powering, power-qhungry government and Big Pharma. I can foresee one months worth of medicinal MJ retailing at $3-4K! As a patient with severe Crohn’s Disease, I already CANNOT afford the expensive treatments of Remicade, Stellara, or Entyvio! Medicare “covers” these meds but what they actually pay is minute. All three Rx’s average out to around $30K per year, out of my pocke. I just can’t do it! And as hard as I have tried, as many forms I have filled out, & as many phone calls I have made, I do not qualify for financial help from the drug manufacturers. You see, I am on a Federal Disabilty. However, my husband of 36 years is employed and makes a decent wage. We are also putting a child through college. She will graduate with a Masters Degee in about one year. We have payed as much as we can all along but even now have accrued almost $50K in school debt! My point is, that we are in that crappy spot (not sweet this time) where our income is too low to be able to afford the medicine I require but cannot qualify for help from the drug manufacturers. Likewise, we do not qualify for grants or even subsidized school loans. My ultimate point, is that I would prefer for MJ to be Federally legalized and allow our Capital Market to take care of regulating product quality & price. I believe the government and a Big Pharma would turn it into another $1000 Epi-pen! #BigGovernmentBad #SmallGovernmentGoog #LegalizeMarijuan
Amen! There is no place in medicine for “one size fits all”. There is more gray area than black and white! Of course the government is going to push medical maijuana because there is profit involved. Just like alcohol and tabacco right? Maybe if the government taxed opioids, it would be a whole different story? Who do they think there are being involved in anyone’s healthcare! As a disabled, chronic, intractable pain patient, my quality of life has been taken from me. My rights violated, and there is not a damn thing I or anyone else can do about it. Believe me, I’m trying!
Just legalize and tax everything. My life has been totally altered because pf Government involvement. I’m a chronic pain patient. I have been treated like a criminal and an addict I am neither. I never thought I would end up like this. There is no compassion in medicine anymore. Unless you are an illegal, a criminal or an addict you get thrown under the bus.
Again, another insightful and thought-provoking blog. Thank you Dr. Webster for continuing to put a spotlight on this medication crisis and the measures that have been taken to remove opioids from reaching the legitimate chronic pain patients that they are meant, and prescribed for, and yes Mr. Kelmenson, on a daily basis. His lack of knowledge about opioids in the treatment of chronic pain is astonishing! I also agree with Jacqueline Schneider who wrote before me about everything she said, and I too am trying to still fight for my quality of life that has now been taken from me and my family. While thankfully, my doctor is still prescribing my SAME doses of two medications that I have been taking the last 25+ years, now I can’t even get my usual RX of long-acting medication filled at any local pharmacy, and I don’t live in a small, rural area. The manufacturers aren’t shipping like they used to, and are only shipping brand name. When I finally was able to get any medication last month, it cost me $1200 for 43 pills, because I’m forced to purchase brand name only. My monthly RX is for 2x per day, or 60x month, so not even the full RX for me. Generic versions haven’t been shipped in the last 90 days and brand name is on ‘back order’ all the time. I’m sure the government has put some sort of controls on how much they can ship and where. I believe, this entire ‘opioid frenzy’ is having far more of a negative impact on the 50 million legitimate chronic pain patients in this country (according to the CDC’s own reporting in 2018), than it will have on the street drugs and overdoses. Whatever happen to personal responsibility for what one puts in their own mouth? For arguments sake, let’s say 500k people are overdosing annually (a grossly inflated number), typically by their own doing in my opinion, that leaves 40,500,000 legitimate chronic pain patients to pay the price for the minority of those who overdose. Talk about “Throwing the baby out with the dirty bath water!” I don’t need the government telling me what I can, and cannot, legitimately take for MY pain. I pray every night that brighter minds might prevail and this injustice will come to an end. Realty tells me however, that sadly, this may be just the beginning…
I was able to help hundreds of opiate refugees in Montana, 80% got off opiates using cannabis.
The stories are incredible.
So
Because I became and accidental pain doc due to massive abandonment in my state of Montana,
I tripped over this issue, but now I have the experience with several thousand patients to claim it’s benefits.
Of course, 20% could not wean off opiates ( I tried, and failure to wean is pretty easy to see- function got worse)