By Tara bannow
For as long as he was able, Jabe Couch was a runner.
For as long as he was able, Jabe Couch was a runner.
“I ran all the time,” said the 35-year-old
Bend resident. A Bend native, he considers himself an “original Bendite
to the core,” which could explain his enthusiasm for physical activity.
At 23 years old, however, Couch noticed that
toward the end of his runs, he would start stumbling. That seemed weird.
By the time he got into his doctor’s office, he had been trying to run
through a knee injury that wasn’t letting up.
An MRI scan revealed a
large region at the top of his spinal cord where the protein covering
the nerves had been damaged — attacked by Couch’s own immune system.
“There was no denying what it was,” he said.
Couch said his doctor diagnosed him with
primary progressive multiple sclerosis, a form of MS that tends to make
it even more difficult to walk or hold jobs compared with other forms of
the disease, partly because it attacks the spinal cord more than the
brain. And unlike other forms of MS, there are no medications for
primary progressive MS.
Medical marijuana patient Jabe Couch pets Tucker, his neighbors Golden
Retriever, in the front yard of his home in Deschutes River Woods. Couch
says marijuana has dramatically improved his multiple sclerosis
symptoms. Andy Tullis / The Bulletin
Couch said his doctor put him on drugs to
stop his immune response, and when those made him depressed, the doctor
prescribed antidepressants. They didn’t work. For the pain, he said his
doctor gave him Vicodin and Oxycontin, to which Couch became addicted.
Meanwhile, Couch suffered through terrible
pain in his legs and uncontrollable leg spasms. He said he even lost
control of his bladder function and had to wear an external catheter.
It hadn’t occurred to Couch to use
marijuana to ease his symptoms. At the time, he was working in the
logging industry, and a co-worker — who told Couch he was sick of
watching him struggle to walk because of his MS — handed him a joint. He
gave it a shot.
Within minutes, Couch said, the pain in his
legs went from an eight or a nine on a one-to-10 scale to a one. It
wasn’t until about a year and a half later he learned about eating
marijuana instead of smoking it.
Since then, his leg spasms have nearly
vanished, except for the really hot days, and he no longer uses the
catheter. Couch’s doctor was not available for comment.
Couch said he no longer feels constantly ill
or tired. In fact, he said, most days, he has too much energy. His wife,
standing next to Couch in their front yard in Deschutes River Woods,
rolled her eyes in agreement.
“It stopped it dead in its tracks,” Couch said of marijuana’s effect on his MS symptoms.
Couch still uses a wheelchair, but he said
he’s very active and can lift himself out of his wheelchair and into
another chair on his own.
“It saved my life, hands down,” he said.
‘We’re scientists’
Countless patients suffering from
debilitating conditions such as MS, arthritis and post-traumatic stress
disorder have made extraordinary claims about how using marijuana
reversed the course of their medical conditions and turned their lives
around for the better.
Many report marijuana relieves physical pain
better than powerful prescription opiates and even allowed them to stop
taking the medications.
But the medical research thus far has not
reached the same level of enthusiasm. In many cases, no study or doctor
can support or explain the often outlandish anecdotes about how
marijuana cured patients’ cancer or restored their vision, for example.
Even for its more common applications,
marijuana has shown only modest results. A recent scientific review of
79 studies found only moderate evidence it helps with chronic pain and
the muscle spasms that are a hallmark of MS.
And yet, the claims keep coming.
That puts doctors — who are scientists,
heavily reliant on data — in a difficult position. Do they trust the
anecdotal evidence of countless people who say marijuana saved them, or
do they go by what the scientific literature says?
The answer for most has been to avoid the
subject entirely, especially because the U.S. Drug Enforcement Agency
still considers marijuana a Schedule I controlled substance. Even in
states such as Oregon that have legalized medical and recreational
marijuana, doctors still face the threat of losing their licenses or
prescribing privileges if they’re found to have recommended marijuana to
patients.
A major point of contention among doctors,
medical marijuana users and advocates is doctors’ refusal to prescribe
opiate pain medications to patients who use marijuana.
Many doctors feel
that since both marijuana and opiates are sedatives, their combined
effects could produce severe impairment. Prescribing the drugs to
marijuana users also could expose doctors to legal liability if the
patients are injured as a result. Patients argue that using marijuana
eventually allows them to get off most or all of their opiates, but that
it can be a gradual transition.
It’s an unfortunate landscape for patients,
who often feel intimidated about discussing marijuana use with their
doctors, even if it’s their sole therapy for chronic pain or other
conditions.
Even if doctors are open to the idea, they often don’t know
enough about the drug to discuss its use.
We should not be in a position of moralizing whether people should be
using cannabis or not. We’re scientists. We should look at the facts.
— Dr. Christian Le
— Dr. Christian Le
Dr. Christian Le said he left his position as
medical director of hospitalist medicine for St. Charles Health System a
few years ago to launch Green Earth Medicine, a practice whose central
focus is helping patients obtain medical marijuana and educating them
about its use.
For much of his professional career, Le said,
he viewed marijuana skeptically, as many doctors do, until he said he
just couldn’t keep ignoring the stories about how marijuana turned
patients’ lives around.
“After a while, I said, ‘You know, it just
can’t be that there are hundreds upon hundreds of patients experiencing
the placebo effect,’” he said.
In a country where nearly half the states
allow medical marijuana, doctors have a responsibility to become
educated on the subject, Le said.
“We should not be in a position of moralizing
whether people should be using cannabis or not,” he said. “We’re
scientists. We should look at the facts.”
Le’s Oregon medical license is listed as
inactive by the Oregon Medical Board, a move Le said he made voluntarily
in late 2014 so he could focus more on managing his practice, which
includes two practicing physicians, and marijuana education and
research.
He no longer personally signs the attending
physician’s statements, which patients are required to have a physician
sign in order to participate in the Oregon Medical Marijuana Program,
and instead dedicates his time to managing his clinics and providing
education on marijuana use. Maintaining an active license is expensive,
and the drug’s federal classification restricts licensed physicians from
discussing marijuana treatment options with patients, Le said.
Dropped from meds
For nearly a dozen years, JD Schwerdtfeger
relied on a potent mix of Oxycontin, Dilaudid and morphine to keep his
pain under control. The Navy Special Forces veteran said his Veterans
Affairs doctors told him no surgery existed that could fix his severe
pain, which stemmed from nerve damage, a bad hip and back, colon
inflammation and gout, a form of arthritis. The VA declined to discuss
Schwerdtfeger’s case through a spokesman, who said privacy laws preclude
the agency from discussing patients’ medical issues.
For about eight years, Schwerdtfeger has been
a member of the Oregon Medical Marijuana Program. Marijuana helps in a
number of ways, he said. First, it gives him an appetite — something the
pain pills further diminished.
“When you’re cramping and you don’t feel
good, the last thing you want to do is eat,” he said. “Without it, I
don’t know if I would eat enough to take care of myself because I just
can’t be bothered with it.”
Post-traumatic stress disorder further
complicates the 61-year-old Salem resident’s daily life, he said. But
whenever he feels a panic attack coming on, he takes a seat and smokes
marijuana, which he said either prevents the attack or greatly lessens
its severity.
Schwerdtfeger said marijuana works so
well, it’s helped him get off most of his pain medications. Many people
who use marijuana for pain, including a handful interviewed for this
article, say it allowed them to stop using all or most of their pain
medications. Schwerdtfeger said he still takes the “bare minimum” of
morphine, but he’s been off Oxycontin and Dilaudid for at least a year.
“I don’t like taking pharmaceuticals,” he
said. “I’ve been taking them for a number of years and there are so many
side effects and other things that it’s just not worth it.”
Nonetheless, for several years Schwerdtfeger
used both therapies — marijuana and narcotic painkillers — to help him
through his days, a practice he said his VA physician permitted. That
is, until August 2013, when his usual doctor transferred to another
facility and Schwerdtfeger was assigned to a different doctor.
A month before seeing him, Schwerdtfeger said
the new doctor cut off all of his prescriptions — even his sinus
medication — and told him the only way he could get them back was to
surrender his medical marijuana card, agree to random drug tests and
attend weekly Alcoholics Anonymous meetings.
“I don’t even drink,” Schwerdtfeger said.
The VA Portland Health Care System — which
includes large medical centers in Portland and Vancouver, Washington,
and several outpatient clinics in Oregon, including in Bend — does not
have an umbrella policy that precludes its providers from prescribing
pain medications to patients who are using marijuana. Rather, they can
decide on a case-by-case basis.
Many doctors are uncomfortable allowing
patients to use both drugs, as their combined sedative effects could
lead to significant impairments. Most doctors who prescribe opiates,
especially pain specialists, make their patients sign so-called pain
agreements that include the stipulation they not use marijuana, or they
will lose their prescriptions.
Schwerdtfeger said his new doctor, whom the
VA did not make available for comment, told him that since there was no
way for her to know the strength of Schwerdtfeger’s marijuana or how
much he was using, there was the possibility he could overdose if it
were used with his other medications.
He said that shows her lack of
understanding about marijuana.
The withdrawals were unbearable,
Schwerdtfeger said, and he was sick for a month without the pain
medication he had come to depend on. In fact, that’s part of the reason
he said he doesn’t take most of them anymore: He doesn’t want a doctor
to have that much control over his well-being.
Schwerdtfeger penned a four-page letter of complaint to the VA. Within hours, he said, the problem was fixed.
“I have no criminal record of any kind,”
Schwerdtfeger wrote in his letter to the VA. “I haven’t even had a
parking ticket for more than 30 years and I am sick and tired of being
treated like a criminal because I believe in the medical benefits of
Cannabis!!!”
Fewer opiates for marijuana users?
Rules that prevent patients who use marijuana
from receiving opiates are very common, especially among doctors who
specialize in pain management.
“Usually if you tell your doctor you’re a
cannabis patient, they kick you out,” said Willy Bogoger Jr., a medical
marijuana patient for five years. “They don’t care what you’re using it
for. They don’t care what your frequency is.”
Bogoger uses marijuana to relieve chronic
pain from a number of conditions. He has avascular necrosis in his right
hip, he said, which is when bone tissue dies due to lack of blood
supply, and arthritis in both knees.
He also said he needs to have both
of his shoulders replaced — the side effect of lots of heavy lifting
while working as a contractor and a chef — plus he suffers from
post-traumatic stress disorder and anxiety.
“I’m a mess,” said the 47-year-old Tumalo resident.
Bogoger, whose doctors were unavailable for
comment, said marijuana relieves his pain, gives him an appetite
(something the pain meds took away) and puts him in a better mood.
But
since he’s been using it, doctors have refused to prescribe him pain
medication. He said doctors look at his records, which show years of
pain medications and — more recently — marijuana use, and assume he’s a
drug addict trying to get high, Bogoger said.
Many large health care providers have
blanket policies around marijuana use and opiates that all of their
providers must follow.
St. Charles Health System, for example, has a
policy that says doctors cannot prescribe opiates to patients found to
be using marijuana, either for medicinal or recreational purposes, said
Dr. Rob Ross, St. Charles’ medical director of community health
strategy. St. Charles also discourages its providers from signing the
attending physician’s statements that allow patients to use medical
marijuana, he said.
There are rare exceptions, such as cancer patients for whom no alternatives provide relief, Ross said.
“The evidence behind marijuana is not
particularity strong for many things in medicine,” Ross said, “and so
our main concern is keeping people safe.”
Ross said St. Charles is reviewing that
policy, which was put in place in fall 2013, and there is a possibility
it could be changed.
Bend Memorial Clinic, by contrast, has a
policy that requires pain management agreements between patients and
providers.
The policy does not explicitly preclude providers from
prescribing opiates to patients using marijuana, but it encourages
providers to discuss the dangers of mixing prescribed medications with
other substances, BMC spokeswoman Katy Sparks wrote in an email.
BMC does not preclude its providers from signing attending physician’s statements.
Catastrophic consequences
Kathryn Keener, a 63-year-old La Pine
resident, used to take a medley of prescription medications every day to
control the pain stemming from her sciatica, nerve pressure that causes
pain from the lower back down the legs.
“You can’t even walk; sometimes you can’t even move,” she said.
She’s been a member of the Oregon Medical
Marijuana Program since September. In less than a year, she said she’s
been able to switch to using marijuana exclusively to manage her pain
and has stopped taking any pharmaceutical pain medications.
That puts Keener among the countless chronic
pain patients, including several interviewed for this article, who say
using marijuana allowed them to get off all or most of their
pharmaceutical pain medications.
A 2011 study of about 1,600 medical
marijuana patients in California found half reported using the drug as a
substitute for prescription drugs. As of April, 93 percent of patients
on Oregon’s medical marijuana program said they used marijuana for
chronic pain.
“I’m thrilled about that, and I would think
other physicians would be stoked,” said Dr. Stephen McLennon, a
physician who went from working at a hospital in The Dalles for 25 years
to now seeing marijuana patients at Mothers Against Misuse and Abuse
(MAMA) clinics in The Dalles, Portland and Bend. “I don’t think doctors
in general like prescribing those medications because of all the
problems associated with them.”
“I’ve just been thrilled to death to not have to eat that poison,” Keener said. “It was not working.”
Cannabinoids, the chemical compounds in
marijuana that activate receptors throughout the body, share
pharmacological properties with prescription opiates. Both have sedative
effects that could increase if combined. The effects of mixing the two
aren’t completely understood in the scientific literature.
Unlike morphine, which allows a doctor to
know exactly how many milligrams a patient is getting, doctors can’t
know exactly how much marijuana a patient is getting, said Dr. Andrei
Sdrulla, an assistant professor of anesthesiology and perioperative
medicine in Oregon Health & Science University’s School of Medicine.
“There is a concern they’re going to be
overly sedated and it’s going to potentially have catastrophic
consequences if you add more sedating medications,” he said.
There is a concern they’re going to be overly sedated and it’s going
to potentially have catastrophic consequences if you add more sedating
medications.
— Dr. Andrei Sdrulla, assistant professor at OHSU
— Dr. Andrei Sdrulla, assistant professor at OHSU
Several documents on the Oregon Medical
Board’s website designed for doctors involved in pain control explicitly
advise against prescribing opiates to patients using marijuana,
including OHSU’s guidelines for safe opioid prescribing, and similar
guidelines from the Oregon Medical Group. State law says doctors must
maintain written documentation of their discussions with patients about
the goals of their opiate use.
All of this, coupled with the federal
criminalization of marijuana, contributes to a wealth of reasons to fear
the drug if you’re a doctor.
Much of the fear stems from examples of
state medical boards fining and punishing doctors who are found to have
prescribed opiates to patients who use marijuana, especially if those
patients were driving while impaired or overdosed, said Dr. Lynn
Webster, past president of the American Academy of Pain Medicine and
currently a pain medicine researcher in Salt Lake City. Doctors have
also been sued, he said.
“It is the acts that have occurred in front
of medical boards and mostly in courts that have been heard by
physicians, and that has created the chilling effect,” he said.
For his part, Webster advocates for
reclassifying cannabinoids as Schedule II drugs, which have a slightly
lower potential for abuse than Schedule I drugs and are recognized as
having some medical value.
The DEA, which requires physicians to
register in order to prescribe controlled substances such as opiates,
could revoke doctors’ prescribing privileges, said Kathleen Haley,
executive director of the Oregon Medical Board.
That said, no law in Oregon precludes doctors from prescribing opiates to patients using marijuana.
“There is no law about it, but it is, I think, the wisdom of those who practice in the field that it is not advised,” she said.
Docs in the dark
Laura Borgelt never expected to become the University of Colorado-Denver’s go-to marijuana expert.
The professor of clinical pharmacy and
family medicine has served on six recreational and medical marijuana
task forces in her state, studying and crafting guidelines around things
like pregnancy and breastfeeding, dosing and labeling. (Recreational
use became legal in Colorado in 2012, while medicinal use has been legal
since 2001.)
It all started roughly seven years ago. A
medical resident at the university was describing to Borgelt her
conversation with a patient, a breastfeeding mother. The patient told
the resident she smoked a joint per day, which the resident responded
was “probably completely fine,” Borgelt recalls.
“As I was listening to her talk about this
patient, in my own mind, I thought, ‘I don’t think that’s right, but I’m
not certain it’s wrong,’” she said. “It just kind of created this
concept of, ‘I’ve got to learn the answer.’”
The answer, observational research has since
shown, is the psychoactive effects of tetrahydrocannabinol (THC) in
marijuana could negatively impact the developing brain, Borgelt said.
The connection still isn’t well understood — and it would be unethical
to study, given the drug’s potential harms — so Borgelt helped draft
guidance for doctors and patients that advises against marijuana use
during pregnancy and breastfeeding.
Still, Borgelt says, doctors in Colorado
continue to see patients who use marijuana while pregnant, often to help
with nausea or vomiting.
“There are women who believe that it is a natural and/or safe option for them,” she said.
Now that Colorado’s laws opened the
floodgates for more marijuana use, the state has convened a number of
task forces to try to get ahead of potential public health issues that
could arise. For example, the state has seen an increase in children
consuming edible marijuana products disguised as typical candies or
baked goods, which the state has tried to remedy by enforcing new
labeling rules.
Health leaders in Oregon are trying to identify similar issues here and prepare for them as best they can.
But even as officials work to educate the
public about marijuana, most doctors know very little about the drug,
even while their own patients rely on it as their primary therapy for
conditions such as chronic pain, multiple sclerosis or depression.
Some of the lack of knowledge can be
explained by the lack of solid research supporting marijuana’s medicinal
value.
Its classification as a Schedule I drug makes it very difficult
to study, as Webster, with the American Academy of Pain Medicine,
learned when he tried to get DEA permission to do so. The DEA must
inspect the study site and protocol, a process that can take up to a
year and cost tens of thousands of dollars, he said.
We still have a lot of gaps that need to be filled. I think that puts
doctors in difficult positions because they want to be able to provide
information to their patients that they know is correct and accurate.
— Laura Borgelt, professor at University of Colorado Denver
In many cases, much of doctors’ dealings with
patients who use marijuana are based on their personal opinions about
marijuana, given that the evidence around its use is inconclusive,
Borgelt said.
“We still have a lot of gaps that need to be
filled,” she said. “I think that puts doctors in difficult positions
because they want to be able to provide information to their patients
that they know is correct and accurate.”
The research that has been done hasn’t yielded clear answers.
A systematic review of 79 medical marijuana
studies published in the Journal of the American Medical Association in
June found moderate evidence supports the drug’s use to treat chronic
pain and the muscle spasms and stiffness common in multiple sclerosis.
Of lower quality, the study found, was the evidence to suggest the drug
helps with nausea, vomiting, weight gain (such as for those with HIV
infection), sleep disorders and Tourette syndrome.
In response to the study, two Yale
University physicians not involved in the research, Deepak Cyril D’Souza
and Mohini Ranganathan, penned an editorial asking whether medical
marijuana laws put the cart before the horse by allowing for widespread
use before its medical benefits are fully established. The physicians
also highlighted the unknown effects of the more than 400 compounds,
including flavinoids and terpinoids and about 70 cannabinoids, found in
marijuana.
Sdrulla, of OHSU, said other studies have
also found no benefit. He has a skeptical perspective on marijuana use
among his pain patients.
“If it’s working so well, then why does the
patient still have a lot of pain?” he said. “From my perspective as a
pain physician, I don’t feel like the marijuana works well for most
types of pain.”
VA lets its docs decide
The VA Portland Health Care System does not
have a policy that precludes its physicians from prescribing opiate pain
medications to patients who are using marijuana. All patients
prescribed the drugs, however, are drug-tested. If patients are found to
be using marijuana, doctors could choose to stop prescribing pain
medications, but that’s determined on a case-by-case basis, said Dr.
David Coultas, chief of staff for the Portland VA system.
“I think it would be potentially very
disruptive to the doctor-patient relationship to just have a blanket
statement and to tell doctors how they need to practice,” he said.
Some research has found people who use
marijuana recreationally are more likely to abuse other drugs and use
pain medications prescribed to someone else. Nearly half of patients who
used marijuana recreationally also used other nonprescribed drugs, most
commonly pain medications and sedatives, compared with one-third
non-marijuana users, according to a 2013 report by Quest Diagnostics, a
company that provides lab testing and other services.
Coultas said he thinks it’s unfair to assume
patients who use marijuana are abusing their pain medications, but he
believes that’s where blanket policies that preclude allowing patients
to use both come from.
Several people interviewed agreed with Coultas that such policies do more harm than good.
Borgelt, of UC Denver, said some larger
hospitals and health systems in Colorado that have such policies are now
reconsidering them.
She said she is a firm believer in the power of
shared decision-making between patients and providers, wherein doctors
and patients work collaboratively toward health goals, rather than
doctors telling patients what to do.
“If a patient knows they’re going to get in
trouble if they admit this, I guess it really creates a bind for that
open communication to occur,” she said.
And while it’s true both marijuana and
opioid pain medications have sedative effects, it’s possible there is a
safe space for patients who use marijuana in the context of the
medications, Borgelt said. In fact, some of the patients she and her
colleagues have seen have been able to use fewer opiates because of
using marijuana, she said.
Several patients interviewed for this
article said they were able to get off of all or most of their pain
medications after they started using marijuana, a sentiment echoed by a
handful of providers who specialize in certifying patients through
Oregon’s medical marijuana program.
States with medical marijuana laws have
nearly 25 percent fewer opioid deaths on average compared with those
without such laws, according to a 2014 study in JAMA Internal Medicine.
The rates of overdose deaths generally decreased over time, the study
found.
Dr. Marcus Bachhuber, the study’s lead
author and a fellow at the Robert Wood Johnson Foundation Clinical
Scholars Program at the University of Pennsylvania, said it could be the
fewer opioid deaths are partly the result of patients supplementing
their opioid use with marijuana, and therefore using fewer opioids.
Other small studies have found people use fewer opioids when also using
marijuana, he said.
Policies that preclude patients from using
both make people feel uncomfortable talking to their doctors about
marijuana use, even if it’s important to them, Bachhuber said.
“I think a lot of doctors don’t create an
environment where patients feel like it’s a safe space to talk about
these issues,” he said, “and it’s not just drugs; it’s other things as
well.”
My sense is that as it becomes legal in the state of Oregon, the
medical community will start addressing it at more of a state level or
maybe even a national level.
— Dr. Andrei Sdrulla, assistant professor at OHSU
— Dr. Andrei Sdrulla, assistant professor at OHSU
‘Paperwork for money’
Now that recreational marijuana use is legal
in Oregon, Sdrulla said its increased use could push the medical
profession to address fundamental questions about the drug that are
currently going unanswered.
Sdrulla said he’d like to see national
evidence-based guidelines developed around how to talk to patients about
marijuana use and address safety issues.
“My sense is that as it becomes legal in the
state of Oregon, the medical community will start addressing it at more
of a state level or maybe even a national level,” he said.
Webster, of the American Academy of Pain
Medicine, said he thinks, if anything, recreational legalization will
only add to the fear among doctors of more scrutiny of their businesses,
especially pain specialists.
Several pain specialists in Bend, including
doctors at Bend Memorial Clinic, The Center Orthopedic &
Neurosurgical Care & Research and Bend Spine & Pain Specialists,
declined requests for comment. Webster said that’s not surprising, as
they’re caught between a rock and a hard place when it comes to
marijuana. On one hand, they’re concerned about federal government
scrutiny if they appear too supportive of its use, while they also could
be subject to loud criticism from marijuana users and advocates if they
come out as being opposed to its use, he said.
Perhaps the best public statement they can make, Webster said, is simply to “be silent.”
Some medical marijuana advocates have also
expressed concern the legalization of recreational use could dissolve
the medical sector, which Le, of Green Earth Medicine, said has
significant flaws but is also necessary.
As much as he advocates for the use of
marijuana for medicinal purposes, Le voted against the legalization of
recreational use in Oregon. That’s because he believes there are major
problems with the medical marijuana industry that must be solved.
For one, because so many primary care
physicians refuse to sign patients’ approval documents for Oregon’s
medical marijuana program, patients are forced to see doctors who
specialize in medical marijuana approvals. That means relatively few
doctors in Oregon sign hundreds of approvals for the medical marijuana
program, and they tend to work out of what Le calls “signature mills.”
These doctors might have between five and seven minutes to sign the
paperwork for each patient, which means they’re probably not doing much
to assess patients’ needs or educate them on its use, he said.
Le learned this from briefly working at one such clinic himself before surrendering his license.
“It was barely enough time for me to review
records and fill paperwork out, so there was obviously no interaction
between doctor and patient, no relationship like that,” he said. “I
realized after a few months of doing work with them that, ‘OK, this is
not a legitimate clinic. This is paperwork for money.’”
In Le’s practice, some patients only want a
doctor to sign the documents that allow them to use medical marijuana.
Others want more explanation around how to use the drug for their
specific ailments, he said.
Le said he is mainly worried if doctors
aren’t sharing important information with new users and following up
with them periodically, they’ll wind up with strains that won’t help
them. Most of what’s sold in dispensaries is high-THC strains.
“My concern is that many of those patients
who would normally be sitting here to get that information from me are
not going to come here; they’re just going to go to a dispensary and
assume that the kid behind the counter is just going to give them some
weed and that’s going to treat their cancer,” he said.
“They’re just
going to go home and smoke pot, get high — maybe get too high — get
freaked out and never touch the stuff again.”
‘They don’t want to get high’
Bogoger, the medical marijuana patient,
wants to dispel the “Cheech and Chong” stereotype about marijuana users:
that they’re lazy stoners who wear tie-dyed shirts, play video games
and eat Ding Dongs.
“That generation of pothead is gone,” he said. “The ’70s are gone.”
It’s not just the way marijuana users look
that’s changed; it’s how they use the drug, Bogoger said. People using
medical marijuana for chronic pain, as he is, generally are not trying
to get high. They tend to use strains that are higher in cannabidiol, or
CBD, the cannabinoid in the drug that doesn’t produce a high, but that
many believe has therapeutic properties. The other main cannabinoid in
marijuana is tetrahydrocannabinol, or THC, which produces most of the
drug’s psychoactive effects. Bogoger said he prefers a strain that’s
more than 11 percent CBD, which is a high proportion of CBD.
Willy Bogoger Jr. holds a plate filled with different types of marijuana at his home in Tumalo. Andy Tullis / The Bulletin
Le said he’s constantly disputing
assertions from friends and colleagues that medical marijuana patients
are just trying to get high.
“They have stacks of medical records,” he
said. “Look at the number of surgeries they’ve had, the number of drugs
their doctors have put them on, and then look at how they respond to
cannabis.”
It’s also a misconception that most medical
patients are smoking marijuana, Le said. The most effective way to
ingest marijuana for medicinal use is orally, through liquid tinctures
or oils, he said.
Couch, for example, said he uses a form of
oil produced from marijuana extract that’s high in CBDs. His daily
regimen includes getting up at 5 a.m. and, shortly after, collecting the
residue from vaporized marijuana into a tea bag, adding turmeric and
cinnamon, and letting the mixture seep into his coffee. He also bakes
marijuana into cookies and desserts, but only eats them after 4 p.m.,
once he’s ready to relax.
“People who are smoking pot and calling it medicine need to take a long look at what they’re doing,” he said.
Sandee Burbank heads Mothers Against Misuse
and Abuse, a provider that operates several clinics in Oregon, including
one in Bend, that help patients access marijuana and teaches them to
use it safely and effectively. The clinics distribute pamphlets with
information on how marijuana interacts with other drugs, its different
forms, how long it takes for the effects to set in and how long the
effects last. An entire page is dedicated to trying marijuana for the
first time.
When medical marijuana first was legalized,
she said, everyone thought they were limited to smoking it or eating it.
Now, she said, there are tinctures that can be taken orally or rubbed
on the skin. Patients who use the tinctures don’t get the same high
effect as they would if they smoked marijuana, Burbank said. That’s
attractive to many of her clinics’ patients, whose average age is 58.
“They don’t want to get high,” she said.
“They’re here to see us because most of them have access to all kinds of
drugs, and the side effects are so severe, and they just want to get
relief without having those side effects.”
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