Drs. object to patient’s medical marijuana use

David Shephard, 51, The Dalles, can no longer get treatment at Columbia Pain Management after failing a drug test for smoking medical marijuana. Photo by Derek Wiley.

By Derek Wiley

#Medical marijuana has been legal in Oregon since 1998 and recreational marijuana is now on sale at dispensaries throughout the state.

#But the U.S. Food and Drug Administration does not approve cannabis to treat any medical condition and it remains classified as a Schedule I drug by the FDA, which has resulted in many doctors, including some at Mid-Columbia Medical Center and Columbia Pain Management in The Dalles, not allowing patients to take marijuana and still get treatment. 

#David Shepard found that out the hard way.

#From morphine to Vicodin to Oxycodone to Percocet to Dilaudid Shephard has been on some type of medication for more than 30 years to deal with ongoing back pain. 

#Shephard’s had five back surgeries and his neck is supported by a metal plate.

#He’s not positive where the pain originated.

#“I played the tuba in the marching band, maybe that caused some of it,” Shephard said.

#But he does know where some of it comes from.

#In 1996, Shephard’s car was at a stop sign when he was hit from behind and slammed into the back of a pickup truck. Doctors removed three discs from his neck and Shephard couldn’t work for a year.

#Overall, he was able to be in law enforcement for over 30 years but the pain never went away and ultimately it became too much and he retired in 2007 to move back to The Dalles where he was born.

#Shephard began getting treatment at Family Medicine at Columbia Hills.

#In 2009, he also got aid from an Oregon Health and Science University doctor who prescribed Shephard with marijuana to help with pain and nausea.

#Last November while spending nine days in Legacy Emanuel Medical Center due to an inflamed liver, Shephard said his pain pills were stolen from a friend’s house in Portland. 

#When he went to Columbia Hills to get more and requested that they increase his dosage after a fall in the shower, he was referred to Columbia Pain Management in February.

#Shephard knew CPM’s policy, which states “The use of non-prescribed or illegal substances including marijuana is not permissible,” but signed the contract anyway.

#“I was honest with them and said I was going to quit but I couldn’t do it,” Shephard said. “Marijuana helps me. It helps me clean my house. It helps me do things for my sister, helps me work with wood, helps me do things where otherwise I’d be lying in bed getting ready to die.”

#In August, Shephard failed a drug test at Columbia Pain Management.

#According to records provided by Shephard, Columbia Pain Management stated, “We discussed the patient’s continued cannabis use, the Material Risk Notice and opioid risk video, which is clear about not mixing these therapies. We can facilitate his transition to a provider who would feel comfortable prescribing both of these, but CPM will not.”

#Shephard’s physician at Columbia Pain Management, Dr. David Russo, wrote a guest column on his views of medical marijuana for the Portland Business Journal.

#He wrote, “There is some scientific evidence suggesting that marijuana, or its components, may be an effective treatment for some forms of chronic pain and neuropathic pain… Even if the treatment effects are small, any benefit in quality of life for patients suffering from these conditions would be welcomed.” 

#In the column, Russo also pointed out the risks that come with smoking marijuana—increased heart rate, breathing problems and addiction. 

#He also noted that using both marijuana and opiates has not been well studied so he wasn’t sure it was safe. 

#Russo added, “It is the ethical basis of my medical practice that the objective of any physician should be to help the patient find health. 

#“Today, I’m not certain that recommending regular marijuana use will help my patients meet their functional goals and find the better health we all seek.”

#He ended the column with, “Oregon’s voters and legislators have elected to embark on a large-scale experiment in marijuana decriminalization. But when it comes to counseling patients on benefits versus risks of regular marijuana use, Oregon’s physicians should abide by their profession’s enduring ethical commitment to ‘First do no harm.’ There are some things no new law or election can change.”

#Sandee Burbank, the executive director of Mothers Against Misuse and Abuse, which has medical marijuana clinics in The Dalles, Portland and Bend, said Shephard’s story isn’t uncommon.

#“It’s definitely a huge problem and we’re seeing it more and more,” she said of doctors not allowing their patients to use marijuana. “It’s nothing new and it happens everywhere. They will put patients in harm’s way because of a prejudice towards cannabis. It’s just bigotry based on ignorance.”

#Dick Baltus, spokesperson for MCMC, said the hospital has “quite a few of those contracts” because “Marijuana is still a Schedule I drug and that’s what we’ve been going on.”

#Columbia Pain Management gave Shephard a month to find another doctor. But in that time, his gallbladder flared up. With complications during surgery, Shephard spent another eight days in the hospital. 

#After he got out, Shephard was able to get an appointment at a medical practice in Portland for Friday, Oct. 2, but his pain medication, which included Dilaudid and a Fentanyl patch ran out on Sept. 24.

#That same day, Shephard received a letter to inform him that CPM found it “necessary to cease providing your medical care. All appointments from this date forward have been canceled.”

#Needing just enough medicine to last until his appointment in Portland, Shephard went back to Columbia Hills but instead of pills was given information on drug treatment programs. 

#Shephard’s instructions from the Columbia Hills doctor stated, “I explained I am not responsible for those particular meds anymore and thus do not feel comfortable managing a taper or intermittent supply. 

I recommended he contact the pain clinic or better yet, self-check into a drug rehab where the withdrawal can be monitored and medications to help given. Of note, I highly recommend he discontinue marijuana. 

#“It has caused multiple stomach issues in the past, which seem to be reoccurring.”

#Shephard disagreed that the marijuana upset his stomach and said, “I’ve never abused [opiates]. I’ve always taken what it says but I’ve had to take it all of my life.”

#Off pain medication for the first time in more than 30 years, Shephard has gone through withdrawal symptoms that include shaking, sweatiness and nausea. 

#“I don’t understand how they can let someone go through withdrawals like this,” Shephard said. “I don’t have a doctor here because I smoke marijuana. They will not admit that it’s used for medical. I shouldn’t have to travel 100 miles to get a doctor because I smoke marijuana. It’s just ridiculous.”