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Chronic pain and cannabis

Cannabis oil: A Shepparton resident has taken her life back with CBD. Photo by Rodney Braithwaite

There are two realities for chronic pain sufferers: unending pain with no cure, or a dependency on opioid painkillers. But one Shepparton resident has found relief in medical cannabis oil.

Anne Smith was diagnosed with an auto-immune disease called psoriatic arthritis about 10 years ago. It’s a chronic illness that inflames the skin and joints all over her body.

It’s a condition that causes crippling agony; but she never got used to the pain, because it was sporadic, fluctuating like the weather.

Ms Smith uses cannabis oil to cope with the pain, but due to the stigma around cannabis she didn’t want her real name published in this story.

“I was in my mid 30s, and I couldn't even walk around a shopping centre because I was in so much pain,” she said.

“So I went to my doctor, and I basically just said, `I'm not living, I'm just existing, I need something for the pain'.”

The only answer was opioids, and she started on Endone (oxycodone).

“I wasn't happy about that, but Panadol and Nurofen just don't touch the pain,” she said.

But she was still suffering from pain, even with the opioids.

“And I was still getting what they call ‘breakthrough pain’, and I was starting to see more symptoms,” Ms Smith said.

“I was just beside myself.”

In an effort to control the pain, Ms Smith was started on morphine patches. But the higher opioid dosage brought the terrifying prospect of addiction with it.

“I was petrified of becoming reliant on this medication. It is a big deal. I was petrified of becoming an addict,” she said.

Ms Smith was also sick of the side-effects of opioids. She was walking through life in a narcotic haze: dopey, lethargic, and still in pain.

She was keen to get off the opioids.

“If I'm in my mid 30s, and I'm already on morphine, what am I going to be like when I'm 50?” she said of her situation at that time.

“I could not keep going on (opioids). It would have killed me.”

The answer to her suffering was cannabidiol, known as CBD, a compound found in the cannabis plant, which is used medicinally for pain relief and the reduction of epileptic seizures.

Ms Smith had been researching CBD as an alternative medication to reduce her dependence on opioids and for coping with her chronic pain. But she was worried about the stigma that could follow her.

“People don't look twice at someone who is on Endone. They're like, ‘oh, well, that person's in pain’ — Endone would make me fall asleep!” she said.

“I was pretty much high the whole time I was on (Endone), and everyone thought that was okay.

“But because people were taking CBD oil all of a sudden, you know, they're a bad person. There's judgment there.”

General manager of Precision Pharmaceuticals and CA Connect Sara Kourkgy still sees this stigma in the medical field and across broader society toward the therapeutic use of CBD, created by decades of criminalisation and policing of marijuana use.

“A huge obstacle — why people may think (CBD) is a narcotic — is simply due to lack of education that's really available,” she said.

“Even when I talk to my friends and family, you know, they say, ‘Oh, Sara is just a drug dealer’.”

But the benefits and efficacy of CBD stood on their own merits, Ms Kourkgy said, and there were now health services that provided medicinal cannabis therapies for chronic pain.

For a start, CBD doesn’t get you high — you can even legally drive on it according to Ms Kourkgy.

“From the study surface the results speak for themselves ... even just from a pain perspective of how it's changed people's lives,” she says.

Ms Smith has seen dramatic results from her CBD treatment. The flare-ups of her psoriatic arthritis are less frequent and much less severe.

“I'm completely off all opioid-based medications. I'm not on (oxycodone), I'm not on morphine anymore, I was off that within a week of CBD oil,’’ she said.

“I have gone down on my antidepressants. I was on 200mg of my antidepressants. I'm now down to 15mg. I was on medication for anxiety, I'm off that now. And that's all from CBD oil. I've also lost 25 kilos.

“CBD has given me my life back. I take two drops of CBD oil three times a day. That's it.”

CBD: Could cannabis oil be the answer to the opioid epidemic? Photo by Rodney Braithwaite

Not everyone will have the same dramatic results as Ms Smith, but chronic illnesses that can be treated effectively with CBD include cancer (pain management), mental health disorders, epilepsy and Parkinson’s disease, endometriosis and arthritis.

And the use of CBD in treating chronic illnesses carries the added benefit of reducing opioid dependency.

“I'm a pharmacist by trade, and the amount of opioids I used to dispense, it's quite shockingly high,” Ms Kourkgy said.

Medically, CBD wasn’t designed to remove all other medication treatments, it was designed to be used alongside other medications, Ms Kourkgy said.

“Let's say you had a patient who was on really heavy opioids; what CBD aims to do is reduce the amount of opioids that the patient is taking, because it may help alleviate the pain and will help alleviate a lot of the symptoms that a patient is using an opioid for.”

Aside from reducing side-effects of opioid use, CBD can significantly reduce the risk of opioid addiction. An added bonus is that CBD isn’t habit-forming.

“There appears to be no issues with abuse and addiction, unlike opioids,” Ms Kourkgy said.

Many people don’t even have the option of taking opioid-based pain medication because they're prescribed non-compatible drugs — blood pressure medication, for example.

“That's where CBD can play a part in not only reducing — let's say — pain, but even potentially taking off those some of those heavy drugs ... which can cause some severe side-effects in the long run,” Ms Kourkgy said.

“If we lessen some of that by adding in something that's natural, and alternative as an adjunct therapy, I mean, happy days for both the patient and the doctor.”

Clinical not criminal: Chronic pain sufferers could reduce opioid consumption with CBD. Photo by Rodney Braithwaite

Accessibility and affordability

There are still many obstacles for chronic pain sufferers in accessing CBD, mostly bureaucratic and economic.

Because CBD is still “unapproved” on the Australian Register of Therapeutic Goods there is a lot of red tape.

An SAS-B form needs to be filled out, justifying whether a person is eligible for CBD treatment; and the patient’s entire medical and treatment history needs to be assessed, which means co-operation with different specialists.

“It’s not just like stoners calling up a number and they get this CBD prescription,” CBD user Anne Smith says.

“It took a week of getting all the paperwork together and filling out all these forms. And basically, they want to know everything about you — pretty much what underwear size you wear.

“It's not an easy thing; someone who's a drug addict is going to go around the corner and buy drugs from a dealer.”

It can be up to a month before a patient can pick up their prescription, according to general manager of Precision Pharmaceuticals and CA Connect Sara Kourkgy.

And because it’s unapproved on the Australian Register of Therapeutic Goods, it’s definitely not on the Pharmaceutical Benefits Scheme, which means it’s an expensive treatment.

“I have friends who have chronic pain diseases, and they just cannot afford $250 every three months, they just can't do that, especially if you've got a disease where you can't work,” Ms Kourkgy said.