Oregon: Chronic Pain Patients Face Medical Marijuana Trouble
Very few doctors are willing to allow opioids and marijuana together
By David Rosenfeld, The Lund Report
June 17, 2011 – Christine Mullins was diagnosed two years ago with fibromyalgia, a condition causing complete body-wide pain. The only way she’s found relief has been a regular dose of Oxycontin, an opioid prescribed by her doctor.
The medication, however, causes nausea and Mullins, 38, is allergic to every anti-nausea medication on the market. So for the past year, she’s been using medical marijuana with a prescription from another doctor to relieve the nausea and regain her appetite.
But recently her pain management doctor has said she can’t continue using marijuana if she wants to keep her opioid prescription.
"He told me they don’t recognize it because they get federal funding and that I needed to choose one or the other," Mullins said. "He said he didn't care what I used it for. It was an illicit drug and if I continued using it he would no longer fill my pain medication."
The doctor who prescribed the marijuana, meanwhile, won’t prescribe opioids. Mullins said she’s contacted 150 doctors in the Portland-area and none of them are willing to prescribe both opioids and allow her to use marijuana.
And Mullins isn't alone.
Paul Stanford, president of The Hemp and Cannabis Foundation headquartered in Oregon with clinics in 11 states, said he's received thousands of similar complaints from chronic pain patients in Oregon.
"It certainly concerns me," Stanford said. "We're trying to help our patients as much as we can. It's a major problem. It's terrible that they torture patients this way."
The issue generally surfaces for patients with severe pain who enter into a "pain contract" with their physician. As one of the stipulations, patients often must take urine tests and stay off any illegal drugs. Although medical marijuana is legal in Oregon with a state issued license, the federal government still treats it as an illegal substance. And thus lies the conflict.
So for the patients that most benefit from medical marijuana, who are perhaps the most legitimate users, they are almost entirely prohibited from using the drug in combination with pharmaceutical pain killers.
"At this point I just feel like the state of Oregon is issuing a card that’s really no good," Mullins said. "Nobody accepts it. It's putting us all in danger. If companies find out we lose our job. If our housing finds out we lose our housing. If doctors find out we lose our medical care. It’s basically a useless card that the state is making money off."
This week, the Oregon Senate approved an Oregon Health Authority budget that includes a doubling of the medical marijuana fee to patients to $200 annually. The program is estimated to raise $7 million in revenue annually that can be transferred to the general fund for other services.
In addition, the dispensaries that supply marijuana in Oregon have recently faced pressure from the U.S. Attorney in Oregon and other law enforcement agencies that their operations could be subject to prosecution. Officers subsequently raided a dispensary in Aloha.
Those who suspect the majority of Oregon’s roughly 40,000 cardholders to not be legitimate pain patients have also criticized the state program in general.
Betsy Boyd-Flynn, deputy executive director of the Oregon Medical Association, said the organization advises doctors to stay away from prescribing medical marijuana because it could endanger their medical license.
"We tell doctors to avoid it, frankly. Because of the interplay between state and federal law, there’s room for significant liability to physicians," Boyd-Flynn said. "If a patient injures someone and a physician provided the card or was involved in the process of substantiated application, they could potentially be liabile."
Kathleen Haley, executive director of the Oregon Medical Board, said there are no rules that prohibit a physician from providing both narcotics and a medical marijuana card, but it’s something a physician has to pay close attention to.
"If they violate the pain contract, the physician obviously has to take appropriate steps when they’re managing that pain," Haley said.
Stanford said he is considering turning his clinics, which currently only prescribe marijuana, into full-service medical clinics. In the meantime, he said, he may ask doctors to consider prescribing opioids in conjunction with cannabis for those patients most in need.
Stanford is also working to promote a ballot measure called the Oregon Cannabis Tax Act that could potentially raise $150 million annually.
Mullins said the current situation puts a blight on the state program.
"To me it’s sickening," Mullins said. "I’m not seeing anything medical about it. The people in the worst shape are the ones being treated the worst."