The Opioid Crisis Solution

Share this post

Pot. Almost 50% of the patients in my practice recently used marijuana to reduce their post-op pain. I didn’t prescribe it; the word just seems to be out.

Post-operative pain is part of surgery. We do everything we can to minimize it. The narcotic drugs available are awful. They are addictive, produce constipation, nausea, and wooziness. Narcotics reduce the ability of the patients to participate in rehab exercises, slow their recovery, and are part of the cause of muscle atrophy. They are not even good pain relievers. Most work by making people feel dissociated from the pain, not really interfering with the pain fibers. To reduce their use we employ a range of tactics.

First, before surgery, we teach patients about what to expect and how to use ice, compression and elevation to reduce swelling that causes more pain. We start physical therapy before the surgery and book daily physical therapy appointments starting immediately afterward. We educate about how mindfulness, calmness before and after surgery and positive attitudes dramatically affect outcomes.

During surgery, we inject local anesthetics and use regional anesthetic blocks to block the pain fibers from communicating the pain signals to the brain. We then use minimalist surgical approaches trying not to disturb any tissue that does not need to be touched.

The post-operative time is where we all get into trouble. While we prefer to use Tylenol and Toradol (Ketorolac), powerful pain relievers that do not affect the brain the way narcotics do, these drugs are often not enough. Opioids such as Dilaudid, Percocet, OxyContin, and Vicodin are often prescribed. The post-operative complications due to these drugs are too many to list.

Today, with the legalization of marijuana in California, many of our patients are self-medicating with various combinations of CBD and THC, the most well-known components of the marijuana plant. The local pot shops sell tinctures, edibles, and various other forms in a dizzying combination of THC-to-CBD ratios. The current buzz is that CBD is not psychoactive but reduces inflammation and the indica version of marijuana plants helps with sleep and relaxation.  

The reality of all botanical medications is that there are a wide variety of other active components and most likely they work together, called the entourage effect, to be most potent. “For the relief of pain…there is no more useful medicine than Cannabis within our reach,” wrote Sir John Russell Reynolds, physician to Queen Victoria, in 1859. Yet, due to government restrictions, we are all at the very early stages of understanding the roles of the two main cannabinoid receptors CB1 and CB2 found in the brain, and CB2 found all over the body, as well as the yet to be found other receptors. Learning how each of these active ingredients work, both independently and together, is a work in progress.

Our patients, however, are not waiting. They report to us a sense of wellbeing after using pot post-operatively. They use fewer opioids, often returning the bottles to the clinic unopened, and have no side effects from the home remedy. And it is not just acute pain situations where cannabis is having a major impact. Chronic pain, which we used to treat with buckets full of narcotics, is also being impacted by the cannabis medical revolution.  

I don’t yet prescribe cannabis, hewing to the “do no harm” part of my medical oath. But how can I not encourage it?

 

Posted by Kevin R. Stone, M.D on May 13th, 2018
Share this post
alternative to a knee replacement-avoid-a-knee-replacement-bioknee
We like to do everything possible to rebuild the knee joint with biologic tissues rather than artificial materials to help delay the time in which an artificial joint replacement is necessary.
VIP Disease
Varying medical protocols because someone is extra-special can lead to problems. If you are extra-special, I suggest you request plain vanilla care—and expect the best outcome to occur. Here is why.
Untethered Athlete
All athletes get injured. The best ones use the injury as an excuse to come back better than they were before they were hurt. Others may not be able to. This may, in part, be due to their inability to let go of the self-image they are attached to. Here are some tips for avoiding that trap.
July 14th, 2015
In light of Wes Matthews and other NBA athletes suffering Achilles ruptures, Dr. Stone speaks to Mavs Moneyball, a...
July 11th, 2018
Dr. Stone gives the nation running tips on how to avoid pain while protecting your joints.
April 27th, 2016
Dr Stone talking about Steph Curry's injury and the Warrior's season.

Stone, K.R., A.W. Walgenbach, A. Freyer, T.J. Turek, and D.P. Speer. 2006.

Stone, K.R., Pelsis J.R., Adelson W.S., Walgenbach, A.W. 2010.

Stone, K.R., A. Freyer, T. Turek, A.W. Walgenbach, S. Wadhwa, and J. Crues. 2007.