My name is Dr. Allen Miller, DC, DACBSP; I am a chiropractor with a specialty in Sports Medicine. I was the team physician for numerous international Track & Field Teams and accompanied them to multiple meets and ultimately to the 1992 and 1996 Olympic Games. In my off time, I raise horses, guide back country horseback camping and hunting trips. I have competed on horses professionally and have the scars to prove it. In the years prior to beginning my life in chiropractic and sports medicine, I was the bodyguard for celebrities beginning with Dinah Shore. To say the least, I have led a very exciting but physically taxing life. I have broken almost every bone in my body, and on one hunt 7 years ago, I was several miles in the back country and my horse slipped, falling crushing my left foot and fracturing my right ankle and leg. After riding the 12 miles back to the truck, it started to snow, resulting in hypothermia and frostbite to my feet bilaterally. This short strip resulted in severe nerve damage in both feet, along with open fractures and chronic pain that required four surgeries to correct. Without a great explanation of every horse that has bucked me off, or every accident, and repairative surgical technique I had to endure, suffice to say if it weren’t for scar tissue I would not be standing. As a result of all these crashes, I was taking 10-12 Norcos a day to be able to walk and function in a very highly physical life. Over the last few years, it’s been harder to get this level of Norco, Vicoden or the other pain opioids because the insurance companies are requiring a 50% reduction of these prescriptions by 2018. This family of Opiates are analgesic alkaloid compounds found naturally in the opium poppy plant Papaver somniferum.[1] The psychoactive compounds found in the opium plant include morphine, codeine, and thebaine.(, p. 1) The opioids were the drug of choice, it was great for the patient, and even better for the doctor because the patient was happy, he was drugged out of his mind, but happy.
Off and on, through injuries, broken bones, stabbings and reconstructive surgeries I traveled down prescription hell. The pills were great, they let me work, think and keep up with my unique lifestyle. The flipside is you have to “whore” yourself, and convince a doctor that regardless of the extensive history of injuries you have had, you still have pain. Because it’s becoming harder and harder to obtain Opioids, I investigated cannabis solutions, subsequently obtained a recommendation and started medicating myself. This is where the fun really begins; the path to finding the right combination of MMJ strains is arduous. For the most part, the “budtender” in essence is acting like your pharmacist providing product advice based on several factors, personal use, research and patient interaction. These people are savant’s regarding the plants, the chemical structure it actions, everything. However they don’t know the other disease process of the body, the impact of the aging process, lack of hormones, aging and all the factors that cascade forward into the current symptoms one has due to a disease. The body reacts, adapts, evolves and changes to different factors allowing the body to function. Where the work comes in is finding the right dosage of which strain to use for your condition. This is very personal, however, the purpose of this article is to explain the rationale behind the products I used and how I got off opioids without withdrawals, loss in function, or production. The following is my personal journey and my analysis. There are two types of pain, mental and physical, for sake of space I will not describe the anatomy of the pain structures. For this purpose, I’m going to speak to the subjective component of Opioid addiction. My biggest fear was and still is I would be stuck in a situation my disabilities rendered me helpless. I kept a pain pill in my pocket that was my crutch if something happened. After obtaining the recommendation for MMJ, without guidance whatsoever I headed to different dispensaries. I did not tell my doctor that I was going to try MMJ to treat my pain. I did bring up the subject, but I was told he would stop seeing me as a patient if I did use cannabis. I have tried most products available for pain, and this is not an incitement of other products, this is what I found works for my me and subsequently a lot of my patients.
As I stated, you have two areas that are going to report pain, whether the pain is real or not is immaterial, that’s another issue, right now the brain has been rewarded every time a person takes an opioid, In essence, you are rewarding the brain for having pain. The more pain, the more pills regardless of the actual level of pain experienced. In my case, I see patients, write reports and manage the marketing for 50 clinics internationally. I, like other patients cannot be “high.” I need to be effective, with this said, and based on my history, blood tests, and following a physical exam with Dr. Stephanie King at Dedicated To Health Medical Group, we decoded that I would start on a regime of 40mg of an edible a day to be divided at 20mg during day for pain and again before bed for sleep. I decided on a high CBD, low THC formula to work at my level. I wanted a low THC level as it helps the CBD’s work better, but because I was taking long term opioids I would have withdrawals, and I can’t have that in my environment nor do I have time for rehab. One other thing to consider that rapidly came to my attention, cannabis is not like prescription drugs, there is no immediacy. I realize this is elementary however it’s a complex issue to the chronic pain patient taking opioids; we patients have been conditioned for years to take a prescribed amount over a prescribed amount of time with expected results. In the case of cannabis, it takes some more time than others to see positive pain killing effects, which is slow in comparison to prescription medication. This is the problem, every chronic pain patient including myself is deathly afraid of the pain escalating into debilitating pain.
Simply put a patient on long-term opioid treatment has been conditioned to take a prescribed amount and this kills his pain and this gives the patient confidence in their surroundings. However when the brain does not get the drug it wants at the time it wants it, the body revolts with increased pain, disability, cramping, nerve pain and muscle spasms. This is because the painkillers (e.g. Vicodin, OxyContin, Norco, Hydrocodone) – commonly prescribed by physicians to treat pain – cause a change in your brain chemistry that is not under your control. (Burke, 2013, p. 3) So as time goes on, the patient has no concept of what part of the pain is residual from the injury or the brain calling out for more drugs.
My philosophy was to use MMJ, or a cannabis product first before taking a pain pill, slowly weaning off the opioids replacing them with cannabis products. I am not a smoker, and can’t smell like marijuana in my work environment. After investigating several products, I settled on edibles, it was discreet, nobody knew what I was taking and it didn’t smell.
In this transition from the controlled result of pain pills to cannabis, a natural product, I discovered I had to be confident in the effects of cannabis. This is difficult because not all products are made equal. First, I had to embrace that it worked, and I had to be patient with the effects and its ability to work. Through significant trial and error, I found a product that killed the pain, reduced the cravings and “energized” me so I could work and live normally. What worked best for me was “The HealthCare Bar”, a 200mg THC nut bar. It had just enough THC that it blocked the pain signals and the craving of the opioid. The CBD’s had an immediate effect reducing my sedentary and active pain. This bar is what I settled on for daytime use, for work, and everyday activities. Again, the philosophy behind dosing with cannabis with a consistent dosage at set intervals with cannabis products to relieve the effects cravings and discomfort associated with chronic pain. This product is great for giving me relief during the day and through everything I do. I take approximately 20mg in the morning 10 mg in the afternoon till about 4 pm.
It is great for everyday use. The second factor to consider is the breakthrough pain, where as sharp pain, comes as a result of increased activity. Doctors love to say, “Curtail your activities. Learn to live within your pain.” I believe that is complete crap. If you’re feeling better, you live life, you do what you want to do, if not, you are not living. What is the point of living stuck on the couch, depressed from your pain, which means to live, one must increase activities, the breakthrough pain is a necessary evil. Seated on a horse for several hours results in significant back pain. Well, I do have significant back pain, I’ve broken my back, and had numerous operations to correct the damage, but I like to ride horses. Instead of using the pain pills shortly before an activity, killing the pain, I now have to be more cognizant of what my activities will be and medicate accordingly. The first and not in any particular order is Jumbo Superfood products in the form of THC/CBD Potion. This is a spray for the mouth that when used kills pain and muscle spasms quickly through product absorption in the mouth. What is great is it tastes and smells like Peppermint. If I have to stand for more than about 15 minutes I get severe bilateral foot pain due to the fractures and nerve damage associated with frostbite. However, life and work do not allow the luxury of sitting after 15 minutes, in my work I have to stand on a stage for a TV show, and other activities that require standing for long periods of time. This is why I favor Jumbo Superfoods THC Potion as its small discrete and does not smell “green.” As I said, I use it for breakthrough pain, and it works great, extending my ability to stand or move and I use it for horseback riding, and all the other activities I participate in. If I am by myself and out of the way of patients or others I utilize the W-Vapes Sativa for breakthrough pain and relaxation as well. W-Vapes has done an amazing job of making a quality product that does not leave an aftertaste that works quickly. Remember, one of my biggest fears is having pain that escalates and I can’t elevate it. This is what was great about W-Vapes, great product and it works well for my chronic pain rheumatoid arthritis patients as well. A third product that I thoroughly enjoy, that again has the highest quality rating I’ve found, is Something Chocolate by Mitch Koulouris. These chocolate truffles taste as good or better than anything I have tasted anywhere in the world. I used to travel with Olympic teams and they just love to feed us every delicacy known to man. Something Chocolate is up there with them all. What I appreciated, is the quality of the product. I found when testing Something Chocolate truffles for my patients, the purity of the product made the absorption of the 20mg of THC/CBD mix enhanced. I only need to cut his product in half to get the pain relief I needed without any memory loss or feeling of high. Speaking personally, and from experience, using cannabis does not get me “high.” It relieves the pain, giving me a feeling of being unshackled from my body. I’m not high; I don’t sit and contemplate my navel. I need my body to keep up with my mind; I cannot be burdened by pain, and muscle spasms, this is what takes me off my game. I require the cannabis to fill the void of pain killers so I can function with the fractures, and biomechanical problems I have from the years of abuse, which was a tremendous amount of fun at the time. One other remedy I have found for quick pain relief and muscle soreness is Xternal Balm. It’s a great topical cream that does not smell like weed and gives instant relief. We compared a similar product from prescription medicines and they don’t work as well as this product and Xternal Balm was at a fraction of the cost.
For sleep, this has been the biggest problem for me as sleep is difficult because everything hurts. I can get to sleep, but staying asleep is tremendous work because my body hurts and spasms waking me up. I again found W-Vapes Indicia Brand to work best getting me to sleep and keeping me asleep. I woke up without a hangover and in most cases I woke up pain-free. This gave me enough time to begin the daytime regime with the bars and other products I mentioned. The advantage prescription drugs have been that it’s easy, very little work with exceptional accuracy, and it’s predictable. However, with times changing and the physicians inability to prescribe these drugs now, people are moving to another easy remedy and that’s Heroin. We’re seeing reports of high school and college-age student athletes that are addicted, as they can no longer get the drugs and subsequently move to Heroin with several reports of deaths due to overdose. One must ask why are people moving to of all drugs Heroin from opioids, not cannabis? Driven people have to function they thrive by being busy and productive. They want the quick fix to the problem, and hide it so nobody knows their secret. Kill the pain in 10 minutes and go back to work is the philosophy, not much different than the football player we used to shoot-up with painkillers so he could go back on the field, same mentality. The good news is cannabis is great in this situation, very little or no harm from ingesting the products. If one does over ingest, it will wear off without significant side effects, and most importantly cannabis will not interfere with anything in the body, it allows the body to heal. The bad news is it’s slow, the body has to accommodate and substitute the more potent synthetic drug for the safer, more natural alternative. This while the brain is screaming in pain, making it physically difficult to even move, motivating the patient to kill the pain as fast as possible. Cannabis is not a quick and easy fix in these situations, it takes longer, but it’s safer increasing a patients longevity and pain-free existence.
In conclusion, substituting cannabis products to treat pain is the course of therapy for surviving and thriving in your life. We all know the disadvantages and side effects of prescription medication. I have found what works for me. I have confidence that the products I use will not leave me stranded in pain. I utilized blood tests, DNA tests to evaluate which vitamins worked best for my metabolism, and I used Bio-Identical Hormone Replacement Therapy (BHRT) and Hormone Replacement Therapy (HRT) to make up for the loss in hormones consistent with my years of physical abuse and the natural consequence in aging. I’m 60 years old, broken everything, and still ride horses, back country camp, fish and more. I’ve had more than 30 surgeries, with plates, screws and other hardware bonded to my skeleton that keep me vertical. I use a cannabis product about every 4 hours to get through my grueling workday. Yes, finding the natural alternative is a difficult one, however, it’s a rewarding one. I have spent the last 30 years treating patients; I wish I had this in my bag of tricks years ago. Not only do I use it personally, I counsel Rheumatoid Arthritis, Chronic Pain, PTSD, Pro Athletes and all patients on the use of cannabis to increase their quality of life.
DR. ALLEN MILLER
STAFF EDITOR
References
Burke, S. (2013, 09/11/2013). How Pain Killers Sometimes Increase Chronic Pain. Spine-Health. Retrieved from http://www.spine-health.com/blog/how-pain-killers-sometimes-increase-chronic-pain
Wikipedia. (2015). Opiate. Retrieved from http://www.Wikipedia.com