TRIBUNE PHOTO: JAIME VALDEZ - Chronic pain is difficult to manage, so some patients are experimenting - without doctor supervision - with marijuana, which became legal in Oregon in 2015. Many chronic pain patients are experimenting on their own with marijuana, especially since recreational weed was legalized in July 2015.

Medical marijuana has been available in Oregon since a 1998 ballot measure passed, but still requires an expensive medical card and a doctor willing and knowledgeable about how to prescribe it. Now, patients over 21 can simply walk into one of Portland’s 156 medical marijuana dispensaries and try some.

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Mike Foley, a spokesman for Kaiser Permanente Northwest in Portland, says their physicians are following Centers for Disease Control guidelines to test the urine of patients on opioids to make sure they are taking the right dosages. Those tests might also reveal any marijuana-based products in their system. While that wouldn’t disqualify them from participation in Kaiser’s pain management programs, Foley says, some physicians might discontinue the opioid prescription for fear of interactions.

Asked if cannabinoid prescriptions might be on the horizon in mainstream medical clinics, Foley says: “It’s fair to say that Kaiser’s not moving toward marijuana.”

Dr. Rachel Solotaroff of Central City Concern says she increasingly sees patients who are trying out marijuana.

“Sometimes they’re embarrassed to come tell me about it,” Solotaroff says. “I just say I’m glad that’s working for you.”

When Solotaroff hears that, she discontinues their opioid prescription, to avoid theoretical complications such as trouble breathing. It’s still difficult to feel comfortable prescribing cannabinoids for pain, Solotaroff says, considering the lack of approval from the U.S. Food & Drug Administration.

“I don’t have the same level of evidence and rigor” as with prescription drugs, she says. “I think in 20 years we’ll be in a very different situation.”

Despite approval from the FDA, the evidence of safety and efficacy of opioids for chronic pain turned out to be overstated.

Dr. Katrina Hedberg, state epidemiologist, says mainstream medicine started down this path because of a report that said people with chronic pain weren’t at risk of becoming addicted. That turned out to not be true.

Hedberg says a work group of the Oregon Opioid Prescribing Guidelines Task Force is working on advice to providers about what to do at this increasingly common intersection of marijuana and opioid users.

“We really need to understand more about why patients are using it,” Hedberg says. “We’ve certainly heard anecdotally that patients (on cannabinoids) are using fewer opioids.”

Dr. Paul Lewis, Multnomah County health officer, says despite the federal government continuing to place marijuana in the same drug class as heroin and methamphetamines, Oregon needs good data on the effects and uses of marijuana and how it can interact with other drugs.

“I think our state in particular, we need to know the answers to these questions because people are asking them,” Lewis says.

By Steve Law
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