Posted 12/15/2018 4:08 PM (GMT -6)
First, your doctor can prescribe you opioids while you're using MJ. There is no legal nor medical reason why not. In fact, using MJ can not only reduce your needed opioid dosages, but also make the opioids you use safer since MJ is a mild respiratory stimulant and significant bronchodilator. My doctor, for example, allows patients to use both -- and I know a good number of other pain doctors who do the same. In fact, the pain management society in my state has a policy position supporting it. If your doctor won't let you -- it is on him/her, biased, uneducated.
As for its benefits, one issue to bear in mind is that too much THC can make pain worse... i.e. it is biphasic.
It is best to start with high CBD strains (e.g. AC/DC or Pennywise), while also trying something like a 3:2 CBD to THC for breakthrough (e.g. Harlequin). Many studies indicate that much of the pain relief is achieved at just 1-2% THC.
Note that CBD is active on the CB2 receptor and also helps your endocannabinoids bond to receptors. Its main effect is anti-inflammatory, preventing cytokine release. THC too works as an anti-inflammatory but in addition also (a) raises nocioceptor thresholds (i.e. the signal needed to propagate pain through the nervous system); and (b) affects the subjective experience of pain (through action on the right amygdala), making it easier to not notice.
Importantly, MJ is not quite a CNS depressant. First, there are next to no CB1 receptors in the brain stem, one key reason why it is so safe. Also, while it reduces response time and has other sedative-like effects, it actually increases right-brain neuronal activity (per fMRI data). In fact, the increase in that activity is the likely cause of the reduced response time (exaggerated attention on thoughts dissociate from some sensory processing).
Overall, here is my personal experience:
a) I use a 10:1 CBD to THC vape pen a couple times each day. As a result, I've been able to reduce my opioid dosage by about 50%. I'm definitely in less pain through the day. I don't find that the vape immediately affects my pain levels, but rather daily dosing increases the available cannabinoids in my system which reduces the inflammation secondary to nerve-root impingements. Think about this as analogous to using a daily vitamin - you're supplying your body with a resource.
b) I've tried many stronger THC strains and some (e.g. Blue Dream) are excellent for pain (due in part to specific terpene profiles). The problem is that I do not like to be "high." So, while its effects may be even better than opioids, I find its psychoactive to be very unpleasant.
c) I take a very low-dose 1:1 CBD THC edible for sleep, which is as effective as xanax... the dosage is just 2.5mg of each. If I take two (5mg), my thoughts intensify and I can't sleep.
d) 1:1 CBD THC transdermal ointments are fantastic for local pain (e.g. a muscle in painful spasm). The problem is that I don't like to smell like MJ, they only seem to last for a couple hrs, and since my pain is so widespread, frequent broad applications are a nuisance/messy/stinky.
Let me emphasize that if you're going to work with your pain management doctor on this, s/he needs to give you a couple months minimum to explore, to let you use your current opioids and through trial and error see what MJ options (if any) work for you. Pain doctors who have been working with this for years find that patients are able to reduce their opioids by around 80% (e.g. no more oxycontin, but just an oxycodone or two for BT episodes).
I received my patient card earlier this year, and it took me three months of trial and error until I found a dosing regimen that helps with pain without interfering with my mental focus. IMO, that should be the goal, and if your doctor doesn't give you the time needed to reach it, the consequence may be you'll either give up on MJ or just migrate into higher THC psychoactive dosage which while helpful with pain will more likely interfere with life activities. So, any doctor who has learned enough to understand the pain benefits and safety of MJ should work with patients to reduce their opioids over a period of months -- expecting a sudden shift from one to the other is unprofessional.