In fact, I’ve already done it. Let me tell you a story about a patient named Brad (actually “Brad” is a composite of several patients’ stories). A native West Virginian, Brad has lived on the mountain all his life. Now in his thirties, he’s spent the last five years addicted to a series of deadly substances. In 2012, while working as a stone mason, Brad got injured in a forklift accident. Initially, the hydrocodone his doctor prescribed took the edge off his back pain and allowed him to return to work, but soon, his wife lost her job, and the bills piled up. With two hungry kids under five, the stress piled up, too.
Soon, Brad was doctor shopping and ER hopping to get whatever pain relievers he could. When the pills ran out, he turned to meth, and Ritalin, and Suboxone, and eventually heroin. While he managed to hold down his job and keep his family together, Brad eventually got busted, and spent six months in jail. The law took away his freedom, but it saved his life.
When I met Brad, he was begging for help. He’d been abstinent from all illicit drugs (except marijuana) for 32 days—cannabis being the only relief for the burning nerve pain in his feet and ankles. If he smoked weed before going to bed, he could manage a decent night’s sleep. But testing positive for THC would get him locked up again. So, Brad came to me, desperate for help—fearing that, without cannabis, he’d soon succumb to heroin, which was seemingly everywhere around him. What a dilemma: go to prison for treating daily misery with a botanical remedy, or struggle without it—constantly tempted to inject dope that could kill you instantly.
Thanks to some courageous effort by some of our elected officials, future patients like Brad may not have to make this agonizing decision. The West Virginia legislature recently passed Senate Bill 386, allowing medical cannabis to be grown, processed, and dispensed in West Virginia. If all goes according to plan, by late 2019, I will be able to legally recommend cannabis to certain patients. If West Virginia follows a positive trend observed in some of the other medical cannabis states, we will see a drop in opioid use and drug overdose deaths. Indeed, one study of pharmacy records showed an association between legalization of medical cannabis and a reduction in filling Medicare Part D prescriptions.
Without a doubt, we should be cautious as we proceed in “getting legal” with our cannabis. Exposing young adult brains to cannabis is associated with adverse mental health outcomes, and there is some evidence that cannabis is a “gateway” to more harmful drug use. But if cannabis is truly a gateway, it swings both ways. People who have been permanently harmed by decades of opioid over-prescribing may now have a legitimate chance of returning through that gateway from the abyss of chaotic drug use.
I am impressed enough with the harm-reduction benefits of medical cannabis that I have accepted the position of chief medical officer for a new West Virginia-based medical cannabis organization. So, this my first time writing as a medical professional that I have to disclose a potential conflict of interest … and I am delighted to do so!
— Dr. Didden is the health officer at the Jefferson County Health Department.