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Cannabis and Chronic Pain, a Canadian story.

Below is a story from a person within the chronic pain community, who has had the good fortune to be on the receiving end of a more progressive cannabis policy in Canada.  In a short space of time, he used Cannabis, a class C drug, to withdraw from Clonozepam, an addictive class C drug (similar to but generally stronger than Valium) and significantly reduce his usage of Fentanyl patches, (an even more addictive class B drug, much stronger than morphine), all the while receiving much more pain relief.  Even the specialist couldn’t argue with such results when he came back to NZ, and so he began the process of obtaining Sativex, a mouth spray of Cannabis oil, and the only Cannabis preparation available in NZ

I am a man in my mid 30s,  who use to work as a mid level manager for a medical organisation,  my Journey to MC began in May 2012….

A car pulled in front of my scooter without looking, rather than collide I put the bike down and shattered my tibia and broke my thumb.

They put a K wire in my thumb.  I was then flown to Auckland to put an External fixator (holes drilled into your bones to hold them in place) in my leg to wait for the swelling  to  go down, which it never did, and eventually they put 2 titanium plates and 13 pins in. But my knee is still crooked and heavily scarred. … They also said there was almost no soft tissue damage………..

I couldn’t even wipe myself or shower for at least 2 months following the accident.

At the hospital they didn’t believe my extreme pain after the first operation (which I started waking up during, suggesting either they didn’t use enough gas, or I have a high natural tolerance for opiates and certain sedatives).

This became my first flare up of what was eventually diagnosed as CRPS (complex Regional Pain Syndrome).

They told me to ignore it and watch TV and gave me a strong Antipsychotic to shut me up, – Halperidol, usually used for Schizophrenia etc.

It took 3 hours of extreme pain and yelling in the emergency department and my wife pleading before they finally got an anaesthetist to administer fentanyl.

Over the next year there were lots of physios. When my leg swelled nice and red they’d put ice on it. It just got worse and worse even though they had me biking hundreds of kms they never took note of it, this is a failure on there part to diagnose my CRPS sooner as the semi-permanent swelling and discoloration is a tell tale sign of CRPS.

13 months later after being treated like a drug seeker they finally sent me for an ultrasound. All those physios and orthopedics had me biking and walking on a snapped LCL, a missing meniscus and a torn PCL and damaged ACL.  (google meniscus for a knee diagram…)

They sent me to what ACC called a pain specialist, who I recently found out is not a pain specialist but a rehab specialist, nevertheless he wasn’t an “ACC Hitman” and he diagnosed the CRPS.

Since then I have tried the tricylcic anti depressants, Nortriptyline and Amitriptyline, I am hyper sensitive to them and even the smallest dose put me in a state similar to a half doz of beer all day every day.  I have been on all the anti depressants under the sun,  I have tried fairly experimental treatments such as Bisphosonate infusions that made my arm swell like a watermelon and made me feel like I had a horrible flu for a week.

The standard medication for dulling nerve pain, Gabapentin, was tried twice to no effect, but I did have temporary success with Fentanyl patches,  Fentanyl is a very strong opiate, somewhere in strength between morphine and the weaponised gas version used in the Moscow Theatre Siege of the early 2000s.  It was originally intended for palliative care where patients couldn’t swallow pills etc, and is a 3 day slow release patch,

The patches would take 1 or 2 points out of 10 off the pain, however tolerance built quickly, and I escalated to the largest patch, of 100mcg,  which is the equivalent of 300-400mg of morphine a day,  usually reserved for cancer pain and palliative care, etc.   With pain and opiates, the answer seemed to be “not working, you need MORE!”

I was a zombie. Stuck at home. In pain.  Incredibly short tempered, and not always  coherent, memory patchy at best, prone to feeling nauseated and vomiting during pain flares, and I slowly lost weight.

I couldn’t drive, reactions were too slow, balance wasnt great either, I was prone to bouts of dizzyness, and made dumb decisions.

So I made a life changing decision, you see, I am originally from Canada, a place where MC is fully legal,  I made a 2 month trip to visit family. While there, my family acquired a Vaporizer,  (Vaporizing  can remove 95% of the unwanted residues etc from smoking). While there I used vaporised cannabis from a compassion club, after getting 2 hits out of a small portion of cannabis, the leftovers would then get boiled down to cannabutter, to extract any last cannabinoids, for use on toast.  (cannabinoids are fat soluble, so there are lots of recipes to soak them in olive oil, butter etc)  While there I made huge gains, within 10 mins of Vaping my pain would have  a 5/10 reduction to just 2 or 3 out of 10,  so over the 2 months, I almost felt normal, a side effect of course was a lift in my mood,  and any nausea was smashed out of the park by the Vaporiser, and I began to put on weight again.  I came off several medications, Including Clonozepam, a drug with significant cognitive side effects, and had a significant reduction in my opiate requirements, Im sure with another 2 months, I could have become opiate free, which is a holy grail for people with Chronic pain.

After 2 months it was time to come back to NZ, and my improvements impressed the ACC specialist, so much so, that he agreed to try Sativex, the Cannabis oil based mouth spray, which is used off label for neuropathic pain, and the only option in NZ.

At this stage I was trialed on methadone while waiting for Sativex which sent me backward fast. I don’t remember much except when I woke up nearly blind at one stage. I did call the  ACC specialist after hours at some stage and apparently mentioned his wife/secretary had bad phone manners and would never let me get in touch with him.  He gave me a trespass order for that.  It was probably because I was on the surly side, (again opiates can in rare cases make people aggressive, depression is usually the main one exacerbated by them)

I also received another from ACC when I was mentioning Cannabis in reference to getting Sativex,  immediately after the Ashburton shootings, so in hindsight ACC staff may have been a little on the jumpy side…..

It was obvious after 2 tresspass orders that methadone doesn’t agree with me, so I switched back to Fentanyl patches. The Specialist did sign the papers before all of this so I could get a Sativex script. But ACC wouldn’t fund it. I am having them do a review in the new year.

I am contemplating paying for it myself and it cost me about $1000 a month. I am sure that’s why they denied me.  Methadone costs less than 20 cents for a 5mg tablet i’m told, Sativex would be $30 a day… Fentanyl didn’t work as effectively as it should, I had a personality transplant on Methadone and lost the ability to form coherent memories, and I don’t miss Clonozepam, So of the Class B Drugs,  Cannabis preparation were the most relief from pain, and also controlled my Nausea and mood, removing the need for even more drugs…

With the truly positive experience I have in my homeland, I can’t understand how anyone can deny MC with a straight face, the night and day difference it provided to me overseas was a revelation for my specialist.

The 2 main active ingredients, CBD and THC are both listed as medicines. That’s why Sativex is legal. Why not import a cheaper alternative from the US or somewhere. Make a market not a monopoly…..  ACC is denying me the only variety available of the most effective and sustainable family of treatments/medicines based on cost,  in Canada the Compassion clubs have given me better relief than ACCs top pain specialists, which is why I believe that domestically grown must be a part of the debate going forward to keep prices in check. I cannot just “live like its legal” and grow my own, as my wife has a medical career herself that would be put in jeopardy.  Something has to change, and I still cry about it. If I could find a grower I would quit all the drugs and go all natural. But alas it’s illegal, with no political will to change it…..

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