Steve May: Marijuana, painkillers and addiction

Editor’s note: This commentary is by Steve May, LICSW, who is a practicing social worker with a practice specializing in addiction medicine. He previously worked in a variety of substance abuse clinical settings across Vermont. In addition, he is a member of the Selectboard in Richmond.

For years I have worked with people, in my case mostly men, who have come into therapy for a drug or alcohol issue, which at its core started as a physical injury. Many of my guys do physically challenging work, they are on and off ladders all day, they climb across trusses on their hand and knees or they milk dozens of cows at a time. And after years of this physically demanding work, they reach middle age and they have completely ravaged their bodies. They can’t bend over and pick up their 15-pound child. That the children stand in front of a hulking man begging for the attention they well deserve matters little as this child might as well be on the surface of Pluto. No matter how much these men might hope, there is no willing oneself through the underlying pain which punctuates the ordinary and everyday reality of their pain.

Over the years, the nature of my practice has changed. Fifteen years ago, I started my career working at Act I, the social detox program in Burlington overnights while I was in grad school. Thursday, Friday and Saturday nights were the domain of the weekend warrior, kids from the university rushing Kappa or Theta who had overdone it sprinkled in with the committed many who had graduated in their consumption to a more regular diet of substances. As time has moved on though, the mix of who is coming in and how they present has changed radically. My caseload these days is made up largely of middle-aged men who tweaked their backs doing yard work, shoveling snow, playing pickup basketball at the park or on the job. These intrepid few all share one thing in common: a bottle of prescription painkillers.

Earlier in my career, I had the pleasure of working in the bleeding disorders community, first as the director of Advocacy for the Regional Chapter organization of the New England Hemophilia Association, and then ultimately promoted to the national director of state affairs for the Hemophilia Federation of America. My work involved advocating for men (hemophilia due to its biology afflicts only men, with few exceptions) who received tainted blood products in the 1980s and 1990s. These men, through no fault of their own, contracted not only HIV, but in most cases, also hepatitis. Not to mention the scores of families suddenly confronting compound trauma. These families knew pain on a daily basis — confronting the reality of living with, in most cases, three chronic medical conditions.

I can’t help but think of these two counterpoints in my professional life when I watch the cannabis floor fight play out again this year. I wish I could share how my patients who had gotten their wisdom teeth out were more likely to abuse prescription drugs because of a painkiller which was written by a well-meaning dentist or orthodontist but tempted through relief and retreat an unsuspecting teenager, and contrast that with my community members who using a combination of medical marijuana, acupuncture and therapeutic massage were able to extend their lives long enough to see their multiple infections become chronic conditions, not terminal diseases which had claimed so many others.

There are those in our Statehouse who believe that cannabis represents a menace, so dangerous that it must be stopped. After 15 years and hundreds of clients, I believe that thinking couldn’t be more misguided. The gateway to addiction runs through pain and specifically, bad pain management.

Legal cannabis is a reality for Vermonters. They will either buy it here and Vermont will benefit or leave the state with their wallets and buy it legally someplace else to our detriment.

There are no surprises anymore. After one’s initial use, no one picks up a blunt or joint out of curiosity. Nobody uses to use, their substance misuse is the result of other factors. Simply stated, they are chasing the dragon … seeking that same measure of relief they got from their first use. The truth is salvation doesn’t exist at the bottom of a brown bottle, whether that be a pill bottle or a booze bottle. While substance use provides a salve for a while, that’s all it is.

By the same measure, one’s drug of choice need not be illegal to create havoc in good people’s lives. Plenty of good people will go home tonight and gamble, or abuse food, or are hoarding across our state right now. Legal cannabis is not going to incentivize bad behavior. Hurt will. We as human beings are compulsive by our very nature, and compulsivity is behavioral. This has been true since the time that man walked out of the primordial ooze hundreds of thousands of years ago. It is wired into the very tapestry of our core. Our misuse of substances is the manifestation of pain. These people didn’t need legal cannabis to amplify their compulsive and anti-social behaviors. Their behaviors — their choices will exert a cost to all of us as taxpayers in one way or another eventually. Cannabis is available in every middle school in this state — if you want it, you can get it; it’s really that simple. Your 13-year-old really doesn’t have to work very hard to get their hands on it. The better question is what’s in your pot?

People tamper with narcotics for a variety of reasons; usually it deals with wanting to create a more addictive product. After all, this is a market just like any other, and return customers are essential to sales, sales, sales … With a black market you have no idea about the origins of the product. While you may have bought from a friend, and they got product from a guy, very quickly you are staring down the shaft of a dark tunnel uncertain of the origin of the product you are ingesting. By comparison, the bottle of hand sanitizer in my office is required to list its ingredients by the government and its poison.

By the middle of next year, the Trudeau government has pledged complete legalization of marijuana in Canada, joining Massachusetts and Maine. Presumably other New England states are going to also legalize it. Legal cannabis is a reality for Vermonters. They will either buy it here and Vermont will benefit or leave the state with their wallets and buy it legally someplace else to our detriment. Meanwhile, our real issue with gateway drugs and prescription abuse continues. While efforts in past years to curb the prescribing patterns of some prescribers were a good first step, a deeper commitment is required.

Pain is a medical condition. When someone discusses pain our public discourse it usually involves asking where it is; and whether it’s sharp or dull. That’s it — this is the equivalent of treating all cancer like it’s a single affliction. That’s what we did 70 years ago. It was a poor response to a medical crisis in 1950, and its equally insufficient today. A public commitment to treating pain as the medical crisis it is in light of our opiate epidemic is critical. We as a society cannot write our way out of this crisis, one script at a time.

In my experience, a combination of allied health approaches including: therapeutic touch, cannabis and oriental medicine (acupuncture) provided a pathway forward for a great many. One thing is for certain, the attempt to conflate access to cannabis with addiction serves no good purpose. I wish our Legislature had spent one-tenth of the time addressing the very real pain issues which drive substance misuse in our state, as opposed to the false choice offered up to members this session.

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