YOUR BIAS MAY BE KEEPING POT FROM PAIN PATIENTS

Patients Humiliated Because They Have To keep Justifying Their Pain: Study

VANCOUVER - The stigma attached to cannabis use keeps dying patients
from taking advantage of the medicinal benefits of the drug, according
to a study by palliative care specialist Dr. Romayne Gallagher, a
professor at the University of British Columbia.

The study, which drew on a survey of dying patients in palliative care
units in Kelowna and Vancouver, showed these patients worried that
smoking marijuana could damage their lungs, be illegal or cause
addiction. They were also worried about the impact pot smoke might
have on family members.

Morphine also has an enduring stigma, said Dr. Gallagher. Even though
many patients are dying in a lot of pain, they are concerned about the
issues surrounding drug use. Often, their fears reflect the
apprehension of the physicians prescribing it, she said.

"What's frustrating for patients is that the physician's apprehension
makes them feel they have to justify that they are in pain all the
time," said Dr. Gallagher. "A GP might not be comfortable prescribing
an opioid, and the patient is humiliated because he had to keep
justifying that he really was in pain."

Public education would help to decrease the stigma associated with
cannabis use for medicinal purposes, she said.

The survey posed 11 statements about cannabis, morphine and
analgesics. These were drawn from perceived concerns about cannabis
and from a previous study done by Dr. Gallagher in 2001 about
knowledge and attitudes about palliative pain management in the
general population.

Patients were asked if they would be willing to use cannabis as part
of a study in forms such as smoking, pill, inhaler, sublingual drops,
added to food or tea, and were asked to state their preference. They
were asked to rate their pain, nausea, appetite and anxiety over the
past two days using a visual analogue scale of zero to 10, with zero
being no symptoms and 10 being the worst pain imaginable.

In addition to age, gender, ethnicity, religion and education,
patients were asked if they had used cannabis before, and if they or a
family member had a substance abuse disorder. A number of participants
chose to enter more than one preference so there were a total of 80
responses from 66 patients.

The majority felt uncomfortable with the idea of smoking pot or
injecting it. Most preferred an oral form, either as a pill (32),
drops under the tongue (15) or added to food (10).

The smoking of cannabis was selected in only 12 responses. There were
also several written concerns about the smoking of cannabis and
harmful effects on the lungs.

Only three responses agreed to "whatever works," suggesting the route
of administration remains a significant concern for patients, even
those with significant symptoms.

"Dying people still consider themselves alive, and therefore are
afraid of harming themselves," said Dr. Gallagher. "They don't know
how long they're going to live, and so they worry about smoking, about
addiction, about the legality."

Morphine is still the most effective drug for acute pain. Medical
literature suggests the effects of cannabis are equal to that of
Tylenol #3, she said.

"What this study taught me is that we still need to do lots of public
education about the stuff we have, which works quite well," she said.
"People who get the best benefit from cannabis say it's wonderful,
that they're getting good pain relief and that they're not stoned. I
have used it in patients, most with non-cancer illnesses in
non-palliative situations, like MS."

Dr. Gallagher said the properties of cannabis are not completely
unknown, but information has been lost over the years.

She said physicians must pay more attention to pain management, and
that begins in medical school. The new generation of doctors does
appear more receptive to the use of these drugs because they didn't
grow up with a bias against them.

"There is patient concern, but then there is physician concern," she
said. "They can't really address the concerns and questions of their
patients. I think we have a real bias about the management of pain and
about the use of these medications.

"A lot of chronic patients feel subconsciously bad about taking pain
medication, and it's kind of reinforced by physician bias. Would they
feel that way if the patient were asking for help with
antihypertensives?"