As attitudes toward pain management change, some researchers say there's better evidence supporting cannabis use for chronic neuropathic pain management than opioids. Yet, for this Vermonter, an opioid prescription costs a dollar, while medical marijuana costs hundreds.
“My kitchen has just become, like, weed zone,” says MaryJane Sarvis, standing in her friend Ann’s much tidier kitchen. “I’ve got oils and you know stuff half-soaking, half-made. It’s really a zoo.”
Until recently, Sarvis was dependent on prescribed opioid painkillers to treat her chronic pain. Now, she relies only on cannabis.
With cannabis instead of opioids, Sarvis says she has less pain and more energy. But to purchase her medicine at Vermont dispensaries, she says “I gotta come up with hundreds of dollars for cannabis."
Here in Ann’s kitchen, Sarvis is learning to cultivate cannabis and use the plant to concoct her own infusions, tinctures and salves.
The two are a raucous pair, cussing and laughing as Ann instructs Sarvis on things like whether and how to process raw cannabis before infusing it into honey. Both women are nearly sixty; both rely on cannabis to manage chronic pain. Neither can afford to buy medical cannabis at a dispensary.
Ann is using her confirmation name to protect her privacy. As for MaryJane Sarvis, “My name really legitimately is MaryJane.”
To really understand Sarvis’s story, you have to go back nearly 50 years. As a child, Sarvis was diagnosed with spinal scoliosis. At 12, a doctor fused 10 of her vertebrae together. The then state-of-the-art surgery held up for more than 30 years.
“What happens is under the fused vertebrae, the discs and stuff starts to break down around the fusion. My lower spine was like all broken down. It was like — bad.”
She had excruciating pain, and began losing feeling in her leg.
Her doctors prescribed high doses of opioids. By the time Sarvis found a doctor who could operate, she had worked up such a tolerance to the opioid painkillers she couldn’t feel opioids the surgeon gave her for the recovery.
“They locked me in a little room where I screamed bloody murder. I screamed,” Sarvis remembers. “That’s all they could do for me.”
After the surgery, Sarvis was told she would have to be on opioids for the rest of her life. “There’s three screws in my sacrum that will create chronic pain forever. But I’d rather have a leg that works than not, so I said 'okay.'”
For nearly a decade, Sarvis went from pain clinic to pain clinic. Some prescribed hydrocodone (Vicodin), an addictive opioid. Others prescribed methadone, a synthetic opioid more often used to treat addiction.
Sarvis believes she was dependent on the drugs, but not addicted. “I remember taking opiates where you get a euphoric feeling,” she says, “it’s a good thing. I personally don’t think I have an addictive personality.”
Still, the drugs didn’t seem to help. “I felt tired all the time and I was still in pain.” She decided to quit the opioids. Her doctors agreed to help.
Detoxing from methadone causes famously miserable withdrawal. “You can’t sleep. You’re jumpy as hell. You have more pain,” Sarvis remembers. “It’s your brain telling your body ‘I want more substance, give me more.’”
It took her six months to get through the withdrawal. “And then I realized I had less pain than when I was on drugs.”
Today, Sarvis believes her prescription opioids actually increased the severity of her chronic pain. Her experience is not as surprising as it sounds.
“There’s really no evidence for opioids at all in chronic pain,” says Kalev Freeman, an emergency room physician and researcher at the University of Vermont. “Opioids are good for acute injuries and surgery.”
Freeman teaches students in the University’s medical school the fast-evolving literature on opioids and medical cannabis.
“For chronic conditions, the problem is that the opioids lead to additional inflammation around the nerves and sensitize the nerves to further pain. So the chances of developing chronic neuropathic pain are higher if you take opioids.” At the same time, Freeman says, “there’s very robust evidence that cannabis decreases pain,” particularly neuropathic pain.
MaryJane Sarvis doesn’t need to read medical literature to believe this. She says with medical cannabis, she’s got more energy and less pain than she did using hydrocodone or methadone.
Now, the pain is in her pocketbook.
Sarvis’s opioids were covered almost entirely by taxpayer-funded Medicaid. “So I can get a bottle of opioids for a dollar on my state insurance," says Sarvis, "I can see how it’d be tempting to say 'give me the pharmaceuticals.'"
Medical marijuana is not covered by insurance, and it's expensive.
A Vermont cannabis blog estimates two ounces of marijuana — a one- to two-month supply — costs at least $560 in Vermont dispensaries. That’s more than twice as much as patients pay in Colorado or Washington State. And it’s exponentially more than patients like Sarvis pay for opioids.
Sarvis says she can’t afford Vermont dispensaries’ medical marijuana. “I just got food stamps and I’m really freakin’ relieved. Let’s put it that way.”
There is an irony here.
Sarvis is an artist whose ultra-fancy scarves and capes used to be sold at Bergdorf Goodman. Oprah Winfrey and Diane Sawyer have worn her designs. However, Sarvis says, opioid painkillers contributed to the demise of her business. She was too tired, and too much in pain to work.
Sarvis turns 60 this winter. She says now that she’s off the opioids and using cannabis, she’s ready for a second chance. “Sixty and having health problem is not a death sentence. I’m ready for round five.”
This time though, Sarvis won't be spent laboring over velvet and silk for famous customers. She’ll be perfecting her cannabis growing techniques – and making her own medicine.