Could Medical Cannabis Help Manage Pulmonary Hypertension Pain?

Could Medical Cannabis Help Manage Pulmonary Hypertension Pain?

In Life with PH

For my last column, Is There a Hidden Drug Abuse Problem Among Pulmonary Hypertension Patients?, I spoke to several pulmonary hypertension patients who use prescribed pain killers to help manage pain. Sarah and Lindsay shared that they began to abuse their prescribed painkillers within the last year. Both admitted that they knew other patients who were also abusing prescribed opioids. However, Jessica said that her use of prescribed pain killers, taken as directed, helps her with mobility and her ability to maintain her career.

Even when prescribed, painkiller abuse can pose a threat to many patients. Users can build a tolerance to their current dose, causing them to need more in order to get the same effect. Those with a history of addition or depression may also be prone to abuse the medications. Pulmonary hypertension is a very difficult diagnosis to cope with, sometimes causing depression. With all these things considered, it is possible that some pulmonary hypertension patients may be vulnerable.

In the previous column installment, all of the patients said they favor having medical cannabis available to them and other PH patients manage chronic pain. While the inhalation of smoke is not recommended, there are other methods to consume medical cannabis, such as oils and edibles.

A study conducted across seven pain management centers in Canada concluded that the use of medical cannabis for the treatment of chronic pain is mostly safe.  Medical cannabis for chronic pain showed no difference in terms of serious side-effects between test patients and those in the control group who were not using cannabis. That includes the need for hospitalization, or even death. Researches also measured changes in pain, mood, and quality of life. Although both of the groups (that included patients with arthritis, fibromyalgia, multiple sclerosis, and spinal cord injury) improved over time, the cannabis users improved much more. Conventional pain therapies had not been effective in either control groups.

Neurological assessments showed that cannabis users had no adverse effects in cognitive function. Patients also showed no signs of damage to kidney, liver, or hormone function. Pulmonary function tests did show that those in the cannabis group had some restriction in lung function after a year, but it was difficult for researches to separate the effects of tobacco use from medical use in patients who used both.

If proven safe in pulmonary hypertension patients, medical cannabis could provide a less addictive pain management option for patients. Medical cannabis might also cause fewer side effects and long-term damage, such as kidney failure which is associated with opioid use. There have been few direct studies on the effects of medical cannabis for pulmonary hypertension patients. Some pulmonary hypertension patients have access to medical cannabis, depending on the laws where they live and choices that are made between the patient and their medical team.

I spoke to two patients who currently use, or have used, medical cannabis and typically prescribed drugs for chronic pain. They shared their experiences.

Patient Interviews

Kelly

Kelly is a young adult living with pulmonary hypertension in Canada, where medical cannabis is legal. Kelly has used Percocet for four years, which she says is fast acting to help manage her pain. Unfortunately, she found that the pain-killer makes her depressed. She also noticed that it caused brain fog, is addictive, and that she was able to build a tolerance to the dosing quickly. She also uses a cannabidiol (CBD) pill for pain management, which is non-psychoactive because of its low THC content. Although Kelly says that the CBD pill isn’t as strong as pain killers like Percocet, it doesn’t cause the brain fog or depression that she experiences with Percocet. As someone who has benefited from using CBD for pain, Kelly believes that everyone should have access to it as needed.

Kelly has a history of addiction, which is one of the reasons she received access to medical cannabis. To help avoid finding herself in a situation where she could become addicted to opiates, she turned to medical cannabis, which is believed to be non-addictive. Kelly said it is easy to imagine why some pulmonary hypertension patients abuse prescribed pain killers. She says, “it’s a slippery slope when dealing with something as devastating as PH.”

Beth

Beth* is a pulmonary hypertension patient in her 30s who used to have access to medical cannabis to help treat her pain until she moved to a state where medical cannabis is not legal. She credits medical cannabis for allowing her to function with less pain. Beth tries to avoid using pain killers unless she finds them necessary, such as for a medical procedure. Traditional pain killers made Beth feel sluggish, nauseous, and unmotivated. She shared that a member of her family is addicted to drugs, which is another reason she tries not to become drug dependent. Beth says: “unlike medications such as fentanyl and dilaudid, marijuana has allowed me to function with less pain.”

Closing Thoughts

While there is little literature available about medical cannabis for pulmonary hypertension patients, we had the chance to hear from two patients who benefited from it. If proven safe for pulmonary hypertension patients, medical cannabis could be a less potentially addictive option with fewer side effects. However, it is important to note that inhaling smoke is not recommended for patients with lung diseases and that there are other options for consuming medical cannabis, such as pills, oils, and edibles.  Different strains cause little to no high, and manage pain differently. We do not suggest the use of cannabis, unless it has been legally prescribed by your doctor. It is important to treat medical cannabis with the same amount of caution used in other prescribed medications. Please be sure to discuss your options with your specialist and pain management team.

Do you think medical cannabis could be another option for treating chronic pain in pulmonary hypertension patients?

* Names have been changed.

Note: Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this blog article are not those of Pulmonary Hypertension News, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to the disease..

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15 comments

  1. DMH says:

    It would be a bad idea for patients with PH to consider using an illegal drug. Federal laws override local ones. But putting that aside, perhaps you’re too early in the stages of PH to have the offer of a transplanted heart/lung combination. The use of cannabis is enough to keep anyone off the transplant list. While I personally am too sick to be considered for PTE surgery, or even transplant surgery, I attended a talk from the head of the Southern California transplant team as I was curious as to what was involved. An Oregon nurse was advocating for two of her patients, who were using cannabis, he said; no, we have no idea what effects this will have on a patient or on recovery and we ask that patients follow simple rules, like no alcohol, no drugs, etc. There are far to few heart/lungs to be given out, and we only give them to those who can follow the rules. It’s simple. The after life of transplantation can be grueling and if one can’t follow the rules before……
    Why take a chance on something like this? While I can’t have a heart/lung transplant, my meds are taking a toll on my kidneys and liver. I’m certainly not going to risk what I might need down the line.

    • Laws surrounding medical cannabis vary by State, Country and Province. I live in Canada where medical cannabis is legal. I have actually spoken to pulmonary hypertension patients in Canada who are on the transplant list, and are using medical cannabis, which their medical team is very aware of.

      I do understand that conventionally, and majority of the time, that patients considered for a transplant to stop drinking, smoking cigarettes etc. It is a little unfair to say that if someone cannot follow the rules before why grant them a transplant. The people I interviewed are using legally prescribed medical cannabis. I understand that medical cannabis may not be the right choice for everyone, and you raise some good points as to why, but it is important to remember that medical cannabis is legal in some places. This means that they should be treated with the same respect as any other patient taking medications to help treat their symptoms.

      My article wasn’t intended to suggest that everyone should be taking medical cannabis, just to discuss whether it was a possible option for some pulmonary hypertension patients if it is legal, and agreed safe for the patient (should they feel comfortable using it) by their medical team. It would be interesting to see more studies about medical cannabis use among pulmonary hypertension patients to see if there were any benefits, or disadvantages, to using it.

      • DMH says:

        I do understand that you were not advocating for the use of medical marijuana, however, in the U.S. there are many, not a lot of places that allow for medicinal marijuana centers to exist. In my area, the local authorities regularly bust them even though they are “legal” here. And they are NOT allowed to deposit the funds they make into a bank because they are not federally allowed to. Just sayin’. It certainly is a slippery slope.

        Now again in Southern California, the head of the transplant team said even medically prescibed usuage was a disqualifier in transplants. Period. No exceptions. One of his explainations was perhaps it was indicative of past behaviors. Maybe in Canada this is different but not here. Here if you don’t have close family support they don’t usually give you a transplant. Again, the recipent has so many things that they are going through after the surgery that this is a consideration. They are tough here, very tough, and with good reason. Too little lungs/hearts to give out. It’s not worth the risk.

        Thanks for your time and response to this.

        • Once again, you do raise some good points. However, it is important to note that it would be difficult to make a generalization because of how differently regulations vary.

          This is a follow up to a column where I spoke to two PH patients who admitted that they abused prescription pain killers, and that they knew other patients are doing the same. It may be a small part of a larger problem. This was simply a follow up to interview patients who have used medical cannabis for PH related pain, and have benefited from using it. It would be interesting to see more PH and medical cannabis related research. It can be an alternative for some, and I have only spoken to patients who use it legally and their medical team is aware that they are using it.

          There are many deciding factors when considering transplant, and as you mentioned, medical cannabis would hinder someones candidacy at some transplant centres.

    • Amy Peeples says:

      Stage 3 who class 1 IPAH . Diagnosed RHC pressures were 168. I had been sick for at least 8 years misdiagnosed . I personally get very very high every day and I kid you not , I run 6.5 miles in 60 minutes . Every day . I couldn’t walk more then 20 ft without my lips turning blue I was literally on deaths door . Marijuana helps me breath better . There is proof that cannabinoids dialate the arteries in our lungs . Also , I did my second RHC 11/14/17 and my pressures had dropped to 38. I’m on remodulin sub q, Adcirca and letairis . I’m going on uptravi soon!!!

  2. Laurie says:

    Cannabis can be a great help to those with various medical conditions. I do think it is a great alternative to some other forms of pain control that can be more addictive such as opioids. Great post, thanks for sharing!

  3. Mauro Filicori says:

    I have ben taking a daily pill of Avinza 120 mg ( a slow release Morphine) for over 10 years to help with the constant pain caused by Peripheral Neuropathy.

    Because of a real bad shortness of breath has afflicted me since the Summer a new Doctor that specialized in PHA had asked me to take both a Cat scan and a Pet scan. In two weeks I will meet with him to see where I am at.

    Meanwhile, worried and depressed, I am trying to figure out what my life could be eventually and would like to know: Is PHA so painful that patients have to use Opiods? Is the use of Cannabis for PHA to relieve the pain ( again where and what kind ? ) or to help with side effects like nausea.

    As an older patient I am very impressed by the positive attitude and desire to have a life as normal as possible that you and other commenters have shown. Thank you.

    • I am sorry to hear about the constant pain you live with on a daily basis. I am not a doctor, only someone living with pulmonary hypertension, so unfortunately I cannot concretely answer a lot of your questions. They may be best directed at your doctor.

      As the article discusses, some PH treatments can cause chronic pain in some patients. I have also had the pleasure to speak to other people living with PH on IV meds who are able to work full-time as teachers and travel, so it is important to remember that side effects vary from patient to patient. Other PH patients have chronic pain due to another chronic illness, so PH doesn’t exactly cause pain. Sometimes the pain is caused by a secondary condition, or some treatment options. Some patients experience no pain, or are able to manage the side effects quite well.

      There isn’t a lot of research in terms of PH and Cannabis use, although it has been shown to help with pain in other kinds of patients (such as cancer, and MS.) This question is probably best directed at your doctor just because cannabis is not always an option for all patients.

      Wishing you all the best with your results.

  4. Kelly Hecht says:

    Thank you to everyone who posted. I was diagnosed with pulmonary hypertension in 2013. I am 58 years old and was never Errol prior to that. I take thyroid pills cholesterol pills pulmonary hypertension pills water pills high blood pressure pills potassium it’s consuming. Until a few days ago I was unaware set medical cannabis was possibly a treatment option. That medical cannabis was possibly a treatment option. My cardioligist will probably look at me like I’m crazy. However I’m going to research it and see how far it goes. I’m interested in how it’s prescribed at what dosage in Canada. It was a heavy diagnosis when it was handed to me. I just don’t know the interaction with my meds.

  5. Jane says:

    Hi,
    I’d really like to read an article on subcutaneous Remodulin and more specifically, I’d like to hear advises from other people on site pain management.
    I’m considering using medical cannabis, but since this product is not legal in my country, I’d like to first hear how it works for other people.
    I’ve used so far paracetamol, nolotil, nimesulid and tramadol. Tramadol was a horrible experience for me and I’d rather not repeat it, even though it’s the only one which actually helped in the worst days.
    I’m quite surprised the net lacks any support groups for Remodulin users. And there is a great need for one. I personally have measured that my pulse reaches 100-110 when in pain and my saturation goes 6% down. And since acute pain lasts for more than 3 days, I think it’s critical to exchange information on best sites locations, best pain management methods and you know, just support each other.
    So please, rather than posting articles by happy people climbing rocks with their transplanted lungs (for which I’m deeply happy and wish them only well!!!), it would be useful and maybe even life-saving for some, to have an article where the last defense – the triple therapy (ambrisentan+sildenafil+remodulin) is discussed.
    So I hope this comment is read both like a suggestion and a plea – please, being the major PAH website, take the time to either give some updated information for subcutaneous Remodulin or at least, write a post on it, so that people can comment and exchange experience.
    Best!

    • Serena says:

      Hi Jane,

      I wrote the column that you have commented on. I have PH but I am not on Remodulin. However, I know that so many of my PHriends suffer from site pain – which is partly why I was inspired to write this column. Although I don’t have first hand experience with site pain, I have several friends who have a difficult time with site pain. I am sorry to hear that you have had a terrible experience with this pain as well.

      I know you mentioned you haven’t found success with support groups, but perhaps the right support group for you is still out there. I am apart of several online support groups where I have seen patients support each other through the questions and concerns you raised. Some of mentioned that they have had an easier time with IV medications like Veletri because they were unable to tolerate the site pain. However, I have interviewed patients on Remodulin who are able to return to their careers. It is hard to have a one step approach because we are all so unique in how we respond to treatments.

      I wrote this a column a while back which highlights some resources you may be interested in using to connect with other patients who could talk to you about your concerns regarding Remodulin. https://pulmonaryhypertensionnews.com/blog/2016/08/25/online-resources-for-pulmonary-hypertension-patients At the bottom of the page there is a suggestion for finding a mentor. I found this service really helpful when I was first diagnosed, they connected me with the perfect person – who I am still friends with today! I have also been able to get a lot of help from connecting with other patients who are my age on different PH support groups found on Facebook.

      Pulmonary Hypertension News also covers the latest news regarding Remodulin. You can find more information here: https://pulmonaryhypertensionnews.com/tag/remodulin/

      An implantable pump will hopefully be launched sometime in 2018. Our most recent coverage about this pump can be found here: https://pulmonaryhypertensionnews.com/2017/04/04/remosynch-implantable-pump-pah-pulmonary-arterial-hypertension-us-launch-postponed/

      The implantable pump is very exciting because it would eliminate site pain. I have spoken to a few patients who were apart of the study, and have heard really positive feedback from there experience with the device.

      Warm regards,

      Serena

      • Jane says:

        Hi,
        thank you for the detailed answer and I appologize if I sounded a bit rough. I was in site-change period if that’s an excuse.

        The reason why I’m so interested in a dedicated webpage for subcutaneous Remodulin, is because I’m a very thorough researcher and when you research it and there is no updated info – that’s not good.

        Living on this treatment is a big change and there are major things like pain and inflammation management and minor things like how to swim or shower with it, which should be public and google-able and not a topic only to closed support groups.

        Besides, I have something else on my mind. The reason for the infusion site pain is the preservative metacresol. There is a way to minimize pain and it is to have lowest infusion rate possible. Which means highest concentration possible. Because open Remodulin vials cannot be used for more than 1 month, this means hospitals cannot prescribe you the highest possible concentration. That’s something that can be solved with something as simple as having different sizes of vials. It doesn’t require research or investment, just adding 1 or 2 more vial sizes! That alone can save so much pain to so many people. But the producer won’t do it without pressure from patient organizations. Instead, they are developing new pump (Trevyavent) and blah blah more way to monetize their patent. When there is much simpler way which can be implemented in about a month.

        I know there is the implantable device – but this is an invasive procedure, it has its risks. And for smaller people, like me, it’s very questionable where they’ll fit in the pump. And also, it won’t be available in all the countries and hospitals. Also I know there is the IV alternative – but this goes with significant higher risks of life-threatening infections. It’s much simpler to pressure the producer to change the sizes of the vials and to update the guidelines.

        Anyway, just my thoughts on the topic. I’m actually very happy with my treatment, because I feel good and can work and be (more or less) normal. But that amount of pain is just wrong. There should be a better way. And since hospitals/insurers/taxpayers are paying that ridiculous price for the treatment, I think we have a right to human treatment.

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