I was pleased to see in Dr. Sanjay Gupta’s April 2018, Open Letter to Attorney General Jeff Sessions that he addressed how medicinal marijuana could help us work our way out of the opioid epidemic. It was Dr. Gupta’s plea to Attorney General Sessions that inspired me to share my own story. If I had know in 2009 and 2014 what I know now about cannabis, my recovery from brain surgery would have been much different.
In 2005 the onset of migraines, vision problems, and pituitary dysfunction led to the discovery of a Rathke’s cleft cyst (RCC) in my brain. A Rathke’s cleft cyst is a benign growth that develops between the parts of the pituitary gland and the base of the brain. In 2009, after four years of increasing migraines and worsening symptoms, I decided to have the RCC removed by a neurosurgery team at the University of Colorado Hospital in Denver. The recovery was painful and took a bit longer than I anticipated. With one child in second grade and the other in preschool, I struggled to balance recovery, pain management, and parental responsibilities. I had been prescribed Oxycontin (oxycodone) for pain management during my recovery. The Oxy successfully took the edge off the pain, but it also made me itchy, nauseous, constipated, irritable, and wholly unable to function normally. I had also heard stories of how addicting the medication could be as well as stories of accidental overdoses, and these concerned me. After about one week on Oxycontin, I decided that the side effects were too much to manage, and I stopped taking it, only to be met with overwhelming pain. The Tylenol (acetaminophen) I was taking was not enough to manage the level of pain I was experiencing. I went back on the Oxycontin for another two weeks and battled through the side effects before finally deciding to quit Oxy once again and push through the remainder of my recovery with Tylenol only.
RCCs are notorious for regrowth, and by 2013 another RCC had grown, larger than the original. Once again, fed up with migraines and all the pain medication I was prescribed to treat them, I opted for surgery. In the fall of 2014, I underwent another brain surgery, although this time I decided to try a new treatment also, intracavitary administration of bleomycin. Bleomycin is a chemotherapy drug, and intracavitary means insertion of a radioactive substance into a cavity. Think of it as soaking a tiny sponge in a chemotherapy substance, then placing that sponge directly into the surgery site and leaving it there to allow the chemical to erode the remaining cell walls of the cyst. The purpose of this procedure is to help prevent regrowth of the RCC.
I had the same style of recovery as I did with my first brain surgery, only this time with the added pain of what felt like acid eating away at my brain…which, essentially, I guess it was. I once again faced off with my aversion to Oxycontin. Was Oxycontin effective in helping with the pain? Yes. Were the side effects miserable? Absolutely, yes. A week after my discharge from the neurosurgery ICU at the University of Colorado Hospital, the side effects of Oxycontin became too miserable to bear and I stopped taking it, deciding to substitute Tylenol instead. I found the pain to be absolutely overwhelming and once again had to get back on Oxy. After two weeks, I could stand the side effects no longer, so I began a very intense Tylenol regimen. I experienced a significant amount of pain during the last leg of my recovery and eventually a number of stomach problems as a result of taking too much acetaminophen.
Skip forward to 2015. I was still managing some pituitary function problems, but the hardest part of my recovery was behind me. I returned full-time to my position as a health and special education teacher at an alternative high school in Colorado, where I worked with youth ranging in age from 14 to 18 years. In 2014 the sale of recreational marijuana began in the state of Colorado, and when I returned to work after surgery my students had a lot of questions about marijuana. They did not understand the differences between medicinal and recreational uses or products, and quite frankly neither did I. One student asked if a child who was using cannabis for treatment of epilepsy was also getting high, and I didn’t know the answer. I was hearing a lot about concentrates and vaping, and I was frustrated by the lack of updated and accurate curricula to address all of these issues appropriately.
That year my coworker and I set out to create science-based youth marijuana prevention curricula that addressed marijuana as a legal substance and differentiated between medicinal use and recreational use as well as recognized the important differences between adult use and use during adolescence when the brain is still developing. We spent a year learning from and working with specialists in various fields to develop our programs. We worked with neurologists, pediatricians, certified addiction counselors, endocannabinoid specialists, and patient advocates, and what we learned not only reshaped our educational approach to prevention but also reshaped my personal approach to pain management. The knowledge that we gained during our journey allowed us to create science-based programming to educate youth about the risks associated with adolescent recreational marijuana use in an informed and balanced way. We were able to move away from the egg-and-frying-pan scare tactics into the world of science- and research-based educational practices.
For me, I was able to move away from relying on prescription pain medications to manage my migraines. In 2016, still suffering from periodic migraines largely a result of my previous brain surgeries, I decided to put to use my knowledge about cannabis, the endocannabinoid system, and the compounds THC and CBD to see whether I could find a better form of migraine prevention and migraine pain management. Not a fan of smoking, I researched tinctures and edibles, working to find a THC and CBD balance that was effective for me. Ultimately, I found a form of cannabis-based pain management that works better and more consistently than any of the prescription painkillers I have taken since 2005. That does not mean that I never need any form of pharmaceutical medication, because at times I do, but by and large I am able to treat my migraine pain with high CBD cannabis-based products without suffering any side effects.
As a prevention educator and a medicinal cannabis consumer, I am perfectly positioned with a foot in both worlds. I understand the risks associated with adolescent recreational marijuana use, but I also understand the benefits of medicinal marijuana. I work with educators, schools, youth-serving organizations, and parents to help with marijuana-specific youth prevention efforts, and I also regularly field questions from adults about how cannabis might help them with any number of ailments, including pain management. My personal experience allows me to bring a deeper understanding and appreciation to the professional work that I do, and when I am asked questions like the ones my students asked in 2015, I can answer them with confidence and science-based facts.
I have two teenage daughters, and I don’t hide from them the fact that I use medicinal marijuana to treat my migraines. Instead, I use it as an opportunity to talk with them about the important differences between my brain (as an adult) and their brains, which are still developing. We also talk about the medicinal uses of cannabis such as in treating childhood epilepsy and how that differs from recreational use. Had I known prior to my brain surgeries what I know now, I would not have had to choose between extreme pain and extreme Oxycontin side effects. I could have used cannabis as a form of pain management instead, and this is an option that I believe should be afforded to everyone.
According to Dr. Gupta, “Not only can cannabis work for a variety of conditions such as epilepsy, multiple sclerosis and pain, sometimes, it is the only thing that works.” From what I have learned about cannabis over the years, and from my personal experience, I believe this to be true. More importantly, I can support this statement as an educator who works specifically in youth marijuana prevention programming. I am uniquely positioned, living in the informed middle ground. For all who believe marijuana legalization must be an all-or-nothing issue, I can assure you it does not have to be. A person can support research on medicinal marijuana while still firmly opposing adolescent recreational use. One can support adult recreational use while embracing the current research that shows the risks associated with teen use and abuse. New technology provides us with opportunities for advanced research on the impacts of recreational adolescent marijuana use. Marijuana legalization efforts provide us with opportunities for advanced research into the benefits of medicinal marijuana. One does not negate the other. Legalization enables us to navigate and adjust our positions as new research informs and drives the conversation around this controversial topic.