No pills for you!

Positive pot test brings pain

Forty years after the fact, just looking at Jimmy Garland hurts.

Garland was riding his Yamaha motorcycle on Stanford Avenue in 1978 when he was struck by a Buick, suffering severe injuries to his left arm. The prognosis was poor, and four years after the wreck, surgeons amputated Garland’s arm above his elbow to help ease excruciating pain. It was an imperfect solution.
“This will be an attempt at pain relief and hopefully achieve some improvement but not completely relieve the pain in any fashion,” a doctor wrote in surgical notes.

By then, Garland was working for the state Department of Public Aid, a job he landed two years after his motorcycle accident. He started as a clerk and worked his way up to systems analyst before retiring in 2011. Doctors were right about the pain. It never went away. Garland confesses that he would drink after work to find relief.

“I couldn’t stand it,” he recalls. “Auto hypnosis, acupuncture – I tried everything.”

In 2008, Garland says, his physician prescribed methadone. It worked. “I’m taking the maximum they allow,” Garland says. “The methadone is my godsend. I’m in heaven. I’m working. Things are great.”

Late last year, Garland’s doctor announced plans to retire, and so Garland went to SpineWorks Pain Center at Memorial Medical Center in hopes of continuing his methadone regimen.

Before taking him as a patient, SpineWorks required an EKG, blood tests and a drug test, according to Garland, who has invoices showing that his insurer was billed more than $1,100. The last step was a psychological test and a conversation with a psychiatrist, he says. “They were trick questions,” he recalls.

“‘Do you want to kill your doctor? Do you want to kill yourself?’”

The day after his psychiatric examination, Garland says, he was driving to Chatham for an appointment with his chiropractor when he got a call from SpineWorks: He had tested positive for cannabis and so he would not be accepted as a patient, now or in the future. Memorial Medical Center declined comment, either on Garland’s case or on policies and practices surrounding patients with chronic pain who use marijuana.
Garland admits to puffing on cannabis concentrates before bedtime. He says that he reacted poorly to Ambien, at one point falling and cracking his head – he suspects an interaction with methadone. Cannabis, however, overcame insomnia without unpleasant side effects, he said, and so he used that instead of prescribed sleeping pills.

Cut off from methadone, Garland says he’s had no luck finding a nearby doctor who will help, and so he’s been in touch with the Mayo Clinic in Minnesota in hopes of finding a physician who will put him back on methadone. “What choice do I have?” he asks. “I’m going crazy. … I can’t hardly get out of bed.”

While Memorial would not comment on Garland’s case or its policies regarding opioids and pot, Dr. Loren Hughes, who is president of HSHS Medical Group in Springfield, said that he doesn’t believe that any local health care providers who treat patients with chronic pain have specific policies regarding marijuana and opioids. Patients asked to take drug tests, he said, should disclose any marijuana use before results come in so that there are no surprises. “What it really comes down to is trust,” he said. “I don’t think you can have a blanket (policy).”

Garland says that he was not given a chance to disclose his cannabis use prior to taking a drug test.
It’s not uncommon for chronic pain patients to be tested for drugs to ensure that they are taking prescribed medication instead of selling it and also to ensure that they are not taking illicit drugs. But the federal Centers for Disease Control in 2016 questioned the need to test pain patients for marijuana. Furthermore, the CDC said in the 2016 guidelines, doctors should not withhold treatment based on drug tests.

“(T)his could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources and the clinician missing opportunities to facilitate treatment for substance use disorder,” the CDC wrote in the 2016 guidelines.

Guidelines notwithstanding, testing for marijuana is common for patients with chronic pain, and positive results are not unusual, according to a 2017 study published by the National Institutes of Health. The study evaluated the results of more than 264,500 urine tests ordered by pain management clinics across the country. More than 15 percent of the samples were positive for marijuana, and nearly 74 percent of the samples submitted by clinicians included instructions to test for marijuana.

The General Assembly this year considered a bill that would allow anyone who has been prescribed opioids to purchase marijuana at state-licensed dispensaries. The bill passed the Senate and was awaiting action in the House at press time.

If it passes, the bill would require approval from Gov. Bruce Rauner, whose administration has rejected past moves to expand the list of maladies that can legally be treated with marijuana.

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