The year 2017 will be remembered as the year Canadian media finally got serious about reporting the deadly epidemic of opioid addiction in this country. The Globe and Mail, the CBC, the Toronto Star, Maclean’s, the Huffington Post, and many other outlets have devoted not just isolated stories but aggressive ongoing coverage of what is now considered to be the gravest health-care crisis of the twenty-first century.
The company that patented OxyContin, Purdue Pharma LP, has earned over $30 billion (US) from the drug since it was introduced in 1992. An aggressive marketing campaign focused on the drug’s revolutionary ability to treat severe pain over long periods of time, but the company has long been accused of concealing the risks of addiction inherent in its signature product.
In 2007, Purdue Pharma was forced to pay a $635-million (US) fine after three of its top executives pleaded guilty in a US Federal Court to criminal charges that they deliberately misled the government, doctors, and patients about OxyContin’s addiction properties. It was the largest monetary penalty in US pharmaceutical history, but it was equivalent to less than the amount of revenue the company earned on the drug every six months! In 2017, the company settled a class-action suit brought against it in Canada for $20 million, representing 2,000 Canadians who had become addicted to OxyContin. The company and other makers of prescription opioids continue to face lawsuits and accusations in many US states and in Canada concerning addiction, negligence, and misrepresentation of the drug’s benefits. And all makers of prescription opioids, like Vicodin, Demerol, Percocet, and their many generic equivalents, are bracing for a crackdown.
Sure, millions have found pain relief from OxyContin and its opioid cousins, but at the cost of thousands dead and tens of thousands addicted. The Globe and Mail reported that, since the turn of the millennium, over 6,000 people in Ontario alone have died from opioid abuse. Billions of dollars have been earned, but at the cost of billions more to the health-care system to treat addiction, and to the economy in lost productivity. And the true cost to families—that may be impossible to put a number on. In 2017, we’re starting to learn the tragic truth about prescription opioids. And even though pharmaceutical companies have been lying to the government and doctors for decades, it’s hard to forgive their ignorance. After all, these are opioids—powerful narcotics synthesized from the opium poppy—the same drugs that many governments sought to ban in the early twentieth century before they decided that it would be politically easier to demonize cannabis — a non-addictive, non-lethal drug.1
After my car accident, my doctors prescribed me opioids for the pain—morphine, Percocet and Demerol at first, and later the infamous OxyContin. I was taking up to 80 milligrams a day just to be able to sit up, walk, and get through my agonizing physical therapy. I never questioned my doctors — I just wanted pain relief. I wanted some part of my life back. But with each patented time-release capsule I popped, I was unwittingly sinking deeper and deeper into an abyss of depression, addiction, and bodily harm. I suffered through the side effects—vomiting, dizziness, irritability, headaches, a zombie-like state of constant drowsiness—because I so desperately needed the pain to go away. Recent studies have shown that prescription opioids can wreak all sorts of gruesome effects on the human body, including irregular heartbeat, difficulty breathing, swelling of muscle and organ tissue, and cyanosis (when your skin, lips and fingernails turn blue from lack of oxygen). We also know (now) that the most catastrophic effect of long-term or excessive prescription opioid use, other than simply death by overdose, is liver failure. The liver is responsible for metabolizing opioids (and other drugs introduced to the body, from Tylenol to alcohol and cannabis). Medical science is just starting to learn how the liver’s basic metabolic operations can become over-taxed by opioids, so severe is the process of metabolizing them. It’s like running your car at 7,000 rpm for hours on end—eventually the engine is going to overheat, the oil is going to burn out, and your car will break down in a smoking heap of charred metal.
Your liver uses special enzymes to metabolize drugs and introduce their beneficial (e.g. pain-killing) properties into your bloodstream. These enzymes essentially die off during metabolism and need to be regenerated. Your liver works hard to reproduce them—sometimes so hard that the organ itself becomes enlarged and starts interfering with other bodily processes. This is what happens with opioids like OxyContin. The liver can also simply start to decay from being overworked. With alcoholism this is called cirrhosis. With opioids it’s simply called failure. And it was, in truth, a massive failure, not just of my own body, but also of the people and institutions that recommended opioids to me in the first place.
My doctors told me I had a year to live—maybe less. This was after I returned home from Cuba, after I registered at Vancouver General Hospital for a course of chemotherapy that left me strung out and vomiting and barely able to stand, after I was prescribed a second, more intensive type of chemotherapy which also failed to work. When I treat or counsel people—anyone who’s suffered from the trauma of cancer—I know I can look them straight in the eye when I speak to them about the difficult choices they face. I’ve faced them too. “Get your affairs in order,” Susan’s oncologist told her. “Get your affairs in order,” Manni’s oncologist told her. That’s exactly what my doctors said to me in 2004. Chemo wasn’t working. My body was too broken. Within a year, the doctors told me, either my liver would fail completely, or I might hemorrhage and bleed internally to death, or the cancer would simply destroy my immunity and a simple infection would be the death of me. “One year to live.” Maybe.
Ironically, it was in Cuba where I met the first doctor who warned me about prescription opioids. When he saw my prescription dosage, he was alarmed: “You’ve got to get off those.” He was shocked my Canadian doctor had said it was okay for me to have even one drink. After the extent of my liver damage was confirmed back in Canada, quitting opioids became the first priority to salvaging even one year of life. It wasn’t easy. Opioid addiction is chemical — the receptors in your brain get used to the drug and can’t function without it. This happens to about 25 percent of regular opioid users.2 The addiction is also psychological—after using opioids for 18 months to mitigate the extreme bodily pain from my car accident, I was dependent on them to get me out of bed in the morning, to play with my kids, to sleep through the night. And so I had to face a difficult truth that made me feel weak and retrograde: I, Sam Mellace, am an addict.
My wife helped me enroll in a Suboxone detox program. Suboxone is the brand name of a mild narcotic called buprenorphine, which is used to treat pain and can be addictive, and is slightly less destructive on the body. It’s a rehabilitation drug because it helps wean opioid addicts off of hard-core drugs, the way a sugar addict might go on a crash diet but still allow himself a daily spoonful of honey to ease the shakes. But quitting prescription opioids even with the help of Suboxone was a wild nightmare. I was insufferably irritable, and I couldn’t sleep. My joints swelled up, and the orthopedic injuries to my hip and back returned, which brought on a bout of post-traumatic stress as I found myself reliving the accident again, feeling sorry for myself, then becoming enraged and finally just tired. Moreover, the doctors worried that my liver might not be able to handle even buprenorphine, and the realization that my liver might just shut down at any moment made me anxious. It’s no surprise I couldn’t sleep.
For the salvation of my life in that hopeless moment, I give full credit to my wife. And not just in the poetic sense of giving me something to live for—she saved me in a very real and medical way. After I’d lost a few days in detox and was sure I couldn’t survive, my wife got on Google looking for “alternative opioid treatment” and after a few clicks she found herself staring at a recipe for marijuana butter.
She called a friend, who called a friend, and within a couple of hours she had an ounce of some powerful strain of kush, and she followed that recipe to the letter. Neither of us recalls the web page, but it was probably one of thousands in those early days of the Internet when half the things online seemed to be taboo. She made a small tub of highTHC butter, and then baked up an enormous batch of chocolate chip cookies.3
She brought them to me at the detox centre the next day. I think I ate just three of them, but after about half an hour, my body began to feel light. The pain in my back became tolerable, like a dull thudding ache rather than a searing bolt of terror. My anxiety and nausea melted away, I became relaxed and calm, and within another hour I was fast asleep. I slept for three days, waking up only long enough to eat more cookies. I quit detox then and there. I quit every other type of medicine. My future, whatever it was, lay in cannabis.
In the weeks that followed, my wife and I read everything there was to read about cannabis—about Dr. Mechoulam and cannabinoids, Pierre Trudeau and the Le Dain Commission, Jim Wakeford and Terry Parker. We navigated the bureaucratic terminology and convoluted guidelines of the MMAR, and decided I had to apply for a Section 56 exemption. With cancer I was eligible—at the time, only patients of cancer, AIDS, epilepsy, multiple sclerosis, and severe arthritis could apply. Today, thankfully, there are dozens of eligible ailments. Sure, I could have called my cousins and landed an endless supply of black-market weed to self-medicate, but even in my desperation I felt resolved not to rekindle my ties with my dubious past. Health Canada obliged me to have two doctors sign off on the prescription, which wasn’t terribly difficult given the horror of my medical chart.4 A few months after my diagnosis of cancer, diabetes, liver disease, and opioid addiction, I became the hundredth or so Canadian to receive a Section 56 exemption under the MMAR. The license was full of warnings and jargon, but essentially the government of Canada said to me: “Okay Sam, we hear you’re going to die, so here, get high on us.”
1 Prescription opioids like OxyContin are classified as Schedule II drugs in the US and Canada, meaning they have a moderate potential for addiction and abuse. You’ll recall from Chapter Three that cannabis has long been a Schedule I drug, implying it’s even worse. That level of gross negligence in drug policy is the most unforgivable aspect of the whole sordid story of the “War on Drugs.”
2 By comparison, some studies of cannabis have estimated that about nine percent of heavy cannabis users will become addicted. But cannabis addiction and opioid addiction are vastly different things, in terms of what your body endures.
3 As an emerging diabetic, cookies may not have been the best idea for me. But facing pain and death from all directions, I deserved a fucking cookie!
4 The two-doctor provision of the MMAR was a terrible obstacle to most patients back then, because most doctors still believed that cannabis was a dangerous psychosis-inducing drug and only people facing imminent death should use it. Remember, the endocannabinoid system was not yet common knowledge in the medical establishment. Even today most doctors still view cannabis with suspicion.
Excerpted from The Great Cannabis Conspiracy by Sam Mellace. Pre-order the book here.
Dubbed “the King of Pot” by National Geographic’s Lisa Ling, Dr. Sam Mellace has been one of Canada’s leading medical marijuana advocates since he was first prescribed cannabis to treat pain and liver complications from a brutal car accident. Like many of his patients, Sam is also a cancer survivor, and has treated thousands of people living with a variety of pain, disease, and illnesses with his cannabis oils, extracts, and other remedies. He believes in establishing a national framework for a patient’s rights to access medical cannabis and advocates for a Royal Commission on Canadian cannabis policy and legality that will enshrine patients’ rights in future legislation. He famously (and legally) smoked a joint in the House of Commons in 2010 to protest the government’s failed medical-marijuana policies.