For almost 50 years now I’ve suffered from a debilitating, often crippling and painful condition called Still’s Disease, a form of juvenile rheumatoid arthritis which strikes children. I contracted the disease at 12 years of age. When I search for an image for the condition I imagine “a hard winter of the bones”.
Fifty years of experience with almost every kind of arthritis drug – steroids, gold, non-steroidal anti-inflammatories (NSAIDs), immunosuppressants, chemotherapy and most recently monoclonal antibodies, as well as many varieties of painkiller ranging from paracetamol to DF118 – has taught me that there are no free lunches. All drugs have side-effects, and some of them are pretty dramatic. One trendy item, for example, gave me a perforated bowel and three weeks on morphine and antibiotics in a London hospital. It almost killed me. Steroids cost me my hips – a side-effect known as steroid necrosis – at 27 years of age. I have more allergies to medication than I like to think about. One of them, Diclofenac, an arthritis drug used to reduce inflammation and relieve pain, causes my throat to close – a potentially fatal response.
Over time (and I’ve had plenty of time at this) most drugs cause serious problems. With a condition like mine you gradually run out of options and end up rationing your medication in order to minimise the side-effects. The other side of that coin is that you accept more pain, more rest, less activity, a narrower lifestyle.
So when politicians express a delicate concern for the possible side-effects of legal medical cannabis I am inclined to hollow laughter. I am prepared to enter an experiment with any politician: he or she can take my usual cocktail of anti-inflammatories and painkillers for a week and I’ll take medical cannabis and let’s see which of us comes out in the best shape after a week’s work.
Cannabis and pain treatment
Cannabis is increasingly used to treat severe chronic pain, as well as numerous neurological conditions. Neurologist Dr Colin Doherty, for example, speaking to the Oireachtas Health Committee recently, stated that the benefits of medical cannabis in his field could be “transformational”. Studies, hitherto mainly concentrated on the effects of illegal cannabis, are now beginning to find benefits in many fields of medicine – specifically in relation to inflammatory diseases such as arthritis. Not enough work has been done on it, of course, partly one assumes because Big Pharma has a vested interest in preventing the medical use of a plant that you can grow in your back garden. But to me it looks hopeful.
What would I like to be able to do with medical cannabis? Already I mix and match my medications, seeking always to minimise the problems they cause. I’m fortunate to be cared for by wonderful doctors who understand my condition and who support my strategy. Ideally, I would like to be in a position to substitute medical cannabis for the painkillers I take, and possibly for the non-steroidal anti-inflammatories. It remains to be seen whether that strategy would work, but I would like to have the opportunity of testing it out under medical guidance.
The research I have done suggests it might very well work, and that it might in fact replace both types of drug. There are versions of medical cannabis that balance the pain-killing (and psycho-active) effect against the anti-inflammatory element. In Italy, for example, where they buy their medical cannabis from the Dutch government, there is a variety called Bediol with 6.5 per cent THC (psycho-active, painkiller) and 8 per cent CBD (anti-inflammatory).
Side-effects of prescription drugs
One of the big objections that governments and some parts of the medical profession have to cannabis is the “high” or psycho-active effect. But it’s not as if the prescription medication I take is not psycho-active. Take Tramadol, for example. It is a strongly psycho-active opioid with all the dangers of addiction and other side-effects of opioids. On the days I have to take Tramadol (I ration myself), I simply cannot work. I am disorganised and unable to assess situations properly. My moods are altered. If I take it late in the day I don’t sleep. My cognitive abilities are impaired. Taken over a series of days it causes severe constipation, sleeplessness and, significantly, dependancy. Withdrawal causes depression among other things. I can’t wait to stop taking it, and when I do I find the withdrawal hard. It’s worse the longer I take it. The humble and rather old-fashioned anti-inflammatory Naproxen, which is the only NSAID I can still take, also causes mood changes.
By contrast there are no known long-term negative effects for medical cannabis taken according to prescription. In part this is because most of the studies in the past have concentrated on illegal use of the drug, often in combination with other illegal drugs. It is probable, as the drug is more widely used for treatment purposes, that hitherto unseen effects will emerge. However, I suspect most resistance to medical cannabis is a simple moral objection to the “high” – probably a hangover from the days when our present politicians hated hippies. However, the “high” from Tramadol is, in my experience, stronger than even recreational cannabis and at least as disruptive of thought processes, possibly more so.
‘My fear is that I will be on the outside looking in’
So, it seems to me that, at the very least, it is possible to insert medical cannabis into the cycle of prescription medication with the expectation that it will make it less necessary to use the more unpleasant drugs. It is also possible that it will completely take their place.
My fear is that, with the understandable concentration on much more severe and dangerous conditions – epilepsy, cancer, chronic severe pain etc – someone like me who comes to cannabis because other options have been exhausted will find himself on the outside looking in. If that is the case, expect to see this Irish writer in court for the purchase of an illegal drug. I am running out of alternatives.
Arthritis in Ireland
According to Arthritis Ireland (arthritisireland.ie), about 1,000 Irish children have some form of arthritis, while the total figure for rheumatoid arthritis including adults is 40,000. It is most common among women (70 per cent of all sufferers). Arthritis Ireland estimates that 70 per cent of all sufferers cannot work outside the home because of the severity of their condition.
William Wall is the author of four novels, two collections of short fiction and three volumes of poetry. His most recent book is Hearing Voices Seeing Things (Doire Press, 2016). His new novel Grace’s Day is forthcoming in April 2017 from New Island
