Cesamet (Nabilone) vs Old School MJ

[Catie]

Anybody on Cesamet (Nabilone) who used to smoke MJ, or vice versa?

I'm curious about how it helps pain, anxiety, appetite, etc... comparatively. We spend so much money on MJ every month (unfortunately we aren't in a medical state) and I'm starting to look around for other options that might me less expensive, or least more legal.

Any thoughts would be appreciated!!

<3
Catie

[foxgrove]

OK.. Yup, I'm on Nabilone... nope I haven't smoked... but I can give you a little insight. 

In my experience.. (note that I say this.. others have had different reactions)... No there is no buzz past the first dose and it has very limited pain relieving qualities.  Where it helps me is reducing my skin sensitivity so I can wear clothes and sleep under a blanket.  The cost difference is HUGE!!!  Nabilone is $400 per month at the minimum.  Compare that with growing your own and it quickly becomes a huge difference.  For me, nabilone is covered by my insurance, MMJ is not.

The problem is that they have only synthesized one portion of marijuana.. the THC.  From what I understand (I haven't smoked weed), the THC levels are only one side of the equation.  Finding what works to relieve your pain requires a precise mixture of the 61 cannibinoids that exist in marijuana, mainly focusing on the Tetrahydrocannabinol (THC) and Cannabidiol (CBD) levels.  THC is actually the mind altering ingredient, causing agitation and restlessness... CBD is the mellowing and sleep inducing ingredient.  I find it very odd that they would not include CBD in a synthesized cannibis med meant to reduce our pain levels.

Take this all with a grain of salt.  Remember that I don't have first hand experience with marijuana but I do have a fair amount of experience with opiates and the feel of a strong med.  It does not appear to me to be a strong pain reducing med. Generally I would say that unless you get a marvelous reaction to Nabilone, it's really hard to justify the cost.

If you have any questions about it though, please feel free to ask.  I am hoping one of these days that my doctor will OK an MMJ card for me but that's a rarity in Manitoba and it would be costly for me as it isn't covered by my insurance.  Still.. some pain relief would be most welcome!!!

[Catie]

Sadly, the $400 per month for the Nabilone wouldn't be a huge jump in cost for us. We already spend $360 per month on MJ. My hope would be that it would at lease be covered by insurance and then be cheaper...

Sucks it doesn't do anything for pain... The pain docs we have talked to won't help Dan much unless he quits smoking, which he's scared to do because it does so much for him (anxiety, appetite, pain...) but at the same time it doesn't seem to be enough anymore. I'm also afraid he's got Narcotic Bowel Syndrome (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2074872/) which basically mimics all the symptoms of IBS and gastroparesis, his main gastro issues.

I feel like if we could find an alternative to smoking then maybe he can get some actual prescribed pain relief too... =/

[jaiser]

Catie,

I'm clueless when it comes to pain clinics as I don't use one.  Do they test for the presence of MJ in their patients' systems? If not (and I don't normally advocate this), LIE.  If the MJ is providing relief in one area, I see no reason not to continue it. At the risk of being too nosy (and even more clueless), if Dan has NBS, wouldn't a prescribed pain med worsen it, given that they're mainly narcotics?

You mention you're not in a medical MJ state, which is unfortunate.  I'm assuming you're buying "street" MJ?  Do you have any idea what strain you're getting?  I ask because there are SOOOO many out there and if you could find out which strain you're buying - and conversely, which strains are available - Dan might be able to find one that works better. There's a site, Leafly.com, that describes the various strains.

Also, $360/month? Either Dan's use is quite high (no pun intended) or the dealers in your area are robbing you blind.  I'm in a legal state, and the dispensaries sell the really good stuff at @ $20.00/gram. Granted, my usage is pretty low, but still...

If smoking is a concern for other reasons (i.e., getting carcinogens from the smoke), he could also use a vaporizer.  The effects are slightly different (though not enough to matter) and you get ZERO smoke.  Hopefully, this helps somewhat. I'm feeling a bit "off" today, so my reply feels really disjointed and, well, crappy.

[Catie]

The initial pain center we visited did conduct a complete drug screen urinalysis, or we would have lied. They kinda sucked away (that's a whole saga in itself). We haven't had an opportunity to try to find another one yet, so I don't know if every pain doctor around here is like that, or just that particular center.

I hadn't thought about the NBS being worsened by a prescription drug... It would be VERY difficult for him to give it up so I hadn't thought much about it, I guess...

We live in Ohio but we're 20 minutes from Michigan, which IS a medical state. We've been trying to hook up with people who have access to dispensaries in Michigan to latch on to certain strains. $360/mo is actually low for him; it used to be $400/mo; he smokes about 2 ounces every month, depending on pricing and such. Side note: his dad pays upwards around $400 an ounce for what's considered good stuff around here, supposedly from Cali...

Thanks for the input guys.

[jaiser]

Hmmm...

Some thoughts:  You could call the pain center and ask them what are their requirements.  The NBS is a concern; but then so is constant pain.  It's a coin-toss, sadly.  As for giving up something that works... Again, a coin-toss.

I did a bit of research and found (to my great surprise!) that the price your paying is really not that out of line.  I use such a small amount, relatively speaking, that I've never priced ounces; I only buy in grams.  A quarter ounce of a good strain here is about $110-$130, so $360-$400/month really isn't out of line.  Now, the $400 an ounce his dad pays... *That* stuff should not only kick the pain, but cook, clean and tuck him in bed for that price.  LOL

There is a %($*%#%$# legal issue here in MI now.  The State Supreme Court has ruled that MMJ patients can buy MJ, can grow MJ, can sell (if they're a certified caregiver) MJ to patients, BUT... Dispensaries are not allowed under the law.  How stupid is that!? There's a huge push here to get new legislation that would allow dispensaries; many are currently still operating, but at great personal risk. I went to one the other day, and they'd lost about 50% of their staff due to fear of being arrested.  Hopefully, this gets resolved soon. 

Sadly, my insurance doesn't cover it either (not sure any insurance does; if it does, sign me up!). 

I'll PM you shortly with more.

[Lucky1]

     HI Catie & Dan     I am not sure where I posted it but GET OT OF THAT(ANY) PAIN CLINIC, A.S.A.P.
  F those jerks!
   I do not want to be treated like a criminal!  Those MFs just want to make you suffer, that's why they call it a pain clinic. The more pain you can withstand, the more successful they think they are in "Managing" your pain.  They interrogate you constantly to see if they can find any reason to further reduce your meds.
This is the way they measure their success, by cutting your meds. again and again, see it is working!
Find a Neuro or Rheummy or a D.O. or a PCP who will get to know Dan and trust him.
Or FIND ONE @ American Board of Pain Medicine.org <corrections 2/21- (ABPM.org)
A PERSON SHOULD NOT HAVE TO LIE TO HIS DOC, TRUST IS A MUST BETWEEN DOC & PATIENT.
  I was so happy to get back to my PCP.  We trust each other, I don't have to pee in a cup.
You can get good weed here for $250-300 per oz. That's about $10 per gram. That is down from $400+                       
  I have more to say, but I gotta go.  good luck

[Catie]

Hey Lucky,

We lasted only one appointment there. Dan wasn't comfortable there so we left. I refuse to send him somewhere where I don't feel like we can be honest with the doctors, and more importantly where Dan doesn't feel comfortable. We haven't found a new one yet, we've had other things on our plates, but it's high time we got some specialists to rely on. We have a GREAT PCP, I absolutely adore him. He's smart and honest and we're honest back. It really is a great relationship.

Looking forward to finding other doctors that give us that feeling. I think 2013 will be our year to "shop around" for specialists...

[looneylane]

I never got to a pain clinic but here they area bit different and focus on holistic that includes behaviour and pain management.

[juss74]

Ive been wondering about this drug too but for me here in Australia it would be heaps cheaper because prescriptions for low income earners are only $5:90 and i could probably get a months worth for that

[foxgrove]

Talk to your doctor and see if they might be interested in starting you on it.  Nabilone is just like any other med.. you start low and work your way to the proper dose for you balancing between side effects and benefits.  Yes, it is expensive but as you said, when medication insurance comes into play and makes it affordable, why not try it. 

[looneylane]

I realized my post is missing some deatails. I never went to a strictly medcine based pain clinic like most people think of I went to a pain management and physical rehab clinic in Regina. Sometimes the fog leaves me unable to fill in important details. Pain management and treatment has to fit individuals and their abilities. Some need physical treatment some need medicinal. I personally dont believe smokig MJ is a good option as there haave been a lot of discussion about ingesting being a far more effective in pain management than smoking and with far less harmful effects. It isnt a subject i take lightly and truly believe if it gives you real relief then I hope you have access to it as a medecine. Pece healing and pain free days is what I pray for all of us.

[foxgrove]

Wow... You mean to say that the "normal" pain clinics are medication only??  I didn't know that any of them were strictly medication based.  That actually sounds really scary.  If they don't teach you the other therapies or at the very least, open the door for you to access them, then I truly do wonder at their usefulness. 

If any of you have been through a medication only treatment and haven't been introduced to the other coping mechanisms available to fibro folks to reduce their daily pain levels and thus reducing their dependance on meds for pain relief... please please PLEASE dig through here and find those therapies.. We talk about them all over the place.  You can find a good example of what needs to be in your fibro toolkit here:

https://docs.google.com/viewer?url=http%3A%2F%2Ffibromyalgia-support.net%2Fdownloads%2FPainToolkit.pdf

[jaiser]

I've been AWOL for a while now (much too much of an update for this post), but yes, Fox - In the good ol' US of A, pain clinics are drugs only and they treat you like a criminal. Now there are holistic places too, but the "normal" definition of pain clinic here is essentially the narcotic dispensary.

Someone commented on smoking MJ not being the best road to go. I agree; you get the carcinogenic effect of inhaling a burning plant. Edibles are great if you can find the right dosage (depends on who makes them and how). Another very safe method is vaporizing (this is my main method, actually). You get the THC, etc. in a vapor form and no smoke is inhaled - mainly due to the fact that no smoke is generated.

[looneylane]

It was probably me about the smoking thing to many years as a fireman drilled into my head the toxic effects of all kinds of smoke! There is no good smoke so if you can ingest it other ways or vaporize it that sounds like a good idea probably wouldn't work for me as I would still probably feel stupid after partaking as me and mj are not a good mix.. think brain fog multiplied a thousand times..