\u201cCannabis is medically real,\u201d Jerry, 64, said in an interview at his home. \u201cI\u2019m a standing, living example of that.<\/a> Photo: Brian A. Pounds \/ Hearst Connecticut Media<\/span><\/p>\n His regimen reflects a new era of pain management. Alarmed by the epidemic of opioid abuse that has killed tens of thousands of Americans in recent years, medical professionals are rethinking how they treat pain. They no longer turn first to prescription opioids.<\/p>\n Instead, an array of new treatments such as medical marijuana are emerging, alternatives that are widely seen as carrying less risk of abuse and addiction than medical narcotics. Pre-emptive, long-lasting nerve blocks and other analgesics during surgery are becoming common. New pain drugs on the horizon include CR845, an anti-inflammatory product being developed by Stamford\u2019s Cara Therapeutics, just down the street from Purdue Pharma, maker of the now-infamous OxyContin.<\/p>\n Spurred by a growing body of research and a diminishing social stigma, marijuana has gained particular traction as a medical alternative to treating pain.<\/p>\n Photo: Carol Kaliff \/ Hearst Connecticut Media<\/span><\/p>\n Compassionate Care Center in Bethel, where Jerry procures his cannabis, comprises one of nine medical marijuana dispensaries in Connecticut and the only one in Fairfield County. Its patient base has grown tenfold since its September 2014 opening to some 3,000.<\/p>\n \u201cWe\u2019re all pioneers in this,\u201d said CCC owner Angela D\u2019Amico. \u201cWe\u2019re really setting the path for this whole industry. Connecticut is the first state with a pharmaceutical model for medical marijuana. Just like the medication you buy at CVS, all our products have manufacturers\u2019 labels.\u201d<\/p>\n Getting sober<\/strong><\/p>\n Jerry\u2019s personal pain journey mirrors the rise and fall of opioids and the recent shift to alternative pain treatments. He agreed to share his story on the condition that certain personal details, such as his last name and hometown, not be disclosed.<\/p>\n Before starting the medical marijuana, Jerry had experienced decades of treatment of his arachnoiditis, with varying degrees of success. The condition likely emerged from failed back surgery he underwent in the late 1970s and primarily affects his legs.<\/p>\n By the mid 1990s, Jerry\u2019s pain escalated to the point that he had to quit his job as a fire and arson investigator for a major insurance company. He could not get enough prescribed opioids to dull his discomfort, so he resorted to buying unprescribed painkillers, like Percocet. The pain also pushed him to drink more.<\/p>\n Jerry got sober about 20 years ago \u2014 he says he has not taken a drink or an unprescribed pill since then.<\/p>\n He initially looked skeptically at medical marijuana because he feared it would undermine his sobriety. But the support of his pain-management doctor, wife and then-AA sponsor convinced him the treatment deserved a try.<\/p>\n Pain and weakness still require him to use crutches to get around, but he can enjoy activities such as swimming with his dogs. He also travels; he did most of the driving on a trip he and his wife took in October to Myrtle Beach, S.C.<\/p>\n Jerry said he has not become addicted to the marijuana. Being clear-headed is crucial to him serving on the boards of Connecticut\u2019s Beardsley Zoo and the social-service agency Recovery Network of Programs. The type that Jerry and other CCC patients take is not addictive because it works on non-opioid nerve receptors, according to D\u2019Amico.<\/p>\n <\/a><\/p>\n Photo: Brian A. Pounds \/ Hearst Connecticut Media<\/span><\/p>\n A syringe filled with medical-grade cannabis oil and a filled capsule are shown at Jerry\u2019s Bridgeport-area home on Tuesday, Nov. 21, 2017.<\/p>\n \u201cYou could not be a (board) secretary of a $30 million corporation (RNP), if you were stoned; it\u2019s not the pot I used to know from college,\u201d Jerry said. \u201cMy experience is not one of getting high, but one of feeling calm and not thinking about the pain.\u201d<\/p>\n Insurance generally does not cover treatment with cannabis, and treatment provided by CCC can run between $250 and $1,500 per month. But CCC offers many discounts. In some cases, it covers all costs for terminally ill patients who are struggling financially.<\/p>\n Rethinking pain management<\/strong><\/p>\n Use of opioids such as OxyContin, from Purdue Pharma, has tapered off in recent years as medical professionals have become more aware of their risks. The amount of opioids prescribed in the U.S. peaked in 2010 and then dropped each year through 2015, according to data from the U.S. Centers for Disease Control and Prevention. But the 2015 prescribing rate still ran at more than triple the 1999 rate.<\/p>\n The growing wariness of opioids has created an opening for competitors.<\/p>\n A block away from Purdue\u2019s headquarters at 201 Tresser Blvd., Cara Therapeutics is working on a drug that could challenge the dominance of OxyContin.<\/p>\n Cara\u2019s first product is an anti-pain and anti-inflammatory drug named CR845. It would treat conditions including hip and knee pain.<\/p>\n CR845 would represent a more powerful pain treatment than over-the-counter medications such as Advil, but it would prevent addiction because it would not act on the brain, said Cara CEO Derek Chalmers.<\/p>\n <\/a><\/p>\n Photo: Michael Cummo \/ Hearst Connecticut Media<\/span><\/p>\n Derek Chalmers is CEO of Cara Therapeutics, a Stamford-based biotech firm that is developing new drugs to treat acute and chronic pain that aim to reduce the risk of addiction, by not acting on the body\u2019s central nervous system.<\/p>\n \u201cBy shutting down the nerve activity at the site of injury, it can produce … anti-inflammatory activity in the absence of a central nervous system brain effect, so you don\u2019t induce euphoria at all,\u201d Chalmers said in an interview at the firm\u2019s headquarters at 107 Elm St. \u201cThe drug is entirely non-addicting.\u201d<\/p>\n Cara aims to file its first new drug application with the FDA within the next two years.<\/p>\n Purdue officials cite efforts to diversify their pain-relief products beyond OxyContin. Among ongoing initiatives, the company has partnered with biotech firm AnaBios to research alternatives to opioids and non-steroidal anti-inflammatory drugs.<\/p>\n Striking a balance<\/strong><\/p>\n Lawmakers in several states including Connecticut have moved to stanch the flow of narcotics by enacting new restrictions. The General Assembly last year passed legislation that generally prohibits medical practitioners from writing opioid prescriptions for more than seven days to minors, or adults who are taking the drugs for the first time.<\/p>\n But doctors warn against overregulation.<\/p>\n \u201cWe\u2019ve got to be very careful that legislative efforts that try to deal with the opioid epidemic don\u2019t turn into window dressing about how many pills can be prescribed at a time,\u201d said Dr. Jeffrey Gordon, immediate past president of the Connecticut State Medical Society. \u201cThat doesn\u2019t get to the root of the problem. We want people who have legitimate pain, as assessed by their doctors, to be able to get the medications, such as opioids, that they might need.\u201d<\/p>\n In hospitals and medical offices, doctors are increasingly turning to alternative pain treatments that can offer patients as much relief as opioids while greatly reducing their risk of addiction. At Stamford Hospital, nerve-block treatments were used last year in 79 percent of orthopedic procedures and 75 percent of other operating-room procedures.<\/p>\n \u201cIf you do pre-emptive analgesia, that\u2019s one of the most important things to do,\u201d said Dr. Betty Ann Robustelli, the hospital\u2019s chairwoman of anesthesia. \u201cThe nerves aren\u2019t fired up, and it really reduces the post-op pain you see in a lot of cases.\u201d<\/p>\n Dr. Paul Sethi, a Greenwich based-surgeon at Orthopaedic and Neurosurgery Specialists, said about half of his patients who undergo shoulder surgeries with a new novocaine derivative injected during surgery are not requiring any post-operative opioids. The other half need significantly fewer narcotics than they would have needed typically without the local anesthetic, called Exparel. The treatment can keep the surgical area numb for three to four days, the period of most intense pain following surgery, he said.<\/p>\n <\/a><\/p>\n Photo: Michael Cummo \/ Hearst Connecticut Media<\/span><\/p>\n Dr. Betty Ann Robustelli, center, and Dr. Juliet Jackson use an ultrasound machine inside Stamford Hospital in Stamford, Conn., on Jan. 16, 2017. The machine helps anesthesiologists deliver numbing agents more efficiently and safely.<\/p>\n \u201cMy patients are my teammates in their care,\u201d Sethi said. \u201cI have patients who come in and say \u2018I don\u2019t want to want to take these opioid medications.\u2019 And I say \u2018OK, let\u2019s talk about it, and let\u2019s explore different alternatives.\u2019\u201d<\/p>\n Effective responses will not necessarily erase pain or eliminate opioids. When Jerry occasionally experiences \u201cbreakthrough\u201d severe pain, he might take a morphine pill. His other treatments include a pump implanted in his side that dispenses minor amounts of morphine to his spine.<\/p>\n <\/a><\/p>\n Photo: Keelin Daly \/ For Hearst Connecticut Media<\/span><\/p>\n![\"Jerry](\"http:\/\/ww2.hdnux.com\/photos\/67\/63\/50\/14629433\/14\/920x1240.jpg\")
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