Document text
1 of 3 Premium Clicks used this month SUBSCRIBE Print + Online Subscriber Activation | Register x Forgot Password | Need an Account? e-edition | subscribe | newsletter | deals Home News Latest Stories Gov. Kitzhaber resigns: 'I have become a liability' Emergency services, Feb. 14 Community leaders saddened by governor's departure Successor Kate Brown must run for election in 2016 She needed time to think Crime, Courts and Emergency Services Emergency services, Feb. 14 Police arrest robbery suspects who wore underwear as masks Purple Parrot robber sentenced Busy burglar still at large in Medford Sheriff's lieutenant may face misconduct charges over ticket dismissals Politics and Elections Gov. Kitzhaber resigns: 'I have become a liability' Community leaders saddened by governor's departure Successor Kate Brown must run for election in 2016 Gov. Kitzhaber announces resignation Read Gov. John Kitzhaber's statement on his resignation Education Logos to receive a slice of Wes Howard Memorial Sports Park Medford School Board OKs full-day kindergarten Former superintendent sues district, board member Sharing black culture SOU board names officers, committees Environment Coho salmon road trip Mt. Ashland Ski Area celebrates snow Company fined for illegally dumping asbestos in White City Solar pavilion going up at Coyote Trails GMO opponents can join Jackson County in defending ban State News Gov. Kitzhaber announces resignation Read Gov. John Kitzhaber's statement on his resignation Top Democrats call on Kitzhaber to resign Legislative leaders join in call for Kitzhaber resignation (updated) Oregon secretary of state calls meeting with governor 'strange' Nation - World Obituaries William J. Holloway Pauline Mae Barnett In Loving Memory of Fred Keene Daniel Arthur Anderson Weather Photo Galleries Since You Asked Videos Web Cams Mail Tribune 100 Shareable This $1 million Mercedes is like an armored private jet for the road Sports Latest Stories Phoenix opens strong at District 3 tourney Beavers win opening baseball game All-Star weekend returns to frigid New York Crater's defense keys triumph over Churchill No. 3 Gonzaga rolls over Loyola Marymount Varsity 541 College Sports Beavers win opening baseball game No. 3 Gonzaga rolls over Loyola Marymount Graduate transfer rule comes under scrutiny Quarterback carousel With Hanson's return, Beavers at full strength Pro Sports All-Star weekend returns to frigid New York Vikings chief says he's support Peterson’s return Puppies, rings, mullets highlight Daytona media day Rose scores 30 in win over Cavs Daly has best first round in 10 years Community Sports Local Events Business Latest Stories Blog: Once Upon A Valentine's Day Medford airport flies past January record Carestream innovation opens new direction Cooperation, not confrontation Ride & Drive: 2015 Dodge Challenger R/T Scat Pack Real Estate News Housing prices climb 9 percent in Jackson County Big plans on the Butte Homes for the long haul New owners of Medford Center promise a hands-on approach: Home loan rates continue to fall, applications soar People In Business People in Business Transportation Medford airport flies past January record The heart of Brammo will remain Want to be an investor? Four companies will be pitching their plan to you Agriculture 1-800-Flowers dumps Harry & David execs Nine companies pitch investment opportunities in Medford Darigold to shutter Medford plant, putting 29 out of work Opinion Latest Landgren cartoon: Disneyland measles outbreak Matthew T. Mangino: The government has access to your emails Letters to the Editor, Feb. 13 Our View: Time to end the vaccine exemption Guest Opinion: Weed killers should not be sprayed on streams, homes Editorials Our View: Time to end the vaccine exemption Our View: Hemp hemp, hooray — old crop is new again Our View: Maintaining a major community asset Our View: A small contribution to fairness Our View: Call for resignation is premature Letters to the Editor Letters to the Editor, Feb. 13 Letters to the Editor, Feb. 12 Letters to the Editor, Feb. 11 Letters to the Editor, Feb. 10 Letters to the Editor, Feb. 9 Columns Guest Opinion: Weed killers should not be sprayed on streams, homes Dana Milbank: Bobby Jindal's unpleasant record George Will: The Pence paradox Kathleen Parker: Brian Williams' six-mile stare Guest Opinion: Understanding Wes Cooley Guest Opinions Guest Opinion: Weed killers should not be sprayed on streams, homes Guest Opinion: Understanding Wes Cooley Guest Opinion: Smokers: Quit before this happens to you Guest Opinion: Our public school system is a stew pot of clashing ingredients Guest Opinion: How long will we look the other way? Lifestyle Latest stories She needed time to think The zwickels shall flow David Murdock: Take a nice little walk Looking Up: The sky on Valentine's night Fishing Report: Friday, Feb. 13 Food The zwickels shall flow Community blog: Custard mashup omits scary step for amateurs Season Stepp: Prepare a steakhouse meal at home Tammy Kelly: Healthy at-home Valentine’s Day meals (and desserts) for two Donna Knight: Meatloaf holds lessons Home and Garden Repair or replace your garage door panel? Dear Monty: Hot markets change agent behavior Carol Link: How to make sure yucca plants are gone Home Help: Repurposing garage doors into stunning walls with a view Landscape lighting for beauty, safety and value Health Health Watch: The rise of wearable fitness tech Community blog: Are You Losing or Gaining on Your Investment in Health? Community blog: Simple Solutions Health Watch: Simple swaps for a healthy lifestyle Community blog: Five "Must Haves" Hiking Biking Faith Religion briefs: Friday, Feb. 13 RELIGION BRIEFS, Feb. 6 Religion News: Church of England consecrates first female bishop Religion briefs Religion briefs, Jan. 23 Milestones and Achievements New arrivals: Sunday, Feb. 8 Columnist for a Day Rogue Healthy Aging Tempo Latest stories Soo Rah Korean Cuisine Southern Oregon Rod and Custom Show Ayron Jones and The Way play Rocky-Tonk Brett Dennen plays the old Ashland Armory Blues Jam at The Little Brown Jug in Talent Theater Le Cirque presents 'City Walk' 'Seven Brides for Seven Brothers' 'Dames at Sea' opens at Oregon Cabaret Theatre Camelot presents Playwright Richard Manley's 'A Question of Words' Classics, premiers highlight '15 season for OSF Music Live Music in Local Clubs Roy Zimmerman's 'The Faucet's on Fire" Victor D. Infante: Just in time for Valentine’s Day, some favorite breakup songs Ayron Jones and The Way play Rocky-Tonk Brett Dennen plays the old Ashland Armory Community Events Southern Oregon Rod and Custom Show Ashland's First Friday Art Walk showcases new exhibits by regional artists Jacksonville celebrates Chinese New Year Comedian Susan Westenhoefer pulls no punches Paula Poundstone performs at the Craterian Dining The zwickels shall flow Soo Rah Korean Cuisine Stylish shareables are the feature at Brickroom Sandwiches and burgers are hits at The Rogue Chef The Vine offers a taste of Italy Tempo Videos Classifieds Jobs Autos Real Estate FEATURED » Obituaries Blogs TV Listings Movie Listings Oregon Outdoors Oregon Healthy Living Magazines & Special Sections NEWS NOW Gov. Kitzhaber resigns: 'I have become a liability' ... Successor Kate Brown must run for election in 2016 ... Purple Parrot robber sentenced ... Gov. Kitzhaber resigns: 'I have become a liability' ... Successor Kate Brown must run for election in 2016 ... Purple Parrot robber sentenced ... Medical middle ground between marijuana and pain pills Medford man caught in medical middle ground between marijuana and pills Apotent cocktail of drugs helps tamp down the stabbing pains in Robert Kridel's deteriorating spinal column. Comment By DAMIAN MANN MailTribune.com By DAMIAN MANN Posted Feb. 16, 2014 @ 2:00 am By DAMIAN MANN Posted Feb. 16, 2014 @ 2:00 am » Social News Apotent cocktail of drugs helps tamp down the stabbing pains in Robert Kridel's deteriorating spinal column. At the same time, a toke of medical marijuana helps keep him "balanced," taking the edge off a life confined mostly to a $24,000 wheelchair. The 61-year-old Medford resident's doctor has given him a hard choice: Give up the pain medication Oxycontin or give up the marijuana. Kridel, who is on disability, has chosen marijuana, which he said he's smoked since he was 8 years old. "It's scary that you have to pick between pot and pain meds," he said. "There's no compassion for me." The animated and talkative Kridel said he's already feeling more pain as his doctor begins to wean him off the Oxycontin. Kridel is in the middle of two hot issues under serious discussion among doctors and public health officials in Oregon and other states: The widespread use and abuse of strong painkillers, and the effects of mixing those painkillers with marijuana. Kridel said his problems started 16 years ago when he got tetanus. He was fixing a tractor engine when an accident nearly severed his right index finger and drove his hand into a pile of barnyard dirt. Surgeons sewed his finger back on and gave him a tetanus booster shot. Within days he began to feel stiffness in his neck and he came down with a fever, symptoms of tetanus, also known as lockjaw. Over the years, some doctors have questioned whether the tetanus actually resulted in the spinal problems, but Kridel said he's convinced the tetanus caused nerve damage that has severely deteriorated his spine. He is being treated for osteoporosis, degenerative joint disease and other ailments. His Ashland doctor prescribed 17 medications, including morphine and Oxycontin. Some of the medications counteract the negative side effects of opiates, which can include constipation, endocrine dysfunction, sleep disturbance, drowsiness, emotional problems and adverse interactions with other medications. On Feb. 4, Kridel was required to sign a pain management agreement with his doctor that included the following sentence: "I understand that marijuana use (with or without a medical card) is breaking this contract." Kridel signed the agreement, but asked for an exception to the marijuana prohibition. His doctor, whose clinic is part of the Providence Medical Group, then wrote: "You will need to choose between marijuana and narcotics for treating pain. I understand that you have chosen marijuana." The doctor filled a prescription for 60-milligram pills and one for 30-milligram pills of Oxycontin. Kridel is supposed to take the 60-milligram pills in the morning and the 30-milligram pills in the evening. Once he runs out of the 60-milligram pills, he will decrease both doses to 30 milligrams. Kridel then needs to follow up with his doctor to find out how he's handling the decreased prescription. He said the effects of the reduced dose are letting him feel pains that he hasn't felt in years. "This is inhumane," Kridel said. "I'm having trouble breathing because my back is in such pain." Kridel, who receives his medical marijuana without charge from a grower in Williams, takes monthly urine tests to determine the levels of opiates in his system. He is also tested for marijuana. James Watson, spokesman for Providence Medford Medical Center, said federal law prohibits him or a physician from commenting on a specific case. He did say Providence doesn't have a blanket policy about medical marijuana and opiates. "It's for the provider to decide," he said. "Providence as an organization does not get in the middle of that discussion." He said Providence doesn't require boiler-plate pain management agreements. Individual physicians decide whether a pain management agreement allows medical marijuana and opiates, Watson said. Doctors are constantly trying to determine the best treatment plan for their patients, he said. Lee Berger, a Portland attorney and marijuana advocate, said it's an ongoing problem for patients who have to decide between medical marijuana and opiates for pain relief. "As a practical matter, that is the contract you have between you and your doctor, so my advice is you need to find a different physician," he said. The problem for many physicians is that they get disciplined for overprescribing and disciplined for underprescribing medications for pain, he said. Berger said marijuana exaggerates the effects of many drugs, including alcohol and opiates. As a result, he said doctors can provide patients with lower dosages of opiates. Also, many patients report they are unable to function with narcotics. Berger said there have been studies that show marijuana is also an effective drug to help patients get off prescription pain relievers. According to the Opioid Providers Group in Southern Oregon, some doctors adopt a "don't ask, don't tell" philosophy and don't require testing for the active ingredient in marijuana — tetrahydrocannabinol, or THC. Other doctors allow the use of medical marijuana and opiates. But the Opioid Providers Group has found that most providers in Southern Oregon do not prescribe opiates to patients who also use medical marijuana. Oregon in 2010-11 had the highest rate of prescription-drug abuse in the country at 6.4 percent, compared with 4.6 percent nationwide, according to the Substance Abuse and Mental Health Services Administration. Dr. Jim Shames, medical director for Jackson County Health and Human Services, said doctors are acutely aware of the potential risk for abuse when a patient is prescribed opiates. The goal is to attain a "steady-state" condition in which patients receive enough opiates for pain management but not enough to put them in an altered state, he said. "Opioids have a whole series of risks in and of themselves, including drowsiness, nausea and itchiness," Shames said. One of the big risks is slowing down the rate of respiration, which could potentially be deadly. Throwing marijuana into the mix adds an extra dimension to the pain management regime that many doctors don't feel comfortable with, Shames said. "There is no doubt about the fact that marijuana is a mind-altering drug," Shames said. "You're in a somewhat altered state on one medication, and on the other medication you have lots of dangers attached to it." Shames said the types of pain management programs he is describing apply to non-cancer patients who experience extreme pain from a variety of conditions. Despite the possible dangers of providing marijuana with opiates, Shames said he personally doesn't have an absolute conviction against mixing medical marijuana with opiates. "It's not something I would fall on my sword about," he said. Because of the widespread abuse of opiates, the trend now is for doctors to try to wean patients off high-dose painkillers or to lower the doses, he said. "It's a complicated area," Shames said. "We have too many people taking strong dosages of opiates." Shames said he is sympathetic to patients who suffer from constant pain. Doctors often try different treatments to lessen the need for painkillers, including physical therapy and exercise regimens. Shames said painkillers are used at the onset of acute pain, but the goal is to eventually taper them off. He said he also suffers from pain issues from time to time that require occasional treatment with Vicodin, though he tries to avoid taking it. "I have the worst shoulders you could ever imagine," he said. Sen. Alan Bates, a Medford doctor and supporter of medical marijuana, said his cancer patients have used medical marijuana to help with nausea and appetite. But, he said, he hasn't allowed it for patients taking opiates for acute pain issues. "There is a lot of anxiety amongst physicians about the whole issue," he said. Also, he said there hasn't been enough scientific studies to determine whether medical marijuana makes sense along with prescription drugs. Bates said the Oregon Medical Board hasn't taken a position on the use of medical marijuana along with opiates for acute pain relief. According to the Mayo Clinic, there is scientific evidence to support that marijuana is effective for relieving pain and lessening the symptoms of multiple sclerosis. Kridel said he would love to be able to discontinue the use of painkillers, but he's also concerned about living life with extreme pain. "Honestly, I am in trouble," he said. Kridel said he used to be a farmer and loves sailing, but acknowledges he may never make it out onto Applegate Lake again. "I can't tell you how much I miss who I was," Kridel said. "I'd give anything to get well." Reach reporter Damian Mann at 541-776-4476 or [email protected]. By DAMIAN MANN MailTribune.com By DAMIAN MANN Posted Feb. 16, 2014 @ 2:00 am » Comment or view comments Reader Reaction » STAY INFORMED Email NewsLetter Sign Up Today Sign up for our newsletter and have the top headlines from your community delivered right to your inbox. calendar Connect with MailTribune.com Facebook Twitter RSS Back to top Reader Services Reader Services Home Subscriptions Subscriber controls Contact us Submissions Photos Events Letters to the editor Corrections Announcements Obituaries Story ideas Since you asked Alerts Email Alerts RSS Feeds Text Alerts Advertise Media Kit Home Products and services Ad rates Advertising contacts Mail Tribune Daily Tidings The Nickel Shop Our Valley Blogs Stay Informed Email newsletter Sign Up Today Sign up for our newsletter and have the top headlines from your community delivered right to your inbox. Your privacy is important, read our privacy policy. © Copyright 2015 Local Media Group, Inc. All Rights Reserved. Privacy Policy | Terms of Service | Local Media Group Publications Original content available for non-commercial use under a Creative Commons license, except where noted. MailTribune.com | P.O. Box 1108, Medford, OR 97501