Former Pain Doc: 'If Opiates Didn’t Cause Tolerance, We Wouldn't Be Here'

By Victoria Kim 10/05/17

A retired pain management specialist spoke candidly about opiate addiction and using medical marijuana as a treatment for pain.

Female hand holding pill

Dr. Bobby Dey, a retired physician and pain management specialist, says that no one is at fault for America’s epidemic of opioid dependence and overdose—but that it had more to do with the nature of prescription painkillers themselves.

“There are many downsides to opiates,” Dr. Dey told Civilized in a September interview, using the term for drugs that are derived from opium like heroin, morphine and codeine. “One of them being that people develop a tolerance over time in that you need higher and higher doses over years and years for the treatment of chronic pain.”

The need to escalate painkiller dosages for patients who need to take opioid pain medication long-term is what presents a danger and the potential of fatally overdosing, says Dey.

“If opiates didn’t cause tolerance, we would not be here,” he said. “If I could give somebody 20 milligrams of OxyContin a day or four Percocets a day, and 10 years later, still be giving them that amount, they would be fine.”

Dey co-founded the Spine Center in Rockville, Maryland in 1998—now known as the National Spine & Pain Centers (NSPC), said to be one of the largest pain management practices in the U.S. that has treated over 300,000 patients through more than 100 NSPC providers along the East Coast.

As a pain doctor, Dey said he noticed that patients who used cannabis did not need to increase their painkiller prescriptions over time. “While giving my patients opiates, I noticed that some were taking cannabis—either on a recreational level or to treat the side effects associated with opiates,” said Dey. “Those patients did not require an escalation in their dosing over time. Those patients were taking cannabis 3-5 years out, and I was giving them the same dose as I did prior to that.”

Dey’s observations echo reports that greater access to medical cannabis results in fewer fatal opioid overdoses and the need for fewer opioid painkiller prescriptions. And in June, Ars Technica reported that a survey of nearly 3,000 medical cannabis patients showed that an “overwhelming majority” said they preferred using cannabis over prescription painkillers. 

Dr. Dey says this is worth exploring. “These patients with severe pain either need something different or stronger,” he told Civilized. “And when you have something like cannabis that’s been under our noses since forever … you really are obligated to use it for its beneficial potential. Especially given that we're in this crisis really through no fault of anybody other than the properties of the drug itself.”

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Victoria is interested in anything that has to do with how mind-altering substances impact society. Find Victoria on LinkedIn or Tumblr