It's a little over a month since I was prescribed medicinal cannabis and have been taking half to a full gummy each evening (aside from not wanting to risk being impaired during the day, higher levels of daily use are associated with lower levels of pain relief). For my prescriptions to continue, I need to (virtually) attend a check up appointment in order to discuss whether it's proving effective (as well as ensure that there haven't been any issues etc). Conveniently (unfortunately?), I have just had a demonstration of efficacy. Last week, I attended a work on-site in Playa Del Carmen, Cancun. Unfortunately, I was unable to carry medicinal cannabis into the country (I asked the Mexican embassy in advance and they said "as far as we are concerned, it is prohibited"). That's _not great_ , but did lead to me having a better understanding of how much it's been helping ("You never realise the value of something until it's gone" and all that). This post talks about that experience. * * * ### Talking About Comparative Pain Levels Ever since starting on the gummies, I've had the sense that they were helping but it was hard to say by _how much_. Pain really is quite weird in that respect: * When you're _in_ pain you know about it (although meaningfully communicating about pain is a known problem area). * When you're suffering less pain, you're aware that it's reduced but it's very hard to say by how much (being _out_ of pain is easier, because you can say that it's gone... I live in hope) This makes it quite difficult to say _how effective_ a given form of pain relief is (particularly when improvements have been gradual). Although it'd be nice to be able to talk comparatively, you can only really talk about pain levels _now_ (the trick, for the record, is to focus on externalities rather than the pain itself - is it helping enough that you're comfortable, not miserable, do stairs make you want to cry etc) But... if you go back from an improved state to where you were, it suddenly becomes _uncomfortably_ easy to see how big the difference is. * * * ### Going A Week Without The relief that I had been getting lasted for about 2 days after my last gummy. After that, I was back to being extremely uncomfortable (even though I was still taking the medications that I _could_ carry into Mexico). Stairs, once again, became a serious obstacle and I strained my shoulder a little by having to support my weight on the handrail (something that I hadn't consciously noticed that I'd stopped needing to do). Swimming was also problematic. I only really felt able to do it on the first morning (whilst still benefiting a little from that previous gummy). Rather than going downstairs and socialising with others over breakfast, I ordered room service, sat on the balcony and tried to mentally prepare for a day of repeatedly getting up and moving around (although the hotel had a lift, there were also areas that were only accessible via stairs). My flying experience was quite different too: despite the seats being physically identical each way, my leg was _much_ more uncomfortable on the journey home. One thing that I'm **not** able to compare, is sleep: * Any sleep disturbances could equally be explained by jet lag and/or sleeping in an unfamiliar environment * I don't _usually_ go to bed full of beer and margaritas (alcohol at volume is also great at pain relief, but the associated loss of inhibition can lead to you making things worse1) Across the trip, there were days that I'd probably have preferred to be laid up (and, arguably perhaps should have been). There were a ton of other smaller differences too (like having to really work to regain focus in meetings after a pang throws your mind off). Because I had my daily tablets, it wasn't entirely unbearable, but could _definitely_ have been more pleasant. The experience made me think of a passage in the open letter that I wrote nearly eight years ago: > I spend every day of my life in pain that I know could be mitigated Pain is awful, but knowing that it could be alleviated and that you're suffering because of _someone else's_ misguided principles only serves to worsen the torment. I _loved_ Mexico, but I did not love how it made me feel. * * * ### Getting Home I've only been home a day, so have only had a single gummy. Much like the very first night of taking them, I had a little bit of relief directly after, but haven't got any today. Clearly, time is needed for it to build back up in my system (although going from ~28C to -1 also can't have helped). I was also a little unsure of dosage when I got home, not knowing whether I should: * pick up where I left off (and potentially find it was too much) * start small and work up (extending the amount of time before meaningful relief) In the end, I chose to pick up where I left off - it didn't end up blowing my head off, so this was presumably the right choice. * * * ### Judging Pain By Stopping It seems worth discussing one of the problems with judging the efficacy of pain relief by withdrawing it. Certain drugs are known to _cause_ pain. Codeine (and other opiates), for example, can cause headaches. The user will then treat that pain with more codeine, potentially leading to a self-fuelling addiction but certainly generating more frequent headaches. Some drugs don't cause pain while _in use_ , but can cause pain during withdrawal. Although it's uncommon, cannabis can be one of these. So, even aside from having to deal with pain, there _is_ a methodological issue with stopping medication to judge pain levels. In this particular case, I know that that's not been an issue: * It's unlikely that I've been using it long enough to develop a dependency * I've not had any other symptoms of withdrawal (I'd certainly recognise those from my previous experiences with Tramadol) * Because of the focus on externalities, it's possible to directly compare to my previous experiences and say that this was not a _new_ form of pain And, of course, I didn't stop solely to judge the pain - it was an unfortunate requirement of me wanting to travel to a country that doesn't currently recognise the validity of my prescription. Hopefully, those will be fewer and fewer over time. * * * ### Conclusion I'm sure that the doctor will have quite specific questions at my upcoming checkup, but last week has shown me that the cannabis gummies are actually more effective than I'd previously realised. Things aren't perfect and I do still have to be a little mindful of what I'm doing, but last week reminded me of various nuisances and pain that I've previously just had to accept as part of living with chronic pain. While writing this post, I also remembered just _how distracting_ it is - barely a paragraph has passed between being distracted by a painful leg twitch, a need to shift in my seat or a yelp as I move uncomfortably. It's now quite clear to me that my life _is_ improved by the availability of medicinal cannabis. It's not just the differences that I've described here, but the fact that it does something that my previous prescriptions never could: it allows me to achieve these benefits without a cost to clarity of mind during the day. * * * 1. One night, after _a lot_ of drinks (even by my standards), I was successfully peer pressured into dancing. I had fun, but the next day was **baaad** ↩

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