How one injured veteran traded opiate painkillers for medical marijuana

Stephen Mandile spent 10 years on a host of pills after he was injured in Iraq in 2005. Now, he uses medical marijuana to treat his pain and wants to help other vets get the same opportunity.

Stephen Mandile, 37, holds a fentanyl patch -- an opiate painkiller 50 times more potent than heroin -- that he was prescribed by his Veterans Administration doctor.
Stephen Mandile, 37, holds a fentanyl patch -- an opiate painkiller 50 times more potent than heroin -- that he was prescribed by his Veterans Affairs doctor. He prefers to use medical marijuana to help his pain, but the VA won't cover cannabis. –Ryan Breslin / Boston.com

One snowy day this past winter, Stephen Mandile did what lots of other homeowners did and snow-blowed his driveway.

Unlike most people, he was thrilled.

Ten years after Mandile was injured in Iraq and three months after stopping his opiate painkiller regimen for chronic spine pain and nerve damage, the father of two from Uxbridge felt like himself again. Clearing his driveway himself was just the latest milestone in his journey.

He says he has medical marijuana to thank for it.

Mandile, 37, was among the first in line when the state’s first dispensary opened up last June, buying cannabis to replace a regimen of powerful painkillers. Over the past 10 years he was on various opiates — morphine and percocet, then fentanyl and oxycodone — plus a host of other medications to help him sleep and combat the side effects.

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He considered himself an addict, his dealer the Veterans Affairs doctors.

“I never thought I was doing the wrong thing, because I was doing what the doctors told me to do,” he said.

His pain was still unbearable, though. And mentally, he was worse. He spent his nights awake, unable to sleep, his mind racing. He spent days counting hours until he could put on his next fentanyl patch, counting pills to make sure he could make it through the day.

Mandile would look at maps and note where the most remote ponds and lakes were, picking out where he’d sink into the water and kill himself.

After he swallowed a handful of percocets in 2014, his wife demanded a change.

“She’s the one who told me, ‘You have to try something else. You have to try something that’s not going to kill you,’” he recalled.

The switch for Mandile and other veterans isn’t an easy path. For one, his VA doctor couldn’t prescribe him marijuana, but just help him safely taper off the opiates.

And the cost can be prohibitive. An ounce of marijuana at a dispensary runs about $400; Mandile needed to smoke, vaporize or eat about two ounces a week for daytime pain and to help eke out four hours of sleep a night. That’s nearly all his monthly benefits, he said.

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Fentanyl, oxycodone and percocets, though, come free with his veterans’ health benefits.

The local cannabis community has pitched in to donate marijuana — likely illegally, Mandile acknowledges — but it’s not a permanent fix.

That’s why Mandile wants to see more help for veterans struggling with opiate addiction, starting with discounted or free medicinal cannabis. Eventually, he’d like to see the state open a location for alternative healing, where marijuana could be grown, packaged and given to veterans, along with opportunities for other therapeutic activities.

Stephen Mandile stands outside of the Massachusetts State House, hoping for a meeting with Gov. Charlie Baker to talk about making medical marijuana more accessible to injured veterans.
Stephen Mandile stands outside of the Massachusetts State House, hoping for a meeting with Gov. Charlie Baker to talk about making medical marijuana more accessible to injured veterans. —Ryan Breslin / Boston.com

Mandile’s journey stands in contrast to the argument many make against legalizing pot. Gov. Charlie Baker, in announcing an anti-legalization campaign with Boston Mayor Marty Walsh and House Speaker Robert DeLeo in April, said making marijuana legal threatens to “reverse our progress combating the growing opioid epidemic.”

The Mass. Medical Society agrees, with the association’s most recent president saying that “we are battling an epidemic of prescription drug and opioid abuse that is already disrupting and destroying too many lives.”

Mandile doesn’t buy that argument. For him, marijuana wasn’t a gateway drug — it was a getaway drug.

“Medical marijuana, which is not toxic, doesn’t kill anybody, is supposed to be this dangerous gateway drug into a life of addiction,” he said. “Here I am … I used it as an exit drug.”

Not all politicians are as fearful of cannabis’ dangers. Earlier this year, Sen. Elizabeth Warren asked the Centers for Disease Control and Prevention to study whether legal marijuana could help the opioid epidemic — specifically as an alternative to opioids for pain treatment.

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Other states, like Maine and Ohio, are pursuing the idea. Advocates of greater cannabis access point to studies showing positive effects on the opiate crisis. One study, published in the Journal of the American Medical Association, found that states with medical marijuana laws had a 25 percent lower fatal overdose rate than states that didn’t.

And a study released earlier this year in Michigan found that pain patients using medical marijuana saw 64 percent drop in their use of opiates for pain relief.

Their quality of life increased, too, the study found, something Mandile said he’s felt since October, when he tapered off the last of his opiates. For the first time, his daughters, ages 2 and 4, are seeing what their dad looks like without unbearable pain.

He’s stepping up his activism, too. Earlier this year, he formed Veterans Alternative Healing, a non-profit working to find non-opiate ways for veterans to manage their pain. In May, he spent a week outside the State House, holding homemade signs reading, “OPIATES KILL. MMJ HELPS,” all day and sleeping in his car at night. He wanted a meeting with Gov. Charlie Baker, to talk about what can be done to help stop the cycle of pain, addiction and death among veterans.

In a statement, a spokesperson for Gov. Baker pointed to the work the administration has done to fix the broken medical marijuana system and help veterans obtain benefits through the state SAVE program.

“Through the Department of Veterans Services, the Commonwealth offers numerous programs and benefits, including access to the SAVE Program, and will continue to work with our federal partners to provide quality health care and services for our veterans and their families,” communications director Lizzy Guyton said in a statement.

Last week, Mandile was back outside the State House, again asking for a meeting with Baker after meeting the previous week with members of the Executive Office of Public Safety.

In his pocket was a fentanyl patch. The same drug that state and local officials are blaming for a rash of overdoses and famously killed the singer Prince in April. The synthetic opiate is 50 times more powerful than heroin.

Mandile had picked up the fentanyl the day before at the VA at no cost. He said he wanted to show Baker and other state officials how easy it is to get a drug that could kill him. A drug so dangerous, it could kill his kids if they touched the tiny patch.

“Doctor’s orders,” he said, as he stuck the postage-stamp size square to his arm in the shadow of the State House. “I’m doing what the doctor said to do.”

He hopes eventually, it’ll be as easy and cheap to get the drug that really helps.

Stephen Mandile, 37, stands outside the Massachusetts State House, hoping for a meeting with Gov. Charlie Baker. He says he used medical marijuana to get off a litany of opiate painkillers after he was injured in Iraq 10 years ago.
Stephen Mandile, 37, stands outside the Massachusetts State House, hoping for a meeting with Gov. Charlie Baker. He says he used medical marijuana to get off a litany of opiate painkillers after he was injured in Iraq 10 years ago. —Ryan Breslin / Boston.com

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