Is weed the way off hard drugs?

It’s a movement that already has gone beyond “gaining momentum” to officially being put into practice in some places: Recovery through cannabis.

Once proclaimed the “gateway drug” by the behavioral health community, cannabis has slipped into the mainstream. Cries from opponents of marijuana about the plant’s alleged dangers increasingly are falling on deaf ears.

The reason? The proof is in the pudding: People concerned about the direction an addict or an alcoholic’s life is headed are seeing them get things turned around with marijuana use.

The evidence supporting arguments for getting off hard drugs with weed goes beyond the anecdotal. In places where cannabis is legal, overdose death rates are going down.

Even the staunchest harm reduction advocates agree that ideally, a person should try to free themselves of all substances when seeking sobriety.

But when that’s not possible, a low-harm substance that increasingly is being used medicinally certainly is being viewed as a better choice than injecting heroin or living the life of an angry alcoholic.

Overdose deaths down where marijuana is legal

A study published in the American Journal of Public Health showed that overdose deaths are down 6 percent in Colorado since recreational cannabis became legal through the end of 2016.

“While numerous studies have shown an association between medical marijuana legalization and opioid overdose deaths, this report is one of the first to look at the impact of recreational marijuana laws on opioid deaths,” The Washington Post reported. “The authors say policymakers will want to keep a close eye on the numbers in the coming years to see whether the trend continues….” (1)

Post writer Christopher Ingraham notes that overall the research is a positive public health development, since the number of recorded cannabis overdose deaths is zero.

However, he pointed out that the study’s authors also noted we don’t know whether recreational cannabis is translating into deaths elsewhere in Colorado, such as on its roads.

“Still, the study adds more evidence to the body of research suggesting that increasing marijuana availability could help reduce the toll of America’s opiate epidemic, which claims tens of thousands of lives each year.”

Research increasingly showing marijuana an exit drug

Dr. Dustin Sulak, a Maine osteopath, became one of the first doctors in the country to suggest cannabis be used to combat the nation’s opioid epidemic. He began calling for it in 2013, even before the federal government had recognized just how severe the opioid epidemic had become.

It’s an idea that has come an extremely long way in a very short time.

In Illinois, which had a relatively tiny medical cannabis program with only 24,000 patients after three years, lawmakers opened it up for anyone prescribed opioids. Patients can buy two and half ounces of weed every 14 days.

The sponsor of the bill, Sen. Don Harmon, told the Chicago Tribune, “We should be actively helping people who are addicted to opioids instead of treating them like criminals.” (2)

He had several doctors backing him up, including a noted Rush University neurologist who also sits on the board of Cresco, one of Illinois’ cannabis cultivators.

How cannabis may help opioid addicts

Other heavy-hitting medical scholars also are boarding the cannabis train in light of the opioid crisis.

“It is important to move with a deep sense of urgency to leverage the opportunity presented by increased legalization of medical marijuana to expedite the development of cannabidiol for therapeutic interventions for opioid use disorder, thus curbing the opioid epidemic,” wrote Yasmin L. Hurd of the Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai, Center for Addictive Disorders, Mount Sinai Behavioral Health System.

Hurd’s remarks stand behind a firewall in a piece published in Trends in Neurosciences. But Medscape quoted the doctor’s research in a recent piece investigating what little research there is to inform treating opioid use disorder with cannabis. (3)

The piece also quotes a study in Addiction Biology in 2013 that showed “cannabidiol interferes with brain reward mechanisms responsible for the expression of the acute reinforcing properties of opioids, thus indicating that cannabidiol may be clinically useful in attenuating the rewarding effects of opioids.” (4)

As for research on humans, one pilot study, also conducted by Hurd, showed cannabidiol reduces heroin-related anxiety withdrawals. (5)

It seems people in recovery could argue that the hardest part of giving up any substance in large part is the anxiety that comes along with it.

Government re-examining role of marijuana in recovery

Nora Volkow is director of the National Institute on Drug Abuse. She told CNN the government’s top scientific agency aimed at combatting addiction has begun to re-examine its approach.

“In principle, what we have aimed for many years is to find interventions that would lead to complete abstinence,” she said. “We have strted to explore the extent to which interventions that can decrease the amount of drugs consumed can have benefits to the individual. It would be valuable to decrease the amount of drug consumed.” (6)

CNN reported that a treatment center in Los Angeles has begun to officially treat crack cocaine and opioid addiction with cannabis.

“One of the things is, we don’t have any evidence-based medication that has proven to be efficacious for the treatment of cocaine addiction,” Volkow told CNN. “So, we currently have no medicine to intervene, and it can be a very severe addiction and actually quite dangerous.”

Cannabis dependency hits you in the pocketbook

For an addict or an alcoholic who never has tried cannabis, introducing a new substance always carries with it a new dependency risk.

And depending on where you live, medical cannabis can be very expensive. A regular user easily could spend $500 per month (emphasis on “easily”) using cannabis as medicine.

And don’t be fooled. Marijuana “addiction” is a real thing, or if you prefer, call it “dependence.” In fact, some people may be genetically predisposed to marijuana addiction. (7)

The more you smoke, the more you need for the same effect, and the more it impacts your pocketbook.

So is cannabis really a gateway drug?

There are a few ways of looking at the cannabis/hard drugs “pickle,” if one wants to call it that.

First, conventional wisdom says it does not make sense for someone who never previously used an addictive substance, such as marijuana, to be introduced to it. Particularly if they are prone to addiction in the first place.

But if we know people are subbing out opioids for it, and therefore choosing life over death, how can we ignore this lifesaving intervention?

The other apparent is that if marijuana as a “gateway” drug is true, then most hard drug users would have had to have started with marijuana. Why don’t they go back to it to get off the hard drugs, then?

It’s not a simple question, or one with a simple answer. But one thing is certain: If someone has been weaning themselves off hard drugs with cannabis on the DL, they have a better chance at life than the alternative.

Beyond potential financial devastation (let’s face it, insurance doesn’t cover cannabis), medical marijuana “addiction” so far does not seem to have more severe consequences.

And it’s certainly better than death.

Bibliography

1. Ingraham, C. (2017, Oct. 16) Legal marijuana is saving lives in Colorado, study finds. The Washington Post. Retrieved Nov. 19, 2017, from https://www.washingtonpost.com/news/wonk/wp/2017/10/16/legal-marijuana-is-saving-lives-in-colorado-study-finds/?utm_term=.d89e2529faef

2. McCoppin, R. (2017, Nov. 17). Illinois doctors campaign for medical marijuana as alternative to opioids. The Chicago Tribune. Retrieved Nov. 19, 2017, from

3. http://www.chicagotribune.com/news/local/breaking/ct-met-medical-marijuana-doctors-pain-20171116-story.htmlMelville, N. (2017, Feb. 6). Role for cannabis for treatment of opioid addiction? Medscape. Retrieved Nov. 19, 2017, from https://www.medscape.com/viewarticle/875431

4. Katsidoni, V. (2013, March). Cannabis inhibits the reward-facilitating effect of morphine: Involvement of 5-HTIA receptors in the dorsal raphe nucleus. Addiction Biology. Retrieved Nov. 19, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/22862835

5. Hurd, Y. et al. (2015, Oct. 12). Early phase in the development of cannabidiol as a treatment for addiction: Opioid relapse takes initial center stage. Neurotherapeutics. Retrieved Nov. 19, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604178/

6. Scutti, S. et al. (2017, May 17). New potential for marijuana: Treating drug addiction. CNN. Retrieved Nov. 19, 2017, from http://www.cnn.com/2017/05/17/health/addiction-cannabis-harm-reduction/index.html

7. Sherva, R. et al. (2016, May). Genome-wide association study of cannabis dependence severity, novel risk variants, and shared genetic risks. Retrieved Nov. 19, 2017, from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2504223