Addiction Treatment and Medical Cannabis
Definition
Addiction refers to a psychological and/or physical inability to stop consuming a chemical, drug, substance or doing an activity, even though it is causing significant psychological and physical harm.
Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Addiction Treatment
Average – there is some good-quality evidence to suggest that cannabinoids may be used as an alternative to prescription painkillers, both opioid-based and non-opioid based. There is also some evidence that access to cannabis reduces the rate of opioid prescriptions where medical marijuana laws have been passed.
As for using cannabis to treat addiction itself, this can depend very much on which drug the patient is addicted to! For those who are physically addicted to opiates/opioids, benzodiazepines and/or alcohol, tapering is essential to prevent physical withdrawal (as well as post-acute withdrawal syndrome (PAWS)). Once the physical dependence is manageable, cannabis may be used to taper down further and as a safer alternative to more physically addictive substances.
There is mixed evidence that cannabis may be useful for amphetamine and cocaine abuse, although those who are using amphetamine-based medications for ADHD may find cannabis and cannabinoid-terpenoid-based medications to reduce intake of such prescription medications. Cannabinoids may therefore be of greater value for treating central nervous system (CNS) depressants, such as alcohol, benzodiazepines and opioids/opiates.
It is also important to remember that there is both a physical and psychological side to addiction. It is just as important to go through appropriate drug treatment programmes, psychiatric help and therapy (as well as changes in one’s environment and peer group) in order to prevent relapse. Without these adjunct therapies, the chances of recidivism go up dramatically.
Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help
Both THC and CBD may help, as well as THCV, THCA, CBG and terpenes such as linalool, limonene, pinene and beta-caryophyllene (which is considered a cannabinoid as well, and may have anti-addictive properties). Different dosages and cannabinoid ratios may be needed for addiction to different substances and stages of addiction.
1:3 CBD:THC or perhaps even higher to help with initial withdrawal and cravings. Slowly tapering to 1:1 CBD:THC.
Medical Cannabis Pros
Cannabis has the potential to stave off any pain opioids are treating.
Increased appetite.
Can help battle insomnia.
“Restless legs” are a common withdrawal symptom – cannabis may help ease restless legs and relax muscles.
Euphoric effects boost mood.
Help stave off boredom, anxiety, depression and cravings.
Can help keep focus in some.
Medical Cannabis Cons
There are social factors to addiction that cannabis cannot necessarily help with. Patient must be willing to change peer group if necessary. Lifestyle changes often need to be made.
Extensive follow-ups are needed to prevent relapse. This includes Integration Therapy, and possibly group therapy and other types of therapy as well.
Long-term alcoholics and opioid and benzodiazepine users may need to still taper slowly, and use cannabis as an adjunct to prevent physical withdrawals.
Although on its own cannabis is not physically harmful, it can be when mixed with opioids and/or alcohol, where CNS depressant effects are increased. Tapering is therefore essential if using cannabinoids for addiction treatment.
Sadly, cannabinoid treatment may get one prohibited from entering any drug treatment programmes they are attending, especially one where all prohibited substances are seen as the same!
Although physical dependence on cannabis is not an issue, there may be some psychological dependence (rare, but this may be a particular concern for those who started cannabis use very young). Although cannabis use may be a safer “crutch” than many other drugs, we must be aware that cannabis has its own unique pharmacological effects that we should be aware of.
More About the Condition
Using one substance to replace another is not an uncommon practice for the treatment of many types of drug addiction. Opiate addicts are often given opioid-based replacements, whereas for alcoholics, slowly weaning off of alcohol (cold turkey is dangerous in such instances) combined with benzodiazepines is often recommended. This is to both prevent the risk of relapse and, in the case of physical addiction, the more extreme side-effects of sudden withdrawal and even death.
The case for using cannabis as an “exit drug” is an intriguing one. As cannabinoids can “talk” to and influence the behavior of other receptors in the body (including opioid receptors), it can theoretically reduce or replace the use of many drugs, whether licit or illicit. Another point for the use of cannabis for drug addiction is that, even if it is a crutch, it is a far safer crutch than opiates/opioids, alcohol, amphetamines, benzodiazepines and barbiturates.
Much depends on the type or class of drug one is using cannabis to help replace. As sudden alcohol withdrawal can cause death, cannabis can possibly be used either to help reduce alcohol intake slowly and/or used towards the end of treatment, when it is time to start giving up the benzodiazepines often used to help alcohol withdrawal.
For opioid and opiate addiction, tapering opioid and opiate use slowly and, eventually, completely with cannabis is possible. Slow tapering of opioids will also likely prevent the likelihood of any rebound effects. Theoretically, tapering combined with high doses of THC (which are also tapered down over time) may also help. Cannabidiol (CBD) may help ease anxiety and beat cravings. Cannabis may help ease any nausea and vomiting, and may help one eat a proper meal and deal with any insomnia.
There is less evidence for the use of cannabis to stop or reduce cocaine and amphetamine use, but there is some (sometimes conflicting) evidence. Whilst ADHD patients may find cannabinoids more tolerable than their stimulant-based prescription drugs, this may differ for an amphetamine addict who does not have ADHD.
There is no real, definitive evidence that cannabis is a “gateway drug”. There is perhaps one way in which cannabis could be a gateway drug, and that is because it is currently illegal, and therefore is traded along with other illicit substances, where introduction to these substances becomes more likely.
Also, if we are to be logically consistent, then it is worth considering, “To what extent are alcohol and tobacco gateway drugs?” Indeed, there are some people who argue that, if the concept of “gateway drugs” is real, then alcohol and tobacco are prime candidates, well beyond cannabis. Again, this could be true theoretically speaking. After all, cannabis does not affect decision-making ability in the same way alcohol does. However, this is more conjecture than empirically true, but there is a logic to this idea.
There may also be a difference between those who are addicted to certain drugs for what may be termed “recreational” reasons (self-treatment for undiagnosed health problems is not uncommon), and those who use medically-prescribed drugs in a more controlled manner in a clinical setting. A different approach may be needed to treat these two different groups, although the two groups may start to overlap at some point (e.g. a prescription opioid addict starting to use non-prescription drugs in order to manage chronic pain).
There is much interest in other plant-based medications for the treatment of addiction, including ibogaine (from the iboga plant), kratom and even psychedelics like ibogaine and psilocybin mushrooms! There are many plants and fungi that also have an entourage effect of their own which are sadly under-researched. Most research so far is based on small population samples or outside of standard clinical practices.
There is also concern about safety and efficacy when it comes to dosing and contraindications with other drugs/medications, and for some their condition (e.g. those with a history of psychosis) may not respond well to such treatments. Extensive integrative therapy is needed both before and afterwards, as well as changes in peer group and restricting access to recreational substances in order for such treatment to be truly effective.
There are also some potential similarities between cannabinoids and other powerful plant-based medications with regards to their effects, such as “cycle breaking” (or breaking the “loser script”) and a feeling of connection or oneness with nature, which one should not dismiss when it comes to breaking dependence cycles and conditions such as depression & anxiety.
Quotes from the Experts
Mark Wallace, MD (edited by Angie Drakulich): “[N]ew state policies have not led to any reported changes in marijuana dependence or abuse discharges in hospitals, but have resulted in a 23% reduction in opioid dependence/abuse discharges per a 2017 study (Shi Y, Drug and Alcohol Dependence, 2017). Another retrospective cross-sectional survey of patients with chronic pain using medical cannabis was associated with a 64% reduction in opioid use, as well as decreased side effects and improved quality of life, he shared (Boehnke et al, Journal of Pain, 17:739, 2016).
With regard to long-term safety and the use of medical cannabis to treat chronic pain, Dr. Wallace referenced a Canadian study by Ware et al published in the Journal of Pain in 2015, which found no significant difference in risks between groups using controlled cannabis and not using it. Furthermore, he noted that cannabis’s abuse potential is significantly less robust than that of heroin, cocaine, or nicotine, based on animal study findings (Cooper ZV, Haney M, Int Rev Psychiatry, 2009:104-112).” Source: Angie Drakulich, MA, ‘Cannabinoids versus Opioids for Chronic Pain Care’, Practical Pain Management (PPM)
