Treatment that includes marijuana use ignites debate | Addiction Professional Magazine Skip to content Skip to navigation

Treatment that includes marijuana use ignites debate

February 21, 2017
by Tom Valentino, Senior Editor
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A “natural” option not being given a fair shake by the addiction treatment field, or a “remarkably irresponsible” practice that isn’t being harshly criticized enough?

The use of marijuana in the treatment of drug and alcohol addiction stirs up fervor from both proponents and those opposed, and the recent opening of a treatment center in West Los Angeles roused experts across the nation. High Sobriety, a self-described “cannabis-inclusive” treatment center, takes a non-traditional approach to treatment by incorporating the use of marijuana to help patients detox from drugs and alcohol.

High Sobriety was founded by Joe Schrank as an alternative addiction treatment program for those who were unable to stop using drugs and/or alcohol after attending traditional abstinence-based programs, according to the center’s website. Schrank, who splits his time between New York and Los Angeles, previously served as a residential therapist at Promises in Malibu, Calif., before moving on to launch Loft 107, a sober living home in the Williamsburg neighborhood of Brooklyn, N.Y., and a recovery program at a New York City high school.

Representatives from High Sobriety declined an interview request from Addiction Professional, but others familiar with the methods being used by the treatment center weighed in with the pros and cons of marijuana having a place in addiction treatment.

The case for cannabis

Cali Estes, PhD, founder of The Addictions Coach in Miami, Fla., has recommended cannabis products in the treatment of drug addiction “ever since it has been legal” to purchase recreational marijuana in Colorado. Estes and her team of certified recovery coaches, addiction therapists, certified interventionists and international master addiction coaches, describe their services as “progressive.”

Estes scoffs at the use of traditional medication-assisted therapy, calling the use of methadone and Suboxone in treatment “ludicrous.”

“(Clients are) coming off heroin, (treatment centers) start them on Suboxone, and within a week, they up their Suboxone,” Estes tells Addiction Professional. “I don’t see why we’re doing that. We’re not detoxing. We’re increasing the opiates to the brain.

“Then, they leave them on that for a significant amount of time—they call that ‘getting the body used to’ or ‘adapting to’ the new product, Suboxone. Then, from there, they want to detox them slowly over the course of six months to a year or, sometimes, three or four years. I think that’s ludicrous. People come to me stuck with Suboxone. They come to me coming off of opiates, and they say, ‘I don’t want to get put on that MAT. I want to come off drugs.’ And that’s why I use cannabis.”

Estes says she believes in using cannabis because it reduces symptoms experienced in detox while on Suboxone, such as restless legs, nausea, headache, insomnia and the tendency to feel flat. In 2009, a study conducted by the Laboratory for Physiopathology of Diseases of the Central Nervous System found that injections of THC into test animals helped eliminate their dependence on opiates. Meanwhile, 40% of substance users who participated in a 2009 study published in the Harm Reduction Journal said they had used cannabis as a substitute for alcohol, 26% as a substitute for illicit drugs and 66% as a substitute for prescription drugs. The most common reasons for using cannabis were reducing adverse side effects, better managing symptoms and reducing withdrawal.

A key to cannabis-inclusive treatment, is working with patients to determine the minimum dosage needed to be effective, then tapering down, Estes says. Products used in treatment can include edibles, with THC levels starting at 20%, or cannabidiol (CBD) hemp oil, which contains trace amounts of THC.

“We’re going to start with the least restrictive first, then add in to see where you’re comfortable and dose you down from there as your symptoms wane,” Estes says. “Give the body a chance to reset itself to homeostasis. Suboxone doesn’t allow that. It doesn’t allow your body to go back to homeostasis. This will.”

Estes adds that cannabis use should not be viewed as a long-term solution and that the goal “isn’t to start smoking marijuana taking edibles. The goal is to get clean, but by way of a less harmful vehicle.”

Still, even with those parameters, she acknowledges the use of marijuana in addiction treatment isn’t for all clients. Those who have developed an addiction to cannabis, as well those who abuse stimulants such as cocaine and methamphetamine, likely won’t benefit from this type of treatment.

Ultimately, the addiction treatment industry’s general aversion to using marijuana comes from a lack of understanding, Estes says.

“The media says you’re treating one addiction with another,” she says. “Not really. There are different things we can do to help you feel better and not necessarily just give you a joint. That’s not what we’re doing. It’s new to people, and anything new to anybody is always, ‘Oh my God! It doesn’t work!’ until they see it does work.”

‘An affront to evidence-based treatment’

The frustration in Kevin Sabet’s voice is palpable at the mere suggestion of marijuana use as a viable part of drug or alcohol addiction treatment.

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It's not as if "traditional" treatment has a huge success rate. Certainly more and more people are learning about the value of Ayahuasca journies, people are learning more about ibogaine treatment programs (in other countries), I believe that cannabis CAN provide some potential benefit and it's worthy of study. MAPS.org is doing great things with regard to psychedelic use to treat such things as PTSD - and edible cannabis is more of a psychedelic than anything. So why shouldn't we at least LOOK for alternatives to a stale treatment approach? I'll be interested to see how/if this proves to be effective or simply creates cross addictions.

I am encouraged to see the subject of medical cannabis as addiction treatment beginning to hit the mainstream. Over the last three decades those afflicted with opiate addiction have told me of the relief they receive from using cannabis as part of a personal detox strategy. To date the medication assisted treatments available to sufferers (with the exception of naltrexone) involve the use of opiate-based medications. This approach operates by keeping the light on for addicts... albeit a bit dimmer. For many it is only a matter of time before they give in to the teasing effect of these opiate derivatives and go back to full-blown use. For some this may result in getting “booted out” of their recovery program for non-compliance… and for others it may mean going to jail.

If the opiate addicted individual takes a step toward the rooms of recovery, why would we find it therapeutic to feed the person a drug that extends their reliance on an opiate-based medication? The use of therapeutic cannabis for the opiate addict, as an alternative form of medication assisted treatment, seems to make much more sense than using an opiate for an opiate. When used in combination with an opiate blocker like naltrexone, we now have a treatment protocol that becomes very well accepted by the patient. Recovery can be improved and retention in treatment can be increased. The integration of therapeutic cannabis holds the promise to not only change lives but can save lives (Church et al, 2001, Wilfred et al, 2009).

-Dr. Mark Welty, LPCC-S

References

Church, S. H., Rothenberg, J. L., Sullivan, M. A., Borenstein, G. & Nunes, E. V. (2001). Concurrent substance use and outcome in combined behavioral therapy for opiate dependence, American Journal of Drug and Alcohol Abuse, 27(3), 441-452.

Wilfrid, N. R., Carpenter, K. M., Rothenberg, J., Brooks, A. C., Huiping, J., Sullivan, M., Bisaga, A., Comer, S., & Nunes, E. V. (2009). Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate dependence, The American Journal on Addictions, 18, 301-308.

The potential of cannabis (aka pot or marijuana) is a very interesting development with the growing acceptance of the medical use of marijuana. Several years ago I was in a debate with Ohio Attorney General Mike Dewine where this subject came up. I essentially flipped his whole argument of marijuana being a Gateway drug to it being a Gateway off the hard drugs.
More recently I was part of panel discussion with the local judicial, health & drug treatment professionals in Portsmouth Ohio. Note Portsmouth was the epicenter of the Ohio’s opioid epidemic. Marijuana as either a substitute or part of adjunct therapy was accepted by the members of the panel.
Acceptance of a positive drug test for marijuana coupled with traditional patient counselling is more likely to achieve long term positive result versus substituting one opioid addictive drug for another addictive opioid drug. This is compatible with the Center for Disease Control Guidelines for Prescribing Opioids for Chronic Pain recommendations.
Note Even the DEA had to recently capitulate to a legal challenge based on the United States Information Quality Act. The DEA’s was charged with promoting numerous false statement (such as marijuana being a Gateway to harder drugs). Their document “The Dangers and Consequences of Marijuana Abuse” has been discredited and removed.
It is time to bury the false classification of marijuana as a dangerous, addictive drug with no medical use and use it mitigate the effects of the truly addictive and dangerous drugs.

When you ask someone who has been a spokesperson for the Feds and an academic to comment on anything new and novel or at least outside of their ivory purview, you will get silliness like this. I don't know if pot would be useful as a detox regimen, but I certainly would not dismiss it out of hand as not being "evidence bases" when it is still in the trial stages. Of course, it isn't evidence based when it hasn't been studied much if any, yet. These folks also dismiss 12 step programs because they haven't been studied in some controlled university investigation.

Personally and professionally, anybody that considers highly addictive drugs like methadone and suboxone to be "evidence based" makes me highly suspect as being part of that long line of medical/academic types that have been inventing newer and more effectively addictive narcotics to cure narcotic addiction. A long line that stretches back to the MDs at the Beyer-Heroin Co.

It is about time that we stopped this nonsense of looking at addictions as a disease that needs more drugs to cure. A more rational approach is to look at the root cause of all addictions as the maladaptive behavioral attempt to cover up the hurt of having little or no self-esteem/love, and then to work on building their self-esteem.

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