Could Pot Help with Addiction?
Mom 101 is wondering whether medical marijuana is a viable option for treating addiction…
"Watched Dr. OZ this week and he had a guest speaking to medical marijuana use to end addiction.
Any thoughts on this?"
Is marijuana the answer for getting off of opiates? That’s an interesting question. I found and watched the segment of Dr. Oz that you are referring to. It was certainly provocative.
I am not a scientist though I strongly believe in the scientific method as a superior process for separating anecdote from harder fact.
Science has its criticisms, two of which are worth noting here: science is carried out by humans, and humans make errors and hold biases. Secondly, money for scientific study can also be biased, in the case of marijuana, historically, against funding for the study of marijuana. It’s worth noting that with the advent of legalized marijuana use, strong commercial interests are now upon us and these interests create more difficulty in teasing out fact from fiction. Simply google CBD, the acronym for cannabidiol – an active property of marijuana, and you will see the plethora of marketing claims.
I went to the most recent and complete review of the study of cannabis from The National Academies of Science, Engineering and Medicine (2017, https://www.nap.edu/read/24625/chapter/1#xii0).
There is almost no study of the use of cannabis as an aid for withdrawal or to support continued abstinence from any drug. Three studies are the exception: two looked at treating cannabis addiction and the third looked at cigarettes. The National Academies assessed these studies and concluded that:
[t]here is no evidence to support or refute the conclusion that cannabinoids are an effective treatment for achieving abstinence in the use of addictive substances.
The only evidence of pot’s effect on opiate withdrawal is one less rigorous study that found pot may help with the induction process to methadone by reducing symptom severity as the patient gets stable on the methadone dose.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717827/
On the other side, The National Academies found limited evidence that cannabidiol (CBD) (the active ingredient in marijuana that is most of interest to researchers, along with THC) improves anxiety and post-traumatic stress disorder (PTSD) symptoms.
This last piece may explain the increase in the use of marijuana when people try to withdraw or stay clear of opiates, with or without the aid of medication-assisted treatment (MAT). The guests on the Dr. Oz show also suggested marijuana could help with cravings. Maybe that’s so, though one would expect that taking any drug during a craving would reduce the initial feeling of craving. I couldn’t find any study of pot use for cravings.
The next question is whether marijuana does a better job at addressing anxiety, PTSD, and craving than do other well-studied medications on the market, when prescribed by a physician. Those studies do not exist.
Many people who are put on MAT start or increase their use of marijuana. MAT clinic providers will tell you it’s part of the process and is an “acceptable” outcome. The goal is to address the opiates. Other drugs matter, like cocaine and methamphetamine and benzodiazepines, but pot, and for that matter alcohol too, well, that matters less, especially in the beginning. This is the commonly accepted position on pot use, by MAT providers.
From the standpoint of a family member and CRAFT, does this means you excuse the pot use as your Loved One ramps up on MAT?
Perhaps. It is, after all, harm reduction. If so, then the line between use and no use shifts slightly and you accept pot as no-use. You act rewarding and loving when your Loved One is high on pot and not opiates. You’ll want to refer to our page on the signs and symptoms of drug use to help you tease apart what a person looks like high on pot as separate from high on opiates.
The question this raises is whether your Loved One will then end up addicted to marijuana. The science (see this article we recently highlighted in What's News) increasingly points to one overarching addiction center in the brain, where drug and addictive behaviors such as gambling are substituted when the drug of choice is removed. In one interesting recent study, clients in a drug treatment program who were helped to stop smoking were less likely to relapse to drug use than their counterparts who continued to leave the door open to addiction through smoking cigarettes.
All of this suggests that the answer as to whether your Loved One will end up addicted to marijuana is therefore: probably…. But there are plenty of examples out there of individuals who are abstinent from the drug that caused them so much harm, and who are more or less moderating with alcohol or marijuana.
My bias: I still think a trip to a good psychiatrist is in order to see if the symptom relief being provided by pot or alcohol could be better addressed with psychotropic drugs.
My next bias: I worry that we are becoming a society in which harm reduction is the goal. With MAT and now marijuana on the scene, are we putting a whole generation of people into a limbo state, part of the way towards recovery (harm reduction) by addressing only one drug (opiates)?
My other bias and one pet peeve: The neuroscientist on the Dr. Oz show, when asked, said that almost no one succeeds in being abstinent from all drugs. The brain, she went on to say, has been seriously damaged/changed to the point where some chemical will always be needed. She was probably referring to opiate use though she didn’t specify. This argument of irreversible brain change was a main driver in the use of methadone to treat opiates back in the 1970's.
Yet the evidence for this simply doesn’t exist. No one has studied long-term abstinent people and found their lives to be sub-standard to those on a substitute drug. These proponents talk of fundamental irreversible shifts in the brain, though again this has not been proven. In fact, recent studies are finding the plasticity of the brain to be more robust than previously believed. In short, the brain’s ability to redress past abuses with drugs and to become healthy again is more in evidence than ever.
Okay, one more bias: In the long run, a full recovery—being fully abstinent from all drugs, along with regular care of the body and mind—is a beautiful thing.
Let’s not hold this generation to a lower standard. Yes, individuals need to cut out the most harmful drugs right away, but there still needs to be a process of insight and recovery that leads to a quality of life for people with addiction that they may never have known. Let’s make sure we provide the pathway and resources for them to aim high (sorry, bad pun).
Hello friends, Its been a while since I commented or posted. Life is definitely a roller coaster ride here. I am surrounded by addiction. I wondered if I could find out all there is to know about “suboxone”. My son recently detoxed at a center and decided to do IOP a few days a week as well as seeing a doctor who counsels and prescribes suboxone. I am a bit concerned because I am not sure how long he is supposed to do this and I can’t seem to get an idea of the plan from him. He is a 40 year old…………….. so I have absolutely no rights to information unless he wants to share.
He has been an addict off and on for at least 15 years. His drug of choice is opioids, fentanyl, oxy, benzos (?) don’t know what these are…. and lately a bit of alcohol…….. (to try to get thru the detox at home). That was AWFUL! He purchased suboxone from dealers and tryed for months to self-detox on weekends using alcohol to numb the sick feelings. It never worked. To add to this, his wife is also having addiction issues. Hers seems to be more on the alcoholism but opioids also played a part. She also went into treatment and is going for inpatient a bit longer than he did.
I want to be supportive but I can’t do that without knowing more about suboxone. He thinks that he can stay on this longterm but I doubt that is what he is supposed to do. He is afraid of feeling sick and of not being able to sleep (which he is not doing much of anyway). He is a wonderful and caring son but he thinks that he can manage his care on his terms. I KNOW that I am not in control. I KNOW that I need to set limits. I also know that I love these two more than the world and I want to help. I want information regarding suboxone, but there is SO much on the internet and I have no idea what is valid and what is not.
Also I would like to do a family counseling type of meeting. Does anyone have information on how to find a good person?
And is there a “sober-retreat” in the Massachusetts area that might be a good ‘getaway’ for them as a couple.
I appreciate all of the info and comments that you can give. I got a book that I just began reading and I am finding it helpful, “It takes a family”. I’m hoping for insight and new methods for helping and supporting.
I am in a very sad and numb place and I can’t imaging feeling any other way until things get ‘healthier’.
Thanks for listening.
Mom101… 🙁
Hi Mom101,
Boy oh boy I can really relate to your comment. I also had concerns and questions when my son was exploring Suboxone as a part of his treatment plan, and my lack of information led to feelings of anxiety. When I look back now, I know I was also hearing a lot of myths and advice that were based on stigma and misinformation, and which contributed to my own apprehension towards Medically Assisted Recovery (MAR).
It’s always helpful to identify the positives in a seemingly hopeless situation
First, I want to point out some incredible positives in your situation that may help relieve a little of your distress and help you to realize there is a foundation to build on:
– Your son is being open and honest with you about his struggles with cravings and informing you that his treatment plan will include Suboxone;
– Your son (and his wife) are not in denial. It sounds as if he’s trying multiple methods to boost his recovery….. Read Laurie MacDougall’s full response to mom101 here: https://alliesinrecovery.net/discussion_blog-is-suboxone-a-good-thing-for-my-lo
Your adult son and his wife are making a good effort at stopping opioid use, and perhaps everything else. Allow me first to say a little about Benzodiazepines, commonly referred to as “Benzos.”
Benzos are a class of psychoactive drugs prescribed for anxiety; they are also a very popular drug of misuse. Their benefits/desired outcomes include the following:
– they soften the crash of stimulants, and help get you to sleep;
– they enhance the relaxation created by alcohol; and
– they help with symptoms of withdrawal from opioids.
You may recognize some brand-names like Valium and Klonopin.
Since Benzodiazepines are prescribed for anxiety, and the rates of anxiety are easily over 50% in our Loved Ones with SUD, many of our Loved Ones have been prescribed and/or are drawn to these drugs. In my experience, they’re mostly used as a mixer with another drug or to induce sleep during withdrawals.
To be fair to the drug, and as we’ve written in this post (https://alliesinrecovery.net/discussion_blog-she-self-medicates-for-social-anxiety-and-refuses), Benzos are a treatment of choice for those with crippling anxiety disorder.
I, myself, have been on one-half of the smallest dose, daily for over 13 years. In my search for wellbeing, this drug has been nothing short of a life changer. After one week 13 years ago, my husband remarked that I had “transformed right before his eyes into the person I was meant to be.” A remarkable statement at the time. I was 47 years old. I remember the day, walking home from town, and the way the sun hit me. I relaxed one huge notch beyond a place I didn’t know existed. I was calmer, things felt less heavy. I could feel this visceral step down from the otherwise constant whirl that was my nervous system.
We often talk at Allies about “the pause” we need to cultivate, to avoid reacting impulsively to our Loved Ones — that “knee-jerk” reaction that just happens when something in life “triggers” us and it feels like our heart has missed a beat. It’s the awareness and purposeful amplification of this pause that will provide you, as the family member, a huge step up when responding to your Loved One.
The pause gives you a fighting chance of bringing on board the more rational/contemplative thinking (suggests more than it is?) part. Your response has a moment to become more reasoned.
For more on this, I think you’ll enjoy our recent podcast episodes, #72 “You Are Not Your Story: How to move out of drama and into consciousness” (https://alliesinrecovery.net/podcast_coming_up_for_air-podcast-72-you-are-not-your-story-how-to-move-out) and #73 “First Thought, Second Thought” (https://alliesinrecovery.net/podcast_coming_up_for_air-podcast-73-first-thought-second-thought)
The Suboxone your son has been prescribed is critical right now, and for his foreseeable future. You will have read our other writings on the subject, including an Allies’ statement about where we weigh in as to its controversy. The web and controversy may be one reason you are nervous about your Loved One’s taking the medication over the long-term.
Suboxone, like methadone, gives you a pass from crippling withdrawals. Suboxone, in essence, crosswalks you over to a state of wellbeing, and supports non-use.
Both your son and his girlfriend will be better protected should either have a relapse. Suboxone is partly a blocker of the opioid high.*
And aren’t you amazing to offer this couple a place to live right now. I just wrote to the state of Massachusetts, making your situation the central argument for why they should continue and expand funding for family training/support services, especially during COVID!
“After all, a family home is the residential setting for most individuals accessing community-based prevention and treatment services. Even if the Loved One isn’t living at home, the family likely has a hand in keeping their loved one housed, as they cycle through early recovery efforts. A family caretaker likely makes health care decisions, case manages, and intervenes in the addiction of their loved one.”
We here at Allies are ready to partner with you as you navigate this rather unique and challenging home life.
What is unique about your home life is that you all seem well-motivated to try creating a healthy home at the same time! And you are here, bless you, asking such an important set of questions early on in the process, where we can quickly teach you the skill set that will protect everyone, especially you. We are here as needed, partner.
You do have a significant challenge in this setup, though, which you can’t ignore, and that is your son and his girlfriend’s potential for losing motivation for complete abstinence from opioids (and the rest?) and/or the likelihood one will lapse and pull the other one down with them.
Your Loved Ones are going to need a community around them that regularly pumps in good recovery messaging and helps them connect to others. They will need to branch out and rely less exclusively on one other. You can help this along by providing them the pdf/list that you’ll find here, of online recovery meetings available during COVID. There are so many cool meetings of every stripe now, online. https://alliesinrecovery.net/resource_supplement-online-support-options-for-loved-ones-and-family-m
Add to this list your excellent idea for a family counselor. Our Resource Finding Methodology (https://alliesinrecovery.net/resource_supplement-airs-resource-finding-methodology) can help you find someone.
I would suggest you put your concerns about Suboxone aside and see it as the potential lifesaver that it is. Suboxone cuts overdose risk by 50%. In terms of your Loved Ones being a couple, it may help to read the posts we have published under the topic “couples.”
The challenge you will all three have is maintaining that motivation when things feel bleak or boring. Allies will do its part to help you with motivation. Videos, podcasts, a moment of calm or a belly laugh watching something in the sanctuary (my personal favorite: https://alliesinrecovery.net/sanctuary-cooper-loves-ice-cream).
*We have reached out to a colleague for further precision on the interactions between Suboxone and Fentanyl. Stay tuned, we will post his response here, on this thread.
I appreciate the detailed feedback. Lots of info and still I feel lost as to how we will get through this. I suppose that the marijuana substitute looked to me like a quick easy fix but it seems that it’s only a new crutch and could just be used ‘in addition to’ the opiates if one isn’t ready to stop or feels that they cannot handle abstinence.
Thank you for your response.
mom 101
I really appreciate the respect and intelligence that this post embodies. I, too, hate to see people miss out on the transformative experience recovery offers. And I want them to live long enough to “get it.”
Can these posts be copied and shared for greater distribution?
Thank you for this article. I appreciate your perspective.
Just had someone ask me about this yesterday – perhaps they saw the show too. In a state where marijuana is legalized, I encounter so many people using it as an adjunct or alternate treatment for anxiety and other issues. I also this week had someone tell me cocaine can be used to lessen opiate withdrawal (of course not a professional, but someone willing to give this erroneous method a try). Your articles are always informative but regarding harm reduction: when no other treatment is selected or preferred by the individual, harm reduction is a place to start. I do not consider MAT harm reduction though – MAT is a different, and effective evidenced based treatment with a goal of helping people reduce risk, reduce and eliminate use, and support longer term recovery. So grateful for all the options out there. Thank you for the informative articles.
“My next bias: I worry that we are becoming a society in which harm reduction is the goal. With MAT and now marijuana on the scene, are we putting a whole generation of people into a limbo state, part of the way towards recovery (harm reduction) by addressing only one drug (opiates)??
I agree with so much of your analysis. Why are you classifying Medication Assisted Treatment as harm reduction though? When it is THE scientifically proven treatment for opioid use disorder? Abstinence is not recommended for individuals with opioid use disorder, yet your post suggests that is the real recovery goal. A full and beautiful life in recovery is possible with opioid replacement therapy – it’s not a “limbo state” when done correctly. What a dangerous message.
THE scientific evidence for Medication-Assisted Treatment (MAT) is that it lowers overdose risk and reduces opiate use. This is very important and a critical first step for those abusing opioids. I maintain, though, that there is more to recovery than just this. This is why the clinical directors of MAT programs I have talked to call it harm reduction.
Read the rest of Dominique Simon-Levine’s response to scituatefacts here: https://alliesinrecovery.net/discussion_blog-mat-whats-the-harm-in-harm-reduction
Also, read the Allies in Recovery Philosophy statement here: https://alliesinrecovery.net/discussion_blog-allies-in-recovery-philosophy-statement
Appreciate this- well written and informative, thanks!