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Treating Addiction With Medical Marijuana

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 5, 2019

Research suggests medical marijuana, or cannabis or cannabinoids, show promise in the treatment of opioid addiction, as well as other addictions.

Treating Addiction With Medical Marijuana

Though marijuana is a controversial drug, it is now linked to a breakthrough medical use—the treatment of addiction. The greatest focus of marijuana as an addiction treatment is in treatment of opioid addictions.

The United States is currently facing an opioid crisis of what is being called epidemic proportions. Opioid drugs include illicit drugs, such as heroin and a variety of prescription painkillers. All opioid drugs hold significant potential for abuse, with some being exceedingly addictive within a short amount of time.

Medical marijuana, research suggests, shows promise in the treatment of opioid addiction, as well as other addictions.

What Is Medical Marijuana?

Medical marijuana, or medical cannabis, refers to either the unrefined plant in whole form, or “basic extracts” which are used to treat a disease or symptom.

The National Institute on Drug Abuse (NIDA) explains,“The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine.” Yet marijuana is being currently utilized in over half the states in the U.S., with laws pertaining to its use varying on a state-by-state basis.

Within cannabis, chemical compounds have been shown to be potentially effective in treating a wide range of illnesses or their symptoms. One chemical, cannabinoids, stands out. Cannabinoids are chemically related to delta-9-tetrahydrocannabinol, commonly referred to as THC, the compound that is responsible for creating the “high,” or psychoactive (mind-altering) properties that recreational users seek.

There are over 100 other cannabinoid chemicals in marijuana. Our own bodies actually contain cannabinoid chemicals, which, according to NIDA, “play a role in regulating pleasure, memory, thinking, concentration, body movement, awareness of time, appetite, pain, and the senses (taste, touch, smell, hearing, and sight).”

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The presence of these chemicals is why our bodies may react favorably to certain external cannabinoids in marijuana in particular circumstances. As cannabinoids enter the body, they are able to attach to specific receptor sites where our own naturally-occurring versions typically reside.

When marijuana is used medically, a person may use either a portion of a medical-grade plant, which may be smoked or vaporized, edibles (food items which contain cannabis extracts), pills, concentrated medicinal cannabis oil, or any number of extracts. Extracts may contain only certain chemical compounds from the whole plant.

In certain cases, THC may be removed from medical compounds of marijuana, negating the high or pleasurable effects, so that the substance delivers only therapeutic or medicinal value. However, THC is useful within certain medical applications, including addiction treatment, as research suggests.

Why Isn’t Medical Marijuana FDA-Approved?

Marijuana is a Schedule I drug, which is the most severe assignment within the Controlled Substance Act (CSA) Scheduling guidelines. This assignment is due to this drug not having a “currently accepted medical use and a high potential for abuse.”

Because of these qualities, the intensive and large-scale studies which the FDA requires to prove a substance’s safety, efficacy, and medical application are difficult to achieve. Though the plant in its entirety is not approved, the FDA has approved two medicines in pill form which contain cannabinoid chemicals, used to treat adverse symptoms associated with chemotherapy for cancer patients.

Despite federal regulations, on a state-by-state basis, marijuana has been approved for medical applications, with currently 28 states and the District of Columbia (Washington D.C.) allowing cannabis to be used in this way.

How Is Medical Marijuana Being Used With Addiction Treatment?

Treatment with medical marijuana or any of its components is dependent on if a given state has a medical marijuana law allowing such use. At this time, these offerings are slim. TIME reports that in April 2016, Maine became the first state to consider adding opioid addiction to the list of conditions that medical marijuana may treat, though efforts to that end were ultimately eliminated.

Currently, marijuana appears to only be utilized minimally in a medical way, with the use being concentrated within Massachusetts.

According to a Boston Herald article, in a medicinal cannabis clinic in Massachusetts, Dr. Gary Witman has utilized medical marijuana within a one-month taper to treat addiction to:

  • anti-anxiety medications
  • muscle relaxers
  • opioids

Out of 80 patients undergoing this protocol, Dr. Witman reports a 75 percent success rate of abstinence from the drug of abuse, stating, “As soon as we can get people off opioids to a nonaddicting substance — and medicinal marijuana is nonaddicting — I think it would dramatically impact the amount of opioid deaths.”

Medical Marijuana May Help Reduce Opioid Abuse And Overdose

Scientists are actively researching the benefits of medical marijuana as a preventative factor within abuse and addiction in the following ways:

For Pain Management:

Prescription painkiller addiction often arises from the diversion of these medicines or the misuse and abuse of one’s own prescriptions. If the numbers of prescriptions drop, the adverse effects caused by them may decrease.

A 2015 article published by The JAMA Network sought to examine if medical marijuana could be used for concerns of pain management, and reported that “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence….suggesting that marijuana or cannabinoids may be efficacious for these indications.”

Other scientific studies support similar claims. Research also suggests that medical marijuana may be more effective for long-term inflammatory pain management versus opioid painkillers, which may be better for short-term applications.

A 2016 Israeli study reported that of 176 patients who used opioids, 44 percent were able to discontinue these medications after either smoking cannabis or ingesting cookies containing cannabis.

Concerns of chronic pain management are often listed within the approved use of medical marijuana within most states.

In pain management, cannabis is reported to help in the following ways:

  • Preventing tolerance to opioids from climbing further, thus reducing the concern of increased dosages.
  • Used with opioids, cannabis may increase the analgesic (pain-relieving) properties of opioids, possibly allowing for smaller doses of opioid drugs (tapering).
  • Providing greater safety and less concern of addiction than opioid drugs.
  • Enabling clients to function in their day-to-day tasks and responsibilities more effectively than with other drugs.

A University of Michigan study cited that study participants reported a 64 percent reduction in their use of opioid painkillers when using medical marijuana.

Reducing Risk Of Overdose:

In addition, JAMA also published research that suggests the use of medical marijuana may help to prevent opioid-attributed overdose deaths. Scientists examined the rate of opioid-related mortalities from 1999 to 2010, in all 50 states. When comparing those states without medical marijuana against those which had medical marijuana laws allowing for the medical use of cannabis, the study’s authors found that the latter group of states actually witnessed a “24.8% lower mean annual opioid overdose mortality rate.”

Researchers attributed this to the possibility of certain individuals replacing opioid painkillers with medical marijuana. More research is needed, but this study provides support for those who believe medical marijuana  may be useful within addiction treatment.

Medical Marijuana To Treat Opioid Addiction

One cannabinoid compound, cannabidiol (CBD) is increasingly reported to have therapeutic benefits, while also being non-psychoactive (not creating mild-altering properties). Continued research is necessary to determine if this chemical stands alone for therapeutic purposes, or if it would work better in conjunction with the whole plant.

Marijuana and various cannabinoid compounds, including CBD, may be beneficial in opioid addiction treatment because they may:

  • be a safer alternative for harm reduction in current, addicted opioid abusers
  • work towards alleviating or reducing symptoms of opioid withdrawal
  • work to reduce cravings
  • aid in relapse prevention
  • decrease adverse side effects in comparison to other treatment drugs

A Journal of Neuroscience study researched the effects of CBD on rat subjects, finding that even after 24 hours and two weeks of abstinence, the rats failed to respond to cues that could prompt a heroin craving, despite the fact they could self-administer the drug. This highlighted the potential of CBD both as an aid against cravings and to protect against the threat of relapse.

A second study on human participants supported these findings, and also showed that CBD may lessen the severity of drug cravings.

One of the biggest focal points within utilizing medical marijuana and its components as a treatment for opioid use disorders is how these elements compare to other pharmacological approaches. The second study noted that CBD may “regulate neural systems modulating opioid-related behavior, thus helping to reduce side effects normally associated with current opioid substitution treatment strategies.”

For harm reduction, research shows that medical marijuana may be useful as a substitution for harder drugs, including alcohol, illicit, and prescription drugs. One study’s findings documents that, “forty percent of the sample reported using cannabis as a substitute for alcohol, 26% reported using it as a substitute for illicit drugs, and 65.8% use it as a substitute for prescription drugs.”

Lastly, ScienceDaily reports on a study also on rat subjects, which documented cessation of morphine dependence after an injection of THC. These results suggest medical marijuana may offer similar effects in humans for this and other opioid addictions. Though the practice of treating opioid addiction with medical marijuana is not widespread, advocates are firmly pushing for its accepted use, due to the growing body of research supporting it.

Ongoing Research In Use Of Medical Marijuana

Research continues, and has highlighted the possibility that medical marijuana may be a positive and effective treatment for stimulant abuse or addiction.

Frontiers of Psychology study examined the possibility of medical marijuana as a treatment form for psychostimulant addictions, such as cocaine and amphetamine addictions. The mechanism of action, as explained by the article, is how the endocannabinoid system (ECBS) regulates certain aspects of neurotransmitter functions that stimulants typically affect.

In addition, this system “plays a central role in various cognitive and physiological processes associated with addiction such as reward, stress responsiveness….” If an individual doesn’t experience stress or the activation of rewards circuits as acutely, they may be able to progress through recovery more successfully.

According to this article, various marijuana compounds may prove beneficial as a potential medicine for both addiction and relapse prevention.

Medical Marijuana To Treat Co-Occurring Disorders:

Preliminary research suggests that medical marijuana, specifically the compound CBD, may be useful in alleviating some symptoms of the following co-occurring disorders:

  • Anxiety: CBD affects areas of the brain responsible for decreasing certain effects of anxiety. In those who have generalized anxiety disorder, CBD was found to aid individuals who have an aversion to speaking publicly by decreasing anxiety, cognitive dysfunction, and discomfort, effects that may help a person to become more positively engaged in group sessions within treatment.
  • Depression: Findings show that CBD may have both antidepressant and anti-anxiety effects.
  • Post-traumatic stress disorder (PTSD): One study shows that cannabinoids may increase pleasure and induce changes to the way a person’s memory functions, noting that these “effects provide a pharmacologic rationale for the use of cannabinoids to manage the three core PTSD symptom clusters: re-experiencing, avoidance and numbing, and hyperarousal.” Other research suggests CBD circumvents the continuous reliving of traumatic experiences known in PTSD.
  • Schizophrenia: CBD has been shown to have potential for treating this disorder due to its anxiolytic (relieves anxiety) and anti psychotic properties.

Risks Of Medical Marijuana

One factor that hinders the legalization of marijuana as a medicine is the presence of various side effects. Though all medical drugs have side effects, it is important to always weigh these negatives against the positives.

Health concerns and side effects of marijuana include:

  • potential for addiction
  • decreased physical health
  • increased potential for risky behaviors
  • reduced life satisfaction
  • difficulties in work, school, or relationships
  • effects to brain development
  • cardiac complications
  • lung complications
  • links to certain mental illnesses
  • possible connection to certain forms of cancer
  • complications to children in-utero

As marijuana may be used illicitly, and is not without risks, the use of marijuana within addiction treatment is a sensitive subject. Prior to pursuing use of medical marijuana, individuals should speak to a medical support team, physician, or other trusted medical professionals.

To learn more about how medical marijuana is used to treat addiction, contact us today.

National Conference of State Legislators - State Medical Marijuana Laws

Project CBD - America’s Opiate Crisis: How Medical Cannabis Can Help

U.S. National Library of Medicine - Cannabidiol, a nonpsychotropic component of cannabis, inhibits cue-induced heroin-seeking and normalizes discrete mesolimbic neuronal disturbances

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