In April 2018, Joanne shot heroin for the last time after six years of active addiction. During that time, she made numerous attempts at sobriety but each time she faced the same roadblock when she sought outpatient treatment: “They told me I wasn’t allowed to smoke weed which made me feel like I was just destined to fail, and I did rather quickly.”
Addiction treatment professionals have begun implementing new protocols including harm reduction and medication-assisted treatment, but like Joanne experienced, most treatment programs completely ban cannabis use. This means that if the program discovers that a patient is using cannabis, the patient will most likely get kicked out.
The stigma against cannabis use persists, especially when combined with the stigma people with addictions already face. New studies, however, are showing how cannabis can actually support people in their journey to recovery. This might surprise you, but I’ll explain…
What is Addiction?
The American Psychiatric Association (APA) defines addiction as “compulsive substance use despite harmful consequences.” Medical and mental health professionals refer to drug addiction as substance use disorder. The Diagnostic and Statistical Manual of Mental Disorders (aka “the therapists’ bible” or DSM-5), defines eleven criteria to determine if a person should be diagnosed with substance use disorder. Substance use disorders span a wide variety of problems arising from substance use. The eleven symptoms include:
- Taking the substance in larger amounts or for longer than you’re meant to.
- Wanting to cut down or stop using the substance but not managing to.
- Spending a lot of time getting, using, or recovering from use of the substance.
- Cravings and urges to use the substance.
- Not managing to do what you should at work, home, or school because of substance use.
- Continuing to use, even when it causes problems in relationships.
- Giving up important social, occupational, or recreational activities because of substance use.
- Using substances again and again, even when it puts you in danger.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Needing more of the substance to get the effect you want (tolerance).
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Addiction as a Public Health Epidemic
As the opioid epidemic has devastated communities throughout North America, members of the public have pushed for greater awareness and understanding of addiction as a public health issue. Activists and public health experts advocate for expanded access to substance use treatment and more compassionate approaches to people who struggle with addiction. Harm reduction and medication-assisted treatment are two of these approaches.
Harm Reduction Treatment
Harm Reduction emerged as a public health approach to substance use during the HIV/AIDS epidemic. It was discovered that injection drug users were contracting the virus by sharing needles and other supplies used to inject. Public health and medical professionals as well as members of the activist group ACT UP advocated for and set up needle exchange programs where people could receive sterile syringes, bleach, and other supplies used to inject substances. Advocates for syringe exchanges refer to the practice as “harm reduction” because the programs reduced the likelihood that their participants would share used syringes and contract HIV. The Harm Reduction Coalition defines harm reduction as:
A set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
The concept of harm reduction has been embraced to address other public health crises as well. Other examples of harm reduction include distributing Narcan, the opiate overdose reversal drug, and drug checking kits, which allow people to see if the drugs that they are about to consume have been contaminated with other substances like fentanyl.
In essence, harm reduction accepts that people use substances and aims to help them be as safe as possible without pressuring them to stop using altogether.
The concept of medication-assisted treatment (MAT) isn’t actually all that new. Professionals and patients living with substance use disorder have been advocating for expanded access to MAT for years.
So what is MAT? The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as
“the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”
While in the past people have described these medications as “substitutes” for opioids or alcohol, MAT is an evidence-based approach to substance use treatment that encompasses counseling and therapy in addition to medications to help individuals in their recovery.
Critics of maintenance medications like methadone and buprenorphine believe that people on MAT are not truly in recovery. They argue that maintenance doesn’t count as sobriety because methadone and buprenorphine are opioids, even though methadone and buprenorphine work differently than opioids like Heroin and Fentanyl and are taken under the supervision of medical professionals. Unfortunately, the stigma towards MAT discourages people from pursuing it as a treatment option. These misconceptions, however, do not change the fact that overwhelming evidence shows that MAT “at least doubles” the rate at which people in treatment for opioid use disorder stay sober (including people who have relapsed in the past).
Can cannabis be a form of medication-assisted treatment?
As states across the nation have legalized and established medical cannabis programs, more researchers are investigating the potential uses of cannabis for pain management and mental health. Unfortunately, the federal government does not recognize cannabis legalization and the DEA still categorizes marijuana as a Schedule I substance with “no currently accepted medical use and a high potential for abuse.”
As a result, scientists who want to research the potential medical uses of cannabis face a number of legal and institutional barriers because the government has historically supported research that demonstrates the health and social risks of cannabis. The government’s view that cannabis has a “high potential for abuse” makes conducting research on the potential role of cannabis in substance use treatment even more difficult. In spite of these obstacles, several preliminary studies conducted in recent years have shown cannabis’s potential to assist in substance use treatment and recovery.
Fortunately these restrictions don’t exist in other countries where various studies are ongoing. A 2016 study conducted in Canada surveyed 473 Canadian medical cannabis patients to collect data on patients’ medical conditions, cannabis use patterns, and if they have substituted cannabis for prescription medications, alcohol, and/or illicit substances. As a follow-up, participants were asked to rank six possible reasons why they used cannabis in place of other medications or substances. The study found an association between patients who had received substance use treatment and those substituting cannabis for “illicit substances.” This connection demonstrates that cannabis has assisted some patients in successfully reducing or eliminating their substance use.
Another survey of medical cannabis patients in Canada similarly showed participants substituting cannabis use- 44.5% instead of alcohol, 35.5 instead of opioids, and 26.6% instead of other illicit substances. Additionally of the respondents who substituted cannabis for opioid use, 60% of them reported discontinuation of opioid pain medications with cannabis to manage their pain.
These studies show that cannabis consumers have found success in using cannabis as a way to address substance abuse. However the use of surveys has a number of limitations. Additional studies specifically focusing on cannabis as a form of medication-assisted treatment are needed to demonstrate the benefits and risks.
Beyond research, people in recovery from substance use disorder have shared about how cannabis helped them transition off of other substances and achieve long term recovery. While these stories are no substitute for rigorous scientific research, they could raise awareness among treatment providers and the public as a whole about cannabis’ potential role in recovery.
Finding Long Term Recovery through Cannabis
Joanne felt discouraged by her experiences in treatment settings: “By the time I was 20 and had been arrested twice for drug-related crimes, I had tried entering an outpatient detox/rehab four times, all with no ‘success’…the only collective time I spent sober during that time was when I would spend a month or so smoking weed and not telling my rehab, until I was told to quit or be kicked out.” For Joanne, abstaining from heroin and cocaine was no easy feat, but the treatment programs discounted her achievements because she was consuming cannabis.
Shortly after her fourth attempt at treatment, Joanne spent a year in prison on drug-related charges. She used heroin and suboxone throughout her sentence. When she returned home, Joanne decided to abstain from drugs entirely, including cannabis. After a month of abstinence, Post Traumatic Stress Disorder, and Post Incarceration Stress Disorder, Joanne returned to using cannabis to manage heroin craving and trauma.
“This helped me to not go to pick up a rig and dope simply because I was using something far less harmful than any of the drugs I actually wanted,” she said.
For Joanne, cannabis was medicinal and a form of harm reduction. On her rocky road to recovery, Joanne was initially able to stay off of heroin and cocaine for 6 months by using cannabis.
The next and final time she sought treatment in April 2018, Joanne was prepared to advocate for herself. She knew that her cannabis consumption had helped her stay sober and engaged in treatment in the past. She recognized that compared to injecting heroin or cocaine, her cannabis use was undeniably safer.
“I told them I was willing to do Vivitrol shots if I was able to smoke weed during the duration of rehabilitation at their center. Vivitrol has no effect on cocaine use which was my main fear for relapse,” Joanne pointed out. “They told me they would allow it, but I wouldn’t get a certificate of completion and would never fully graduate from the program. I was told to not speak about it in groups even if I found it helpful for me and wanted to discuss it.”
Joanne accepted these terms and completed her program, albeit without a graduation certificate or pizza party. She has been sober for over 2 years and continues to use cannabis to manage her cravings and mental health symptoms, which she refers to as her “marijuana maintenance program.”
While she did not need a certificate or party to validate her recovery, she expressed frustration and sadness with how the mainstream treatment and recovery world views her approach. Julia and others who use cannabis for harm reduction or MAT treatment continue to hide their use from the rest of the recovery community. Various meetings and recovery events necessitate “total abstinence” as part of their tenet.
“Because of my use of weed, I can’t necessarily speak openly in recovery groups or 12 step meetings or in IOPs, and it’s devastating that I can’t clearly speak out about my success because it’s due to the use of a somewhat ‘illegal’ drug.”
Julia made a point to say that cannabis use in recovery does not work for everyone.
“I always suggest to folks who want to continue smoking weed in active recovery to do so if they see that it doesn’t hinder any progress. And once it doesn’t work, to switch it up and find other forms of recovery that work for them! It’s an ongoing process even for me, finding the right dose and making sure that I don’t allow it to control my life the way heroin and cocaine did.”
Cannabis has the potential to become addictive, so people who use it in recovery should be mindful of the signs of substance use disorder described at the beginning of this post and whether their cannabis use is interfering with other aspects of their lives. Additionally, Tetrahydrocannabinol (THC) consumption is not recommended for people who experience or are at risk for psychosis.
Policy Change and More Research on Cannabis is Necessary
Joanne’s story of attaining sustained recovery through cannabis use demonstrates the life changing potential of cannabis in substance use recovery, but it also shows the barriers that cannabis consumers experience when seeking addiction treatment.
Cannabis has the potential to help people struggling with addiction, but cannabis prohibition and the dominance of the abstinence-based model prevent people from accessing the treatment that works for them. The overdose epidemic warrants a new approach to substance use treatment as tens of thousands of people continue to die of fatal overdoses every year. Advocating the US government to reschedule (or de-schedule) cannabis will create more opportunities for experts to research how cannabis can help support substance use treatment.
Do you want to reduce the stigma of cannabis use and medication assisted treatment in recovery? Share this post and start the discussion with your friends and family.
If you think that cannabis should be de-scheduled, look up your elected officials’ stances on the matter and lobby them for change.
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About the author
Rebecca Dayan is an aspiring content writer living in Washington, D.C. She is passionate about reducing the stigma surrounding mental health and addiction. Beyond writing and activism, she loves vintage fashion, playing guitar, and snuggling with her cat Mazzy.
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