A POTENTIAL ROLE FOR CANNABIS IN ADDICTION TREATMENT

Many people have already seen the CNN documentary by Soledad O’Brien “Gary and Tony Have a Baby”. Those who have not seen the documentary yet will likely see it, as CNN practically goes out of its way to bring this touching story to millions of people around the country. The story is about two professional gay men in a stable relationship of twenty years who, determined to have a family, overcame many obstacles, both legal and financial, in their quest to become parents, a story that they agreed to share, in all its intimate details, with their fellow countrymen, and they did it with a clear sense of pride and accomplishment. This story, as far as I could see, was not just about Gary and Tony and the people who helped them in their quest, it was about our society’s views on this sort of things, or rather the evolution of these views that has taken place over the last 35 years or so. If a documentary such as this one had been shown by anyone 30-40 years ago, the reaction would not have been of sympathy and support, it would have been entirely different altogether. The documentary would have been considered an “abomination” and “affront” to “family values” and to “common decency”. All the advertisers would have probably pulled out, the courts would have declared the whole affair illegal, and Moral Majority would have called for a boycott, if not an outright shutdown, of the station responsible for such an “insult” to our “common moral ideals”. In other words, to put it philosophically, the whole thing would have had a different “existence”.

What this simple example demonstrates is that all our perceptions are determined by the state of consciousness. As our common consciousness changes and evolves, so do our perceptions which are more than our sense experiences by virtue of sight, hearing, touch, taste and smell. Indeed, if “Gary and Tony Have a Baby” had been shown 35 years ago, we would have seen and heard the same things, but we would have perceived them very differently. It is exactly the same evolution of consciousness that is taking place right now with respect to Cannabis legalization. As our scientific knowledge accumulates, and the racist stereotypes of the past gradually fade into oblivion, our common consciousness gives rise to different perceptions about Cannabis and its users.

We are now suddenly able to “see” that our neighbor who “smokes weed” is actually not a bad person, that we would even much rather deal with him than with the drunk across the street who beats his wife, neglects his children and gets into all kinds of trouble with an almost predictable certainty. We begin to realize that we never “hear” about Cannabis overdoses, although we do hear about prescription drug-associated deaths quite often, even in people like Michael Jackson or Craig Cory, the people we almost worship collectively and individually. The Nation’s nurses, our main caregivers, whose opinion we seek and value, cannot deny the fact that it is much easier to deal with Cannabis using patients, who tend to be polite, respectful and non-aggressive, as opposed to alcohol, or hard drug, or even prescription drug abusers.

In fact, prescription drug abuse has reached truly epidemic proportions in this country and around the world, and the medical professionals, both doctors and nurses, are well aware of its destructive potential and the difficulties inherent in dealing with prescription drug abusers. This is why more and more doctors and nurses are now able to “see” that prescription drug abuse is far more dangerous than Cannabis use can ever be, or have a potential to be. There are almost two million opiate addicts in this country, the opiate addiction originating from contact with heroin or prescription opiate pain-killers, such as Morphine, Percoset, Oxycontin and others, with chronic methadone maintenance therapy as a “final common pathway” for these patients in case they seek help for their dependence.

Methadone is a long acting opiate that is capable to suppress opiate cravings if given at a proper dose. If opiate addicts do not seek help, their addiction is often fatal, the cause of death being an overdose, violence, or diseases transmitted as a result of intravenous drug use. Methadone maintenance therapy is frequently complicated by other prescription drug abuse, as many patients in methadone clinics take benzodiazepines, such as Valium, Xanax and Klonopin that produce a heroin-like “high” when combined with methadone. A program physician in a methadone maintenance clinic has to constantly “walk a fine line”, for if the methadone dose is too small the patients will use illicit opiates, and if it is too large, they may easily overdose by ingesting benzodiazepines or other prescription drugs on top of methadone.

The reason for a potential for overdose with opiates, both legal and illegal is that opiate receptors upon which these drugs act are located in a very close proximity to the “respiratory center” in the brain stem, so that an overdose usually manifest as a cessation of breathing, a very dangerous condition, as it is easy to see. Another hallmark of opiate dependence is the rapid development of “tolerance”, a condition where more and more opiate drug has to be consumed for the same effect, so that even “experienced” opiate addicts sometimes “miscalculate” the amount or strength of a drug with the disastrous consequences.

There is a common misunderstanding about the nature of addiction where it is erroneously believed that all that the addict needs to do to “recover” is to have enough “willpower” to get over his “sickness” for a “couple of days”, and then just to stay away from drugs. The fact of the matter is that addiction is much more than drug “cravings”, and it is also more than even physical dependence on a drug. There is a great emotional instability that is observed in most addicts, a “negative affective state”, or whatever else it may be called, an inner “uneasiness” that persists long after the drug use has stopped, and that may actually have been present before it began, the cause and effect relationship between a certain personality structure and the development of addiction often being far from clear-cut, in a sense that it is impossible to say which condition is a “cause” and which one an “effect”.

This is the reason why the relapse rate is so high, being over 90% for opiate addicts, often happening years after the termination of heroin use. This is also the reason why many authorities now believe that it is the functional stability, and not necessarily the total “abstinence”, that determines the treatment success in the final analysis. This is also the reason why most authorities now believe that in order to treat a severe addiction, be it to heroin, cocaine, alcohol, or prescription drugs, the underlying emotional balance must be addressed as well, or otherwise the relapse is practically inevitable. The persisting symptoms of anxiety, insomnia, mood swings and depression are so severe and poorly tolerated by patients that they lead to unrelenting drug-seeking and other risky behaviors, and eventually to a full-blown relapse to dangerous levels of drug use, both legal and illegal.

This is why some authorities, especially those advocating for a “harm reduction” in addiction treatment, are now also looking at Cannabis as a possible solution in a “long-term” management of addictions, both chemical and behavioral. Why would they ever do something like that, especially considering a strong opposition from the DEA and its prohibitionist allies who, despite all the accumulated scientific evidence to the contrary, still consider Cannabis to be a “dangerous drug” with “no medicinal use”? I recently listened to Dr. Donald Abrams, one of the leading specialists in medicinal Cannabis use, himself an oncologist by training. As Dr. Abrams put it, “I can either use five different drugs on a patient, one for anxiety, another one for insomnia, another one for mood swings, another one for pain, and yet another one for depression, or I can use CANNABIS to address all of these symptoms at once”. Dr Abrams also correctly pointed out that Cannabis is less addictive than caffeine and definitely less addictive than alcohol or nicotine. I believe this refutes the prohibitionists’ argument portraying Cannabis as an “addictive drug” unsuitable as an aid in addiction treatment.

The same, the very same logic would apply for addiction treatment. It has been shown that Cannabis can alleviate anxiety, and insomnia, and depression, and pain, and mood swings in a sizable number of patients. Cannabis would also induce a mild euphoria along with a calm, relaxed state that will address and alleviate this deep-seated “negative affective state”, so conducive to chemical relapse and risky, often violent, behaviors. And the beauty of this approach is that Cannabis does all of this without inducing a physical dependence and with no danger of overdose, since by some very strange “coincidence” (which holistic philosophers consider to be no coincidence at all), that cannabinoid receptors upon which Cannabis acts in our “system” are, as opposed to opiate receptors, quite scarce in the vicinity of vital brain centers, making a Cannabis overdose impossible.

Unfortunately, the very same mechanism responsible for preventing a physical dependence on Cannabis is also “at fault” in “driving” people to indulge in alcohol, hard drug, or prescription drug abuse. Sounds strange? Let me explain. Cannabis is dissolved in fat tissue after use, being then gradually released into the blood stream. This prevents wild fluctuations in Cannabis blood levels due to mechanism known in addiction medicine as “self-tapering”. But this “built-in” safety feature of Cannabis is also the reason as to why it can be detected on random urine drug screens for such a long time, which in turn “encourages” people to use much more dangerous substances as they leave the “system” rapidly and are much less likely to be “detected” by an employer, court system, or any other “concerned” entity.

The legalization of Cannabis for responsible adults will eliminate this “fear of detection”, and together with it the “incentive” to engage in alcohol or other dangerous drug use. This way, as I firmly believe, Cannabis will serve as a “barrier” to the initiation of a serious chemical dependency on physically addictive substances. No less importantly, by using Cannabis as a potential “adjunct” in addiction treatment, we would be able to address the main precipitating factors for relapse at a very “low cost”: there is no potential for either physical dependence or an accidental overdose. If I am not mistaken, the State of Pennsylvania now considers the recovery from opiate addiction “possible” in a patient using Cannabis. I would, of course, change the word “possible” to something like “much more likely”. The proponents of “harm reduction” in addiction treatment now correctly view Cannabis as an “exit” drug for former alcohol, hard drug, or prescription drug abusers. I expect that at the upcoming conference in LA organized by the California Society of Addiction Medicine in cooperation with “New Directions” in recovery these issues will be discussed in greater detail, and I will do all I can on my part to help convince my colleagues of the validity of this approach.

As I indicated in the beginning of this article, our perceptions change as our consciousness evolves. This new, scientific view of Cannabis reflects the evolution of consciousness as well, and it is a long process, for it has to come all the way from the absurdities which led to Marijuana Tax Act of 1937 back to scientific reality. I mentioned the CNN documentary “Gary and Tony Have a Baby” with yet another purpose; just like our opponents do right now, the gay rights opponents used the scare-tactics against the gay people just a few short decades ago. And the scare-tactics, if we pay attention, are almost the same, namely, “What will happen with our children???” And just as nothing at all happened with “our children” when gay people won their civil rights, nothing will happen with “our children” when we finally recognize the remarkable medicinal properties of Cannabis plant except, perhaps, that they will have a much safer alternative to alcohol and dangerous drugs, including prescription drugs, and more effective ways to treat addictions to those substances if, for whatever reason, genetic or otherwise, they do develop in susceptible individuals.

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