Treatment that includes marijuana use ignites debate

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.

“It’s an affront to evidence-based treatment and it has no place in recovery,” Sabet, a drug policy consultant who previously served as senior advisor at the White House Office of National Drug Control Policy ONDCP) under the Obama administration, tells Addiction Professional.

“There is no evidence that marijuana is a treatment for substance use disorders. There IS evidence that it exacerbates substance use disorders, and there is a lot of evidence showing that people with substance use disorders either started with marijuana or marijuana is part of their poly-drug using experience.”

He also strongly disagrees with the notion that using marijuana in place of Suboxone in detox is preferable because it will eliminate the side effects experienced by patients. “To say there are no effects to using marijuana is like living in an alternate universe,” he says.

In January, the National Academies of Sciences, Engineering and Medicine published a report on the health effects of marijuana and cannabis-derived products. Nearly 100 conclusions are reached in the report, which was compiled after reviewing 10,000 scientific abstracts. Among the report’s findings:

• Cannabis use is likely to increase the risk of developing schizophrenia, other psychoses, and social anxiety disorders.
• Evidence suggests smoking cannabis on a regular basis is associated with more frequent chronic bronchitis episodes and worse respiratory systems.
• Learning, memory and attention are impaired after immediate cannabis use.

To this end, Sabet says providers increase their exposure to legal action by using marijuana in addiction treatment. “Frankly,” he says, “I wouldn’t be surprised if this were a lawyer’s dream because the liability a treatment center is going to have to deal with when things go wrong is going to be a big problem.”

The push to use marijuana in addiction treatment bears a resemblance to messaging from the tobacco industry 50 years ago, Sabet says.

“At the end of the day, the move to do this is about money,” he says. “I feel sorry for the people it’s attracting. It’s going after an extremely vulnerable population and dangling one of the most unscientific ideas in treatment I’ve heard about in decades.”

In the midst of what Sabet calls “a pro-marijuana cultural wave” and as marijuana laws continue to loosen in states across the US, the consultant says it’s on the addiction treatment field to become more vocal.

“This should be a wake-up call to anybody interested in getting people into recovery and promoting evidence-based treatment,” Sabet says. “It’s easy for all of us in the field to not talk about marijuana because it’s a difficult issue and we don’t want to be against history and what’s going to happen. It’s really easy to ignore, and this is a consequence of our field not stepping up. There should be a massive outcry—and I hope there will be—by the entire addiction field. Prevention, treatment, recovery, law enforcement. We should not be standing on the sidelines thinking this is OK.”