High on Harm Reduction

We’ve all likely been harmed by some kind of substance, in one way or another. You may have watched a friend get into heroin or meth or even seen yourself spiral out of control during a night of booze and blow. The simple truth is that not all psychoactive substances are as beneficial as our cannabis plant.

Harm reduction is a strategy that acknowledges that people use drugs and works to decrease the dangers and damage caused by their use. One common example is the syringe-exchange programs so that users have clean needles to help them stay safe from HIV, hepatitis and the other health risks that result from sharing syringes. Another is to substitute a less harmful substance for a more dangerous one, like setting up methadone clinics to help people get off heroin.

As the legal landscape for cannabis evolves, its important role in harm reduction has come to be increasingly recognized. From hardcore addicts seeking relief from withdrawal symptoms, to heavy drinkers looking to replace booze with pot, research and science are showing the benefits of cannabis in recovery.

Of course, this remains a controversial notion in traditional recovery programs, especially 12-step groups that preach total abstinence. While Alcoholics Anonymous works well for some, it’s certainly not for everybody. In fact, “peer reviewed studies peg the success rate of AA somewhere between 5 and 10 percent …. About one of every 15 people who enter these programs is able to become and stay sober,” write Zach and Lace Dodes in The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

When I first quit drinking three years ago, I tried AA. While I’ve seen others benefit from the program, it really didn’t jibe with me—specifically, the organization’s beliefs about cannabis. The fact is that I stopped drinking because booze makes me an asshole. Cannabis has allowed me to abstain from alcohol and therefore not screw up my life. It mellows me out and allows me to become a more mindful human.

As a result, I’m grateful for cannabis—and I’m not the only one. Take the 2009 study conducted by Amanda Reiman, a marijuana-law manager for the Drug Policy Alliance and a lecturer at UC Berkeley, which was discussed in the Harm Reduction Journal. Reiman surveyed 11 medical cannabis doctors in California and found that all were treating patients who used cannabis as a substitute for alcohol. “Furthermore, one said that over half of her patients reported preferring cannabis to alcohol, and another reported that 90 percent of his patients reduced their alcohol use after beginning the use of medical cannabis,” Reiman wrote.

As the laws evolve to allow greater research into the therapeutic benefits of cannabis, it’s encouraging to see medical science confirm what so many have been saying all along. Reiman’s study also found that 40 percent of the Berkeley patients surveyed used cannabis as a substitute for alcohol, 26 percent as a substitute for illicit drugs, and 66 percent as a substitute for prescription drugs. When asked why they preferred to use cannabis instead, the subjects provided reasons that included fewer adverse side effects (65 percent), better symptom management (57 percent) and less withdrawal potential (34 percent).

It’s wonderful when anyone can quit a drug that’s causing them problems; my own life certainly got a hell of a lot better when I stopped using alcohol. And anyone who’s spent a night curled up in the fetal position will tell you: Drug withdrawal is hell, and relapses are easily triggered.

Thankfully, cannabis works wonders for withdrawal symptoms, too. “So many people relapse because they just can’t handle the physical problems of withdrawal,” Reiman notes. “So it’s kind of a one-two punch. Cannabis both helps with the withdrawal symptoms and also enables someone to maintain abstinence.”

But despite the abundance of anecdotal evidence, the idea of cannabis as a recovery tool is still scoffed at. “It’s this stigma: ‘Aren’t you just substituting one addiction for another?’” Reiman continues. “That’s what we hear a lot.” She believes the stigma is a result of our antiquated federal laws: Reinforcing this abstinence-only paradigm “is the idea that marijuana is inherently harmful. Marijuana has been lumped in with all these other substances. If we’re really going to regulate drugs according to their therapeutic value and level of safety, we would see cannabis—and psychedelics, and other plant-based substances—almost completely legal and widely used in therapies.”

Breaking Free From Opiates

Living in Seattle with her husband, Lilith used to be a heroin addict and was once homeless. She too credits her recovery to the medicinal properties of cannabis. But she’s encountered bias against the plant as well. When she attended Narcotics Anonymous meetings in Washington, she possessed a medical card and used cannabis as medicine. But “they regarded marijuana as just as bad a drug as heroin,” she recalls. “That’s one thing that drove me away from the program, for sure.”

For those recovering from heroin, another trigger that can cause a relapse is the use of opiate pain relievers. Once again, cannabis can save the day with its pain-relieving properties.

Lilith lives with chronic pain. Due to a physically demanding job, she needs some kind of medicine to cope; otherwise, she wouldn’t be able to work to support her family.

“Once I was off the opiates, I had so many problems that I hadn’t realized that I had,” she says. “The chronic pain was crazy. I made the decision to go back on the cannabis oil that I’d been taking for pain before the opiates, because I remembered it helped. I don’t count cannabis as a drug, because I see it as a medicine.”

She uses Rick Simpson’s oil. “I take two little drops, about the size of a piece of rice, every two hours. It keeps a low, steady dose for my symptoms at all times.”

A study published last fall in JAMA Internal Medicine showed that states with legal medical marijuana experienced a 25 percent reduction in opiate-overdose deaths. Thanks to these reduced death rates, statistics show that, in cities where cannabis has been legalized for recreational or medicinal purposes, the role of cannabis in addiction recovery is getting more attention. Ronnie Swartz of Humboldt State University compared medical marijuana users and non-users at a public substance-abuse treatment center in California. Noting the limitations of the study’s small sample size, he nevertheless found that those “who used marijuana during treatment did not show any negative outcomes. They tended, in general, to show more positive outcomes.”

Swartz, like many other harm-reduction researchers, is looking forward to a future when even more of the plant’s healing properties have been proven. “I hope it becomes possible for people to have an opportunity to use cannabis as part of their process of breaking free from the problematic use of riskier substances,” he says. “I think it makes a whole lot of sense for people to have it as an option if it will eliminate or reduce their use of more risky stuff.”

Another study conducted by Reiman showed that cannabis provided methamphetamine users with the “mindfulness” to control their meth use. “There’s a relationship between cannabis and mindfulness,” Reiman asserts. “One of the earmarks of compulsive behavior is that it’s done without much thought. Behavior change is about creating mindfulness—the ability to slow that messaging down so you can rationally think, ‘Do I really want this?’ Whether it’s food or whether it’s drugs, that mindfulness is very important.”

From food to crank to blow, science is consistently coming up on Team Mary Jane. A study by the New York State Psychiatric Institute, cited in the June 2012 issue of the Journal of Psychoactive Drugs, found that when it came to cocaine dependence and comorbid attention-deficit hyperactivity disorder, “cannabis users were more successful than other patients in abstaining from cocaine use.” Even for those trying to quit smoking—cigarettes, that is!—the evidence suggests that cannabis will aid in reducing nicotine cravings.

A Natural Healer

Recovery is not a one-size-fits-all process. If you’re struggling with a drug or drinking problem, there are other options than the abstinence-only philosophy encouraged in 12-step programs. Encouragingly, cannabis dispensaries are beginning to offer harm-reduction-based support groups, and as medical science increasingly shows the benefits of cannabis in the recovery process, it’s likely that the plant will take its rightful place within the mainstream treatment industry as well. “People within the treatment industry need to recognize that cannabis is a therapeutic tool to be used in treatment,” Reiman says, “not something to be lumped together with the harmful subjects that people are coming into treatment for.”

Much of what we’ve come to understand about the role of cannabis in addiction recovery has been discovered thanks to our body’s own endocannabinoid system. For Reiman, as for many others, this is the key to cannabis’s medicinal powers. “It’s no surprise that we have an endocannabinoid system that produces chemicals similar to the plant,” she observes. “And the supplement of these chemicals to our bodies helps the body heal.” Because of this natural medical efficacy, “I’m a big fan of the cannabis plant,” Reiman says. “I think it has so many different applications.”

Every year in the US, there are nearly half a million tobacco-related deaths, while another 90,000 people die due to excessive alcohol use. Additionally, 44 people die each day from an overdose of prescription painkillers. The Centers for Disease Control states: “The United States is in the midst of a prescription painkiller overdose epidemic. Since 1999, the amount of prescription painkillers prescribed and sold in the US has nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Overprescribing leads to more abuse and more overdose deaths.”

It bears repeating that not a single person has ever died from a cannabis overdose. But the plant can be instrumental in preventing overdoses from other substances. And yet, it remains widely illegal and demonized—and we remain the poorer because of that.

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