New potential for marijuana: Treating drug addiction

Story highlights

  • Harm reduction is a strategy for treating addiction that accepts incomplete sobriety
  • Experts are exploring cannabinoids to ease addiction to cocaine, opioids and other drugs


"Some say it's hypocritical because, you know, you're supposed to go to rehab to get off drugs," said Schrank, who recently celebrated 20 years of sobriety from alcohol and all drugs. "And cessation of drug use can be a goal for some people, but pacing is also important." Some patients want to gradually move into abstinence, weaning themselves off drugs over time. Others want to maintain sobriety from a drug by using a less harsh drug, such as cannabis.
Others, including Todd Stumbo, CEO of Blue Ridge Mountain Recovery Center in Georgia, do not favor using marijuana as treatment for addiction.
"I'm all about adding interventions and therapeutic techniques that have proven to be significantly profound in the changes to somebody's life and treatment. Unfortunately, I don't know that there's evidence to substantiate that marijuana's had that effect," says Stumbo. "Our take is abstinence based and we use every tool or intervention we can that's been proven effective in the past."
Schrank is clear on the value of simply reducing drug use.

Reversing heroin's damage


Studying crack users

Crack cocaine is said to be a low-end incarnation of a rich man's drug. Cocaine, an expensive stimulant made from the leaves of the coca plant native to South America, can be processed to make a cheap crystal rock or "crack." The name refers to the crackling sound the rock makes when heated so its vapors can be inhaled through a pipe, but many users prefer to mix crack with vinegar to form a liquid that can be injected. This form becomes much higher-risk to users who are likely to share needles.
Your brain on weed
Your brain on weed


    Your brain on weed


Your brain on weed 01:39
To explore whether smoking marijuana might reduce crack use, researchers led by M-J Milloy, an infectious disease epidemiologist and research scientist at the BC Centre for Excellence in HIV/AIDS, recruited drug users living within the greater Vancouver area of British Columbia.
Milloy and his colleagues measured and analyzed how frequently 124 drug users smoked or injected crack before, during and after a period of cannabis use, based on their own self-reports.
Crack use did not decrease during the period when participants intentionally self-medicated with cannabis, compared with the time before trying marijuana.
Afterward, crack use decreased significantly, with participants reporting using it on average about half as often as before the intervention.
"We certainly have no illusions that this is the final word on the matter. Indeed, I think what it really is, it may be a first step," Milloy said of his study, which was recently published in the journal Addictive Behaviors. "So what we hope is that further study will let us know if it is in fact an effective substitution treatment for crack cocaine use disorder. To that end, we are putting together a clinical trial, which we hope will better test the hypothesis that cannabis could be useful to people who are suffering from this disorder."
Although the Vancouver study did not investigate the brain science to explain how marijuana might have this effect, Milloy and his co-authors say that emerging data "provide biological plausibility" for the findings.
They reference animal studies demonstrating that THC and cannabidiol may help eliminate cocaine-craving and heroin-seeking behaviors. One study in rodents showed cannabidiol to disrupt the reconsolidation of cocaine- and opioid-related memory, while findings from human trials suggest that high doses of cannabidiol effectively decreased cravings and anxiety among heroin-dependent people.
Volkow believes the Vancouver study result, showing that smoking marijuana reduced use of cocaine (though without producing abstinence), is an "interesting finding that cannot be ignored."

'Be yelled at for 30 days'

Generally, she says, not a lot of study has been done in the area of swapping cannabis for cocaine, and she emphasizes the need to determine whether the result can be replicated and studied even more extensively "under a clinical trial-type design, so you can actually document that cannabinoids can decrease consumption of cocaine."
"There have been a couple of papers that have reported actually some beneficial effects of marijuana smoking and the use of other drugs, but there also was one other paper that reported the opposite," Volkow said.
That paper found, "an increase instead of a reduction in the severity of cocaine withdrawal symptoms," and concluded, "worse detoxification treatment response."
Other studies have also shown that long-term dependence on marijuana may intensify cocaine cravings while increasing the risk of relapse.
To remedy the lack of scientific evidence, the National Institute of Drug Abuse is funding projects investigating synthetic THC for treatment of substance use disorder and providing grants for other projects testing cannabidiol for the treatment of methamphetamine use disorder and relapse prevention. The institute is also looking at the endocannabinoid system as a potential therapy for alcohol use disorder and opioid withdrawal.
In the meantime, the picture is not always rosy in the field of addiction.
Join the conversation


"The paradigm as it is now is, wait until it's a crisis and then be yelled at for 30 days, and then you're never supposed to do it again," Schrank said.
Abstinence is "a hard thing for people to do, and I don't know that we give people enough space to grow and develop," he said. "Most people coming off crack or heroin would want the insulation of some kind of feeling change."
Although most people in the treatment world would say an addicted client who swapped harder drugs for pot has a relapse and not recovery, Schrank said, "to me, if somebody was using heroin and now they're using cannabis, that's a major victory."
"If you smoke the wrong rock of crack, your heart stops," he said. "It's very, very, very dangerous."
"I've had so many clients who were in treatment and seemingly doing well, and then they dropped dead," Schrank said. "If rehab worked so well, why is the success rate like 5%? We're definitely doing something wrong."