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, 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 (MAT), calling the use of methadone and Suboxone (buprenorphine) in treatment “ludicrous.”
“(Clients are) coming off heroin, (treatment centers) start them on Suboxone, and within a week, they up their Suboxone,” Estes says. “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 or 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,” says 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.