Ask an Expert: Is Marijuana an Effective Treatment for Opioid Dependence?

By Jordan Hansen 05/03/16

Our expert weighs in on the potential consequences of prescribing medical marijuana to opiate and heroin addicts.

Ask an Expert: Is Marijuana an Effective Treatment for Opioid Dependence?

I've heard that the state of Maine is considering approving the use of medical marijuana for opioid and heroin addiction. On one level that makes sense to me, since I think marijuana is a much safer drug than opioids. But on the other hand, if somebody is prone to addiction, does it really make sense to "prescribe" marijuana as a treatment? 

Jordan Hansen: First off, we can’t talk Maine without acknowledging that Governor Paul LePage won’t even allow naloxone for addicts, electing to veto a bill which would save potentially hundreds of lives. “Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote. So, I won’t be holding my breath on cannabis-assisted treatment for opioid addiction. It does present an interesting question, however. 

The short answer is: No. I wouldn’t recommend cannabis as a treatment for opioid addiction.

I have no qualms with medical cannabis. The only thing I look for in my clinical practice is if something works. If I could be convinced that a diet of DMT and cheerios combined with ferret-assisted therapy leads to positive outcomes, I would be obligated to try it. Although I have seen many promising studies showing therapeutic potential for using cannabis in the treatment of all sorts of medical issues, I have seen nothing about treating opioid addiction. Here are my major concerns:

• Overdose: One of the major benefits of opioid agonist therapy is retaining some tolerance to opioids. If one returns to use after being on the weed plan for a while, they lose their tolerance and would be at higher risk for overdose and death. 

• Efficacy: I would rather have a person smoke marijuana all day than have them use IV heroin, but I would be concerned that the effect of using marijuana may not prevent using opioids, or worse, lead to increased or more dangerous use. I am not familiar with any data that shows how this might work. 

I can see both sides of the argument, but at this point, there is no reason to think that marijuana could help in this situation. I mean, it might, but we have no idea. My anecdotal experience in practice has been that people often appear to be able to sustain abstinence from opioids while using marijuana, until they can’t anymore and relapse, with occasionally fatal results. Treatment using various therapies including Suboxone or methadone has been studied rigorously and provides an evidence base from which to practice. These traditional types of treatment, while effective, are not nearly as effective as I would hope. I can’t imagine any clinician feels comfortable with our current state of treatment for opioid-dependent persons. For this reason, I would love to have more data to develop and further treatment for opioid addicts, including data on the use of medical marijuana. It’s a shame though, because we should have so much more research on medical cannabis than we do currently. 

Marijuana is a Schedule I drug, and for that reason, research is difficult to perform. The DEA describes Schedule I drugs as substances “with no currently accepted medical use and a high potential for abuse.” I think that even the most hardline, fundamentalist clinicians would concede that cannabis has accepted medical uses at this point. I would hope that we could reschedule cannabis to allow for ease of research. Until then, we have relatively little data to work with.

Jordan Hansen MA, LADC, LPC is an experienced clinician, speaker and writer focused on integrating the science of cutting-edge treatment modalities with the wisdom found in peer-supported approaches to recovery. Full bio.

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