An old treat­ment be­comes new again. But does it re­ally work?

Modern Healthcare - - NEWS - By Steven Ross John­son

High So­bri­ety, a re­cov­ery treat­ment cen­ter in Los An­ge­les, of­fers pa­tients daily doses of medic­i­nal cannabis as a means of wean­ing them off opi­oids.

Joe Schrank, the fa­cil­ity’s founder and pro­gram di­rec­tor, said the harsh ef­fects of with­drawal often cause ad­dicts to avoid go­ing clean. That’s where the often con­tro­ver­sial use of cannabis can help, he added.

“Us­ing med­i­cal cannabis can be re­ally help­ful for all the things that peo­ple ex­pe­ri­ence when they go through detox, whether it’s in­som­nia, bone pain or flu­type symp­toms,” he said.

But op­po­nents say the prac­tice switches out one ad­dic­tion for an­other and that the ef­fi­cacy of us­ing cannabis to treat opi­oid ad­dic­tion hasn’t been thor­oughly re­searched.

“To me, it’s a mas­sive im­prove­ment if they’re switch­ing from a drug that could kill them to a drug that can­not kill them,” Schrank countered.

Cur­rently, 29 states have passed laws al­low­ing the use of cannabis to treat a host of med­i­cal con­di­tions de­spite its des­ig­na­tion as an il­le­gal drug by the fed­eral gov­ern­ment and the fact that the Food and Drug Ad­min­is­tra­tion hasn’t ap­proved it for med­i­cal use. Mostly, cannabis is used to treat nau­sea in can­cer pa­tients un­der­go­ing chemo­ther­apy. States have also ap­proved it to in­duce ap­petite in HIV/AIDS pa­tients, as well as to al­le­vi­ate the ef­fects caused by mul­ti­ple scle­ro­sis, Parkin­son’s dis­ease, Crohn’s dis­ease, glau­coma and epilepsy.

No state has ap­proved cannabis for the treat­ment of opi­oid ad­dic­tion, and re­cent pro­pos­als in Mary­land and New Mex­ico were ul­ti­mately re­jected due to a lack of ev­i­dence that it works. Mar­i­juana, how­ever, has a rel­a­tively long his­tory in be­ing used to treat opi­oid ad­dic­tion.

When it first en­tered the of­fi­cial drug com­pound and use di­rec­tory of the U.S. in 1850, cannabis was listed as a treat­ment for opi­ate ad­dic­tion. Back then, mar­i­juana could be pur­chased as an over-the­counter rem­edy.

Iron­i­cally, it was the in­creased pop­u­lar­ity of opi­ate-based medicines in the early 1900s that caused a de­cline of cannabis for med­i­cal use un­til the drug was even­tu­ally re­moved from the U.S. Phar­ma­copoeia in 1941.

Since then, a tight reg­u­la­tory frame­work has made it harder to pre­scribe cannabis for med­i­cal purposes or to con­duct re­search on the plant.

When cannabis was clas­si­fied as a Sched­ule 1 drug

“To me, it’s a mas­sive im­prove­ment if they’re switch­ing from a drug that could kill them to a drug that can­not kill them.” Joe Schrank Founder and pro­gram di­rec­tor High So­bri­ety

un­der the Con­trolled Sub­stance Act of 1970, the plant was flagged for its high po­ten­tial for abuse and was listed as hav­ing no med­i­cal pur­pose.

“This is the catch-22,” said Yas­min Hurd, pro­fes­sor of neu­ro­science, psy­chi­a­try and phar­ma­co­log­i­cal sciences at the Ic­ahn School of Medicine at Mount Si­nai Health Sys­tem in New York City. “The rea­son why we have all of th­ese peo­ple think­ing that mar­i­juana may be ben­e­fi­cial for this or that is be­cause there is not enough sci­ence out there to help guide us.”

Hurd ex­am­ines the ef­fects of cannabid­iol, a com­pound found in cannabis that could help re­lieve symp­toms of heroin with­drawal while work­ing to im­pede the de­sire to get high.

But she ad­mits there are a lot of open ques­tions on how to use the treat­ment.

“The clin­i­cians who are pre­scrib­ing med­i­cal mar­i­juana for their pa­tients don’t ac­tu­ally know which for­mu­la­tions or which dos­ing or so on to give for spe­cific symp­toms and dis­or­ders,” Hurd said. “We are re­ly­ing on anec­do­tal in­for­ma­tion from peo­ple us­ing the drug to give us sci­en­tists and clin­i­cians in­sights about it.”

Dr. Matthew Ro­man, founder of Na­ture’s Way Medicine, a pri­mary-care clinic in Delaware, be­gan us­ing cannabis as a treat­ment in 2015.

“I’ve found in my ex­pe­ri­ence now that pa­tients re­ally get a lot of ben­e­fit from this new al­ter­na­tive,” he said.

Ad­mit­tedly, there are vari­ances in how prac­ti­tion­ers use it.

Schrank en­cour­ages clients to take cannabis in ed­i­ble or va­por forms over smok­ing in or­der to bet­ter con­trol dosage. Ro­man said half of his pa­tients choose to smoke it and half opt to vape through elec­tronic cig­a­rettes.

“A lot of it is based on life­style with this treat­ment when it comes to form of use rather than what works bet­ter,” Ro­man said. “I think a lot of the peo­ple who are most af­fected by the opi­oid epi­demic are be­com­ing more open to mar­i­juana be­cause they see it as a gate­way out of the opi­oid epi­demic.”

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