The Maine Department of Health and Human Services is considering adding opiate addiction to the list of conditions that may be treated with medicinal marijuana.
Maine, like much of the East Coast, has been a flashpoint for opioid abuse and fatal heroin overdoses recently. A majority of the 272 overdose deaths in Maine in 2015 were the result of heroin, fentanyl or some other opioid, either taken together or separately, reported the Portland Press Herald.1
A report in JAMA Internal Medicine in 2014 showed that deaths by opioid overdose have dropped almost 25 percent in states that have legalized marijuana.2 The study did not make a specific, scientific declaration as to why the overdose deaths have dropped in these states, however. At the same time, overdose deaths continue to skyrocket nationwide, quadrupling since 1999 to 165,000 people in 2014, according to the U.S. Centers for Disease Control and Prevention.3
For this piece, Foundations Recovery Network talked to Maine doctors on both sides of the debate. Dr. Dustin Sulak, an osteopath, has become one of the most widely known and respected advocates for medicinal marijuana in the nation. He recently founded a website called Healer.com, which gives physicians guidance about prescribing medicinal marijuana. Medicinal marijuana has been legal in Maine since 1999.
Dr. Leah Bauer is a psychiatrist and medical director of the Addiction Resource Center at Mid Coast Hospital in Brunswick, Maine. She regularly treats patients for opioid addiction. She sides with most of the medical establishment and does not believe treating opioid addicts with marijuana is a good idea.
Cannabis Already Approved to Treat Pain in Maine
Already, cannabis is approved for pain treatment in Maine. “Taking opioids in combination with cannabis is safer than taking opioids alone due to widening of the therapeutic window,” Sulak says. He explained that it has been shown in animals that combining opioids and cannabis has a synergistic effect. Therefore, you can use lower doses of the lethal, more habit-forming opioids to achieve the same reduction in pain when you add cannabis. The “therapeutic window,” or amount of time that a person can be safely treated with opioids, is lengthened in this way, Sulak says.
He also argues that cannabis can treat the symptoms of opioid withdrawal, such as spasms, insomnia, agitation, diarrhea and vomiting.
Dr. Bauer says she is not familiar with the science behind those claims. She said the fundamental flaw in treating any sort of addiction with marijuana is this: “Essentially you’re relying on an intoxicating substance to cope with different feelings and situations. That part of it is the same no matter what the drug is.”
Bauer says you’re not really succeeding in recovery if you still are relying on an intoxicating substance to get through each day.
She says studies show that people who use “marijuana maintenance” to get off of alcohol and other drugs risk relapse, particularly when they have previously used marijuana in a recreational setting. The use could trigger abuse of other substances as well.
“I don’t think I’ve spoken to any of my patients once who never used marijuana,” Bauer says. In a 2005 study, “Post-discharge Cannabis Use and Its Relationship to Cocaine, Alcohol and Heroin Use: A Prospective Study,” one-third of 250 psychiatric/substance abuse patients used marijuana upon discharge.
“Post-discharge cannabis use substantially and significantly increased the hazard of first use of any substance and strongly reduced the likelihood of stable remission from use of any substance,” the authors of the study concluded. “Examination of specific substances indicated that cannabis use affected first use of alcohol, stable remission and subsequent relapse of alcohol use as well as first use of cocaine and stable remission but was unrelated to heroin outcomes.”4
Still, people with active addiction need to have the underlying causes of their addiction treated as well, such
as mental health disorders, Bauer says. Without an ability to cope with life’s stressors, relapse is certain when medicating with an intoxicating substance.
For an Addict, Marijuana May Be No Safer than Methadone
Sulak counters, “Mainstream medicine accepts the fact that complete abstinence is not an acceptable solution to all opioid-dependent patients,” adding, “For those who cannot tolerate abstinence, harm reduction, the practice of substituting a safer substance for a more harmful substance, is an acceptable approach.”
He said that current harm reduction options for opioid addiction include suboxone and methadone. “Both methadone and suboxone are more addictive than cannabis and have much stronger withdrawal effects.”
Bauer says many opioid addicts have a hard time obtaining suboxone and methadone, which is a problem. And those who abuse it, as Sulak suggests, are likely to abuse cannabis too.
At a hearing before the Maine Department of Health and Human Services, opioid addicts gave impassioned pleas to allow medicinal marijuana use. Matthew Low of Waterville told the Portland Press-Herald he was caught in a cycle of stopping heroin, starting methadone, then relapsing.
Cannabis has helped him, he said. “The cravings stay away longer every time I use cannabis,” he said. “The (methadone) clinics aren’t helping. They’re treating, not curing. I believe cannabis can cure this epidemic.”5
Bauer says there are plenty of anecdotal stories that support both sides of the argument. But science has to be based on facts, not anecdotes.
“It’s an interesting idea, and I hope it’s studied,” she says. “I just worry that it has the potential to worsen problems until the verdict is in.”
1.Lawlor, J. (7 March 2016). “Drug overdose deaths surged by ‘shocking’ 31 percent in Maine.” Portland Press-Herald. Retrieved May 7, 2016, from http://www.pressherald.com/2016/03/07/drug-overdose-deaths-hit-new-highs-in-maine/2.Bachhuber, M.A. et al. (2014, October). “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010.” JAMA Internal Medicine. Retrieved May 7, 2016, from http://archinte.jamanetwork.com/article.aspx?articleid=18988783.Prescription Opioid Overdose Data. (16 March 2016). U.S. Centers for Disease Control and Prevention. Retrieved May 7, 2016, from http://www.cdc.gov/drugoverdose/data/overdose.html4.Aharonovich, E. et al. (2005, Aug. 1). “Postdischarge Cannabis Use and Its Relationship to Cocaine, Alcohol, and Heroin Use: A Prospective Study.” The American Journal of Psychiatry. Retrieved May 7, 2016, from http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.8.15075.Graham, G. (19 April 2016). Advocates ask Maine regulators to consider marijuana to treat opioid addiction. Portland Press Herald. Retrieved May 7, 2016, from http://www.pressherald.com/2016/04/19/advocates-ask-state-regulators-to-consider-medical-marijuana-as-treatment-for-opiate-addiction/Written by David Heitz
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