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PHOTO: Kara Allyson
[Names of some individuals in this story were changed at their request.]
When Joe hit rock bottom, he knew it. At age sixty, he’d been drinking since he was sixteen and his liver was a mess. Every time he tried to quit in the past, he failed. “But this time was different,” he told me with a steady gaze. “This time I was about to lose my wife, my career and everything I’d worked for.” Realizing he faced the final straw, he knew he couldn’t fail again. He quit “cold turkey” but the shakes, sweats and anxiety that followed became overwhelming and he was tempted to have a drink. Then a friend gave him a joint and Joe reluctantly took a few hits. Within minutes, his anxiety diminished, the “edge” softened and his body appeared to regulate itself as the shakes and sweating gradually stopped.
Joe hasn’t had a drop to drink in nearly two years. But every night after work, he comes home and takes two or three hits off a joint to “tamp down the day.” Without it, Joe is convinced he’d be back drinking. “When I look in the mirror now, I see a totally different person,” Joe told me. “I’m more engaged in life, more social and just healthier overall. And I really do think that the pot has a lot to do with it.”
While Joe might not realize it, he’s one among many who have quietly and sometimes secretly used cannabis as an “exit drug” from their addiction to alcohol, tobacco, hard drugs and pharmaceuticals. A recently released study acknowledged that three-quarters of medical cannabis patients use the herb as a substitute for prescription drugs, alcohol or illicit substances. The three main reasons cited in the study for cannabis being chosen over any other medicine were “Less withdrawal, fewer side-effects and better symptom management.” Furthermore, it was found that cannabis worked when stronger drugs failed. “Clinical trials with those who have had poor outcomes with conventional psychological or pharmacological addiction therapies,” the study states, “could be a good starting point to further our understanding of (the) cannabis-based substitution effect.”
This “substitution” theory is not new. Tod H. Mikuriya, M.D. and Jerry Mandel, PhD published a paper in October of 2001, titled “Dependence.” Dr. Mikuriya collected statistics from his database of 6,500 patients and selected one hundred and four patients who had used cannabis to successfully get off alcohol, illicit drugs and pharmaceuticals. The age range of the one hundred and four patients varied, with twenty-eight participants over the age of fifty. Alcohol was the most prevalent substance that individuals sought to quit, with prescription pain killers, anti-depressants and illicit drugs not far behind. One patient in the study reported that, “Cannabis has allowed me to significantly lower my stress levels, which has directly reduced my back problems and enabled me to make positive lifestyle changes as well. I am focused more than before…Cannabis greatly improved the pain in my back and consequently my sleeplessness, which has been directly related to my desire to drink alcohol. I have not been using alcohol to combat discomfort, physical or otherwise.”
The doctors’ study concluded that, “In using cannabis as a substitute for alcohol, the cumulated problems of a hard alcoholic life did not disappear; but they could be seen and acted upon from a distance, and soberly. At minimum, more effective coping and control resulted from cannabis substitution. Hope is restored with relief from chronic poisoning (of alcohol), and a life line back to functionality and dreams replaces injuries and nightmare.”
Making Sense of It
I understand how counterintuitive all of this may sound to some readers. If you believe the government line that cannabis is “as dangerous as heroin,” the declaration that it could be successfully used to get off morphine or synthetic opioids (Oxycontin) sound ludicrous. But if you’re willing to accept that decades of “statistics” and horror stories regarding cannabis are ridiculously misleading and patently false, then your ability to research and understand the truth about this plant improves drastically.
It’s exactly what happened to me over three years ago when I delved into the study of cannabis before writing Betty’s (Little Basement) Garden, the first novel about medical cannabis in Colorado. When I talked to people who had used cannabis or were in the process of using the plant to get off hard drugs, alcohol and tobacco, I didn’t buy into it at first. My knee-jerk impression was that they were just using it to “get high” or that they couldn’t fully embrace sobriety. Just as I’d ignorantly bought into cannabis prohibition propaganda for decades, I also supported the “all or nothing” abstinence mentality promoted by treatment centers and physicians. It was a tough one for me as I’ve dealt with alcohol addiction in my own family. Two relatives who finally got sober told me repeatedly that, “You can’t touch anything mind-altering! Not even cough syrup.” When you consider I used to also believe in the “Gateway Theory,” you can understand why I needed to do a lot more research and fact checking before entertaining cannabis as an exit drug.
That’s exactly what I did. And the more I studied this controversial theory and talked to doctors, patients, caregivers and family members who supported the herb’s use in this manner, the more I realized that it wasn’t such a crazy, unsupported, idea after all. Cannabis, I learned, can work within the body to actually help addicts, instead of hinder their progress. In fact, in a perfect world, cannabis might be the sanest method for addicts to get that monkey off their back.
Frantz Fanon popularized a term in his book, Black Skin, White Masks—cognitive dissonance. In short, when people hold strong “core beliefs,” it’s very hard to shake loose of them, even if those core beliefs prove to be false. When presented with evidence that works against the core belief, the person often feels a sense of deep discomfort and even resentment–what Fanon termed cognitive dissonance. At that point, Fanon asserts that, “to protect the core belief, (people) will rationalize, ignore and even deny anything that doesn’t fit in with the core belief.” In essence, I think this is one of the biggest hurdles that needs to be jumped by physicians, psychiatrists and other medical professionals in order for us to have a coherent discussion about cannabis’ use as an exit drug.
Clearly, there is a still a “cultural hostility” toward cannabis by many people, including seniors, who believed what they were told about the plant. Thus, in order to wrap one’s head around this contentious proposition, it’s helpful to at least be open to three possibilities:
First, the propaganda campaign against cannabis for the last seventy plus years is blatantly false and misleading.
Second, cannabis is documented to have many medicinal capabilities, including creating a state of homeostasis via the Endocannabinoid System (more on this later.)
Third, understand that this is a whole plant “drug” that, when used responsibly, has very few negative side effects. In fact, some users would say the plant has no negative side effects.
Refuting the “Gateway Theory”
Probably the biggest obstacle to cannabis being accepted as an exit drug is the competing “gateway drug” dilemma. The more I researched the gateway theory when I talked to addicts about their use patterns, the more I began to wonder if alcohol and tobacco weren’t the real “gateway” drugs since most of the patients I interviewed started with one or both simultaneously. As I repeatedly heard from addicts, the gateway drug is nothing more than the “first drug that showed up.” It had nothing to do with the properties of the drug–if the substance did the job, they kept using it. If their first hit of nicotine helped to temporarily quell their anxiety, then nicotine stood at the “gate.” If a stolen beer or bottle of whiskey from mom and dad’s liquor cabinet made it into their hands first and they enjoyed the dulling of their senses, then liquor owned that “gate.”
Studies are proving this out. In the August 2012 edition of Journal of School Health, a study was published that determined alcohol–not cannabis–was the primary “gateway drug” for adolescents. In their findings, they note that high school seniors who drank alcohol only once in their lives “were thirteen times more likely to use cigarettes, sixteen times more likely to use marijuana and other narcotics and thirteen times more likely to use cocaine.” A 2010 study published in the medical journey Lancet boldly stated that, in ascending order, amphetamines, tobacco, cocaine, meth, crack, heroin and alcohol were all more “harmful” than cannabis, with alcohol taking the top spot. Thus, the emerging pattern of “legal” drugs leading to “illicit” drugs is far more likely in the real world than the scenarios put forth by many health professionals and educators.
“The ‘Gateway Theory’ is a canard,” Dr. Tom O’Connell told me. O’Connell puts a lot of the blame on Richard Nixon and John Mitchell, saying, “The worldwide drug war is based almost entirely on the unsupported opinion of these two convicted liars who had zero knowledge of drugs.” O’Connell, a former thoracic surgeon who practiced surgery at William Beaumont Army Medical Center and then continued his career at San Francisco General Hospital, now works with medical cannabis patients in Northern California. He was not always a staunch believer in cannabis as medicine, let alone as an exit drug. But genuine interest in the subject along with extensive face-to-face interviews changed his mind about the plant. At age eighty-one, he’s personally created an impressive database over the last twelve years of nearly 6,900 patients, ranging in age from eighteen to over eighty. Spending as long as forty-five minutes with each patient to take their history, O’Connell said he’s become more of a “psychiatrist of sorts” as he listens intently to his patients’ stories.
After amassing a great deal of information about each patient’s past and their experience with cannabis as well as alcohol and hard drugs, he feels he has uncovered the root cause of addiction: Anxiety. However, O’Connell takes his theory a step further and says he has identified a consistent pattern with all addicts that prompts the anxiety to become chronic and leads to substance abuse. “In my view,” he stated, “the chronic anxiety that can be generated in both males and females by literal or emotional absence of the biological male parent during a critical interval in childhood is capable of creating a type of post traumatic stress disorder (PTSD) throughout adult life. It’s a form of insecurity that can lead to terrible consequences, including addiction.”
O’Connell’s anxiety connection made a lot of sense to me. I have a line in my novel that states, “Marijuana is only a gateway drug when the gates are closed at home.” From O’Connell’s point of view, all the “syndromes” such as ADD, ADHD, “disorders” such as social anxiety disorder and even chronic depression have strong tentacles that attach back to “Absent Daddy Disorder,” as he calls it. But after years of turmoil and layers of traumatic events, the underlying childhood anxiety (the root cause) has no exact mooring in the person’s adult memory. It’s left to freely float and continues to increase unabated with each passing year, adding new phobias along the way. This is, he says, when the need to “do something or take something” to stuff it down often begins and when addictions start to take shape. But as he sees it, addiction to one substance or another is merely a need to do whatever it takes to calm the anxiety and gain some relief from the constant rumbling in the gut, the edge that never gets rounded off and that sense that “something awful” is about to happen.
While this often-buried psychological weight affects women, O’Connell found that men suffered even more from not having a physical biological father present or having a biological father who was present in the house but “absent” emotionally and physically. In fact, having the father present but not engaged with their son or showing any interest in his life is possibly the most damaging and leads to a life, according to O’Connell, “that can quickly manifest into many different ‘syndromes'” that are all tied to a simmering anxiety that has never been faced or addressed. “That’s when cannabis can be a lifesaver for the addict,” he enthusiastically said, “because it works incredibly well to calm the anxiety that addicts usually get when they are weaning off alcohol or hard drugs. Cannabis is a gateway out of trouble with drugs, not into it!”
How Cannabis Works As An Exit Drug
I asked Evelyn, 68, a recovering addict who used cannabis in a concentrated oil form over an eight month period to get off eleven different pain medications (including a two-hundred and seventy-five tablet a month Percocet addiction), how she felt the plant worked. She pensively considered the question. After a few studied moments, she said, “I think it enhances your confidence and supports the process of learning why you choose to do what you do. For me, it made me see where I was getting in my own way with my recovery and that was the biggest ‘A-ha!’ moment I’ve ever had. Cannabis is probably the best self-awareness tool I’ve encountered. It’s like a mini-therapist.”
Everyone I talked to was able to give me concise reasons why they believed cannabis worked for them. And as valuable as subjective experiences are, they lack the necessary science that gives a theory its foundation. Despite limited cannabis research in the United States, due to numerous Federal restrictions and a Schedule 1 status (i.e, the plant is lumped in the same category as heroin and LSD), progress is being made in Europe, Israel and in private labs. Since access to the plant for research purposes is restricted, much of the cannabis studies are done with animals and synthetic THC or the non-psychoactive cannabinoid, CBD (Cannabidiol).
One of the most important findings into the science of how cannabis works was the discovery of the Endocannabinoid System (ECS). As much as the addiction issue in relationship to cannabis is brought up, many medical professionals who study the plant and understand the profound science behind it, wonder if the attraction and, often, downright infatuation with this plant isn’t due to the fact that the plant has a profound regulating effect on the ECS. According to author Clint Werner, who penned Marijuana, Gateway to Health, the ECS is an “important biological regulatory system” with receptor sites in the brain, stomach, liver, and other organs as well as within the body’s immune system. Well over sixty known cannabinoids (the most well known of which is THC) bind to the many receptor sites and create what appears to be homeostasis or equilibrium within the body. A kind of “reboot” occurs with some users that one woman described to me as, “a feeling of being more receptive and open to addressing problems, rather than running from them.”
Working within the brain and considered part of the ECS triggering system, is the amygdala, an almond shaped group of nuclei. The amygdala is involved with how we process emotional information along with long-term memory. It’s what makes us human and capable of compassion. But, due to the strong emotional component, the amygdala can also absorb what is also called “fear memory” or “fear conditioning,” which is best represented with the onset of PTSD. Located in the part of the brain known as the limbic system, the amygdala goes on high alert to check for possible threats to safety. When it’s over-stressed due to significant life challenges, a debilitating chain reaction occurs along the “amygdala-hypothalamic-pituitary-adrenal axis” and this is when addicts often reach out for anything to quell their anxiety. But luckily, cannabis has a direct, positive effect on the amygdala.
A September, 2009 article in the Journal of Neuroscience discussed how cannabinoid receptor activation in the basolateral amygdala can block the effects of stress and reduce anxiety. A series of animal studies demonstrated how medical cannabis used in a consistent manner, can “heal” the part of the brain and in some ways, “re-set” the damaged/stressed amygdala, “preventing the surfacing of stress symptoms.” The technical term for this is, “Depolarization-induced suppression of inhibition.” And to a war Veteran, trauma victim, or anyone who has dealt with PTSD and attempted to function with it, anything that positively restructures that “memory cache” is a valuable medicine.
Author Clint Werner cites famed researcher Dr. Raphael Mechoulam–considered one of the “founding fathers of cannabinoid research”–and his assertion that, “There is barely a biological, physiological system in our bodies in which the endocannabinoids do not participate.” But here’s where it gets really interesting and why the health and support of the ECS is critical for those who are trying to get off of everything from tobacco to prescription drugs. If you purposely block a CB1 receptor site in the brain with a chemical/drug, nothing short of dire consequences result. This was proven out with Rimonabant, a drug that worked as an appetite suppressant and was approved for use in Europe. Rimonabant was specifically engineered to turn off certain CB1 receptors in the brain. But not too long after Rimonabant’s human drug trial began, participants reported a cascade of disturbing side effects. Everything from “adverse psychiatric events” (including two suicides), to neurological problems, severe anxiety, panic attacks, severe sleep disorders, erectile dysfunction, gastrointestinal symptoms and an alarming increase in symptoms associated with Alzheimer’s disease, ALS, Parkinson’s Disease and Huntington Disease were found in users of the drug. Less than two years later, the European Medicines Agency suspended its approval.
Not satisfied with one failed experiment, other cannabinoid antagonist drugs were produced with the same predictable, destructive psychiatric side effects. “The suppression of the ECS,” writes Clint Werner, “has been connected to numerous health-related problems, from cognitive function and sleep cycles to digestion, sexual response, physical coordination, and overall happiness.” This discovery lead cannabinoid researcher Ethan Russo, M.D. to theorize that there was merit in his idea of Clinical Endocannaboid Deficiency (CECD). Rather than just being another alphabet “syndrome” that’s made up on a whim, Russo believes that CECD might be “an alternative biochemical explanation for certain disease manifestations.”
As cannabis is known to feed both CB1 and CB2 receptors throughout the body, the visual of the receptor being the lock and the herb being the perfect key that turns that lock, helps to demonstrate on a simplistic level how cannabis allows the body to adapt to stress, including addressing deep or chronic anxiety. “Cannabis won’t kill you,” Werner wrote, “but a lack of cannabinoids could.” Furthermore, he suggests that, “When our receptors have an adequate supply of cannabinoids, we experience a heightened state of health.”
Furthermore, cannabis’ proven “neuroprotectant” abilities–thought to occur through activation of the CB1 receptors in the brain–have been shown to protect alcoholics’ brains during withdrawal. If you think the U.S. Government is not aware of this, think again. The U.S. Patent Office issued a patent #6630507, on February 2, 2001, titled, “Cannabinoids as Antioxidants and Neuroprotectants.”
Confronting the “Abstinence Approach” to Addiction
You can’t have a discussion about using cannabis as an “exit drug” without confronting the dilemma that many addicts face. And that is that most treatment programs require total abstinence from all almost all drugs. (I say “almost all” since nicotine–considered one of the top addictive drugs–flows freely at every addiction treatment facility.) This is where the conversation regarding cannabis usually gets heated. Methadone, a synthetic opiod, is one of the approved drugs used to help addicts wean off substances. But patients often report that they become seriously addicted to methadone and suffer a host of side effects, including anxiety, hallucinations, chest pain, insomnia, lack of appetite and sexual difficulties. Is it any wonder that patients would prefer to use a milder and far safer alternative? But the stigma around cannabis–the Federal Schedule 1 status, its obvious “illegal” standing that dogs it in non-medical marijuana states, and the societal pressure from employers, family and friends–prevents most medical professionals and addiction centers/groups from being allowed to recommend it.
“If AA would embrace cannabis,” Dr. Tom O’Connell boldly told me, “their success rate would be closer to ninety percent than what it is now.” And the psychiatric profession doesn’t fare any better in his opinion. “The worst betrayers of medical cannabis are psychiatrists because they’ve jumped on the ‘all or nothing’ bandwagon. If you tell your therapist that you are using cannabis, they will tell you to stop it immediately because they are taught that it’s a ‘drug of abuse,’ which is absolutely ridiculous.”
This is exactly what nearly prevented Grace, 53, from using cannabis to get off her dependence on morphine, anti-depressants and anti-anxiety drugs. After consecutive back surgeries over a period of eight years left her physically disabled and in constant, excruciating pain, Grace was prescribed high doses of morphine at night in order to sleep and dull her pain, along with a daytime dose for “breakthrough” episodes. In addition, she was taking a sleep drug, two anti-depressants and one anti-anxiety drug. But the drugs began to catch up with her as she gained a tolerance to them very quickly. She was also “losing time,” admitting that an entire year of her life was cloudy due to her dependence on the cocktail of drugs. Her concerns as to what the drugs were doing to her liver were increased when she did her own research into the long-term effects of the morphine alone.
Grace was initially against cannabis, telling me that she believed the “horror stories” she heard about the plant when she was a teenager. But after a friend convinced her to try a few drops of a strong cannabis liquid concentrate, she became a convert. After only the first dose, her pain reduced greatly and she was able to get a full night of sleep, only waking up once. Within days, her entire attitude shifted to a hopeful state as both her physical pain and mental outlook on life drastically improved. Weaning slowly over a period of weeks, she has been able to reduce her morphine dose, eliminating her daily “breakthrough” tablet in favor of a few drops of the cannabis extract. She is now completely off her anti-anxiety drug and is slowly reducing her anti-depressants as well. Her goal is to be off everything but the cannabis this year. But Grace admitted to me that she doesn’t feel comfortable telling friends and even her adult children about what she’s doing because she’s afraid they’ll think she’s just doing it “to get high.” The irony is that Grace is now using a high CBD cannabis extract during the day, which is completely non-psychoactive. But unfortunately, the anti-cannabis crowd doesn’t have any idea that high CBD extracts exist and explaining it to them is often clumsy and ineffective since they really don’t want to hear anything about cannabis. So, for now, Grace has decided to not come out of the cannabis closet. “Because of the stigma and ignorance, that I admit I bought into, I am now a closet medical marijuana user, but one with hope and less pain. Even though I’m sharing my story with others anonymously, I want people to know that there is another option that works to get off all these poisons. And that option is cannabis.”
“Lose the grip.”
Dr. Mark Dahlstrom, a critical care physician who practices in Basalt, Colorado, is one medical professional who supports the use of cannabis to alleviate the symptoms of addiction. When I asked Dr. Dahlstrom what he thought about the abstinence approach that is presented to addicts who are often compelled to attend court ordered treatment programs, he didn’t mince any words. “If we’re going to use drugs to help addicts withdraw from all this poly-pharmacy that’s being given to them, we should use the least toxic drug…the one that’s shown to have zero mortality. And that’s cannabis. We have the most dishonest dialogue about this drug and it’s got to stop.” He maintains that it’s imperative to “lose the grip over (cannabis’) Schedule 1 status so we can start doing some serious research about this plant drug that contributes in a meaningful way to the scientific data.” Dahlstrom also offers that, “Every society has the desire to alter consciousness” in order to relieve anxiety and stress. “Alcohol is our national intoxicant. If you go to Columbia, they’re chewing coca leaves. In Yemen they chew Khat. Travel to Fiji, and they’ll offer you Kava. And if you go to the Middle East or Afghanistan, they smoke pot.”
He’s not convinced that an “all or nothing” approach for addicts is reasonable or sustainable. But he stressed that many more studies need to be done that show once and for all that cannabis–even in low doses that don’t produce much of a “high” or using non-psychoactive, high CBD strains–is a safe, non-toxic aid that deserves credible attention from the medical and scientific communities. “Oxycontin killed well over 10,000 people in the U.S. in 2011,” Dahlstrom informed me. “There’s never been one death attributed to cannabis. We simply have to get smarter about this.”
Dr. Tom O’Connell agrees. “If the stigma of the illegality could be removed, cannabis would be accepted as a legitimate medicine that heals both the body and mind.” He gave a thoughtful pause. “You know, we’re aging into legalization, but the damn stigma is still there and needs to be removed if we’re going to have any kind of sensible discussion. Addicts need to have something safe they can choose that cuts their anxiety. Insomnia, angry behavior, timid behavior…these are all forms of anxiety. And these are all ‘symptoms’ that cannabis can resolve very quickly. Emotional pain–especially for men–is not macho. Cannabis addresses both the physical and emotional pain and through continued use, you can get out of your own way and heal.”
Laurel Dewey’s novel, Betty’s (Little Basement) Garden, is available here.