The lesser of two evils. Fighting fire with fire. Throwing a Band-Aid at the problem? If you find yourself scratching your head in concern right now, you likely are not alone. Many of us may recall a time in school, out in the community, through the news, or various other sources when marijuana was referred to as the “gateway drug.” Ultimately suggesting the use of marijuana will open the flood doors and lead to the use of more and worse drugs. Now, we are seeing the very same drug being used as a way of treatment for heroin addiction. Believe it or not, some treatment facilities are even going as far as saying marijuana is a cure for heroin addiction. The adhesive on Band-Aids isn’t super glue and even super glue does not last forever.
While this claim has gained attention countrywide, there are still experts in the addiction field that are highly skeptical. Dr. Mark Willenbring for example, a psychiatrist who provides treatment to addicts (and formerly oversaw research at the National Institute for Alcohol Abuse and Alcoholism), believes that alternative approaches are needed for traditional drug treatment, but not this – stating “the concept on its face is absurd.” Dr. Willenbring, further states “I’m not prone to making exaggerated or unqualified statements and in this case I don’t need to make any: It doesn’t work.” — “Like trying to cure alcoholism with Valium.” Common sense should tell us substituting one drug for another doesn’t bring a solution. It develops yet another layer to the addiction. If the goal is ultimately to be drug-free, how is adding another drug to the mix an effective means of treatment?
Why Medical Marijuana?
The zeitgeist contradicting Dr. Willenbring’s perspective is that medical marijuana has reportedly become a less harmful way to treat certain diseases and ailments including but not limited to multiple sclerosis, arthritis, epilepsy, glaucoma, HIV, chronic pain, Alzheimer’s and various forms of cancer.
To complicate matters further, medical marijuana is now being used to treat substance use disorders. A 2014 study conducted by the Journal of the American Medical Association found that the death rates for opiate overdoses were significantly lower in states with medical marijuana as compared to states that continue to outlaw marijuana.
Let’s look at the other side of the coin…
Wait – isn’t marijuana still considered a drug? Therefore, medical professionals are essentially treating one form of substance use disorder with a different substance? Yes. Marijuana is still considered a Schedule 1 drug by the federal government. Why is this important? Well, Schedule 1 drugs are drugs that according to the United States Drug Enforcement Agency have certain characteristics which includes drugs or other substances that have a high potential for abuse. More notably, among the drugs considered to be a Schedule 1 drug is heroin. That’s right, we are now being told that marijuana – a drug with the same classification and the drug for which we are trying to cure an addiction to – heroin – is supposed to be a solution.
As shown in the above image, the Centers for Disease Control and Prevention found that those addicted to marijuana are three times more likely to become addicted to heroin. Haven’t we learned from past attempts to treat drug use with additional drugs that put us at risk for comorbid addiction? The late 19th and early 20th centuries were characterized by using morphine to treat alcohol addiction. The next “solution” was to treat all the morphine addicts with, wait for it, heroin! Additional renditions of using drugs to treat drugs continue to occur, with an eerie feel that we’re in a Simpson’s episode, blindly following Seymour Skinner’s philosophy on extinguishing invasive species.
What are the prescribers saying and doing?
Several states are authorized to dispense medical marijuana to treat opioid addiction however, there are opposing points of view. While it’s possible that close monitoring of a program using medical marijuana to treat heroin addiction, the ongoing concern is that we’re just creating a second addiction which will eventually be super ceded by the harder drug, heroin. This suggests that long-term monitoring with significant attempts to ensure accountability for heroin addicts will be necessary for successful prescription of medical marijuana.
While there is data that suggests using medical marijuana as an effective harm reduction approach in reducing opioid overdose mortality, do we want to continue using addictive drugs to treat drug addiction considering the aforementioned failed attempts? The Yale Journal of Biology and Medicine suggests using the following prevention techniques to curb our populations’ initial and current involvement with illicit and prescribed drugs:
- Targeting high-risk populations
- Targeting those with a history of substance use disorders
- Involve immediate and extended family members
- Propaganda discouraging the sharing of prescription opioids
- Encourage appropriate disposal of unused and expired opioids
- Medication take back days
- Prescription monitoring programs
- Increase prescriber use of pain contracts
To drug, or not to drug: is it even a question?
There’s significant history suggesting that using addictive substances to treat substance use disorders is highly (no pun intended) unsuccessful. An argument can be made that marijuana is the least of its preceding evils (i.e. morphine, OxyContin, hydrocodone). Despite marijuana being excused as much less harmful drug, by the buyers and sellers, an argument can be made that marijuana can be debilitating and increase the risk of harm to the user and those around him or her.
Should we prescribe to this new school of thought, how can we actually determine that medical marijuana is a solution? Will states be willing to install an infrastructure that sanctions those in receipt of medical marijuana so they can have a license to operate a motor vehicle while under the influence? How does one get to work if they smoked three hours before a shift starts? What if that employee needs the marijuana to control his or her chronic pain at their place of employment? How does that affect those in rural areas that don’t have access to public transportation? Are we contradicting the ‘buzzed driving is impaired driving’ campaign? These are important questions that seemingly have not been answered yet.
We all undoubtedly want to find the solution for drug addiction – especially when it comes to heroin as it has claimed so many lives. But at what cost? Normalizing drug use has a history of being a slippery slope. Operating a motor vehicle is just one of the seemingly infinite variables that will need to be addressed and we’re doing it on whim with an absence of years of conclusive studies and evidence.
So many questions with so few answers
If we’re betting on history and lobbying against prescribing addictive drugs to treat drug addiction, something’s got to give. Between 2001 and 2015, the rate of opioid overdose fatalities quadrupled. What’s interesting is that many longitudinal studies on marijuana use are tainted because the people being studied are often combining marijuana with other illicit drugs, including heroin. The studies are further skewed by the increasing THC content in marijuana over the last couple of decades. So, we’re trying to study marijuana use but its historical cautionary slogan of it being a gateway drug is becoming true to those that are trying to push it through legislation. Follow the money! Taxes in states with legal medical marijuana are much lower than their counterparts.
Need for a cure
Not only have the heroin-related overdoses deaths quadrupled over a fifteen year period but individuals using heroin are likely to also be abusing multiple other substances, including cocaine and prescription opioid pain relievers. It is estimated that nearly all people who use heroin also use at least one other drug. Based on this information alone – yes we are in desperate need for a cure.
One way to combat the heroin epidemic is to educate yourself and the ones you love on the risk factors associated with the addiction. The following are some risks of those most at risk of heroin addiction:
- People who are addicted to prescription opioid pain relievers
- People who are addicted to cocaine
- People without insurance or enrolled in Medicaid
- Non-Hispanic whites
- People who are addicted to marijuana and alcohol
- People living in a large metropolitan area
- 18 to 25 year olds
Do any of the above apply to you or someone you love? The risks are not limited to these situations as the Centers for Disease Control and Prevention has found that some of the largest increases actually occurred groups with historically low rates of heroin use. These demographic groups include women, the privately insured and people with higher incomes. It appears there are no bounds when it comes to the heroin epidemic.
Perhaps most notably, as it relates to the current subject matter, one of the risks associated with heroin addiction is in fact people who are addicted to marijuana and alcohol. Based on this alone, how are doctors considering using a drug that increases an individual’s risk to become addicted to heroin as a cure?
While it is quite clear that there is a need for a cure for heroin addiction and other substance use disorders, it is not as clear that medical marijuana is the solution. Since there is no time to lose as heroin addiction is truly a life threatening disorder, instead of relying on this new treatment with medical marijuana which has very little scientific backing, there are multiple other treatment and prevention options available to you or someone you love.
Below are some options which may be the right fit for you or someone you love:
- Medications. There are several medications which aided individuals who are trying to combat their addiction. These medications have been well-researched and also are FDA-approved.
- Therapy and support groups. This option may suit you or someone you love as well. No one treatment is the right treatment for everyone. Speaking with a professional will help find the right treatment plan for the individual and may just be the missing piece to the puzzle to aid in recovery.
- Call SAMHSA 24-hour national helpline. If you are not sure where to start, please pick up the phone. The helpline is always available to you or someone you love and it is an invaluable resource as something as simple as reaching out may just save a life.
Most importantly, whatever treatment is right for you, the time for treatment is now. Don’t waste anymore of your life – get help before it is too late.