Should people in recovery from alcoholism or drug addiction use medical marijuana? Can medical cannabis provide alcoholics and drug addicts in recovery needed pain relief, or is it a threat to their recovery -- and their lives?
As recently as 20 years ago, this dilemma would have been primarily academic. In 1996, California became the first state in the U.S. to legalize marijuana for medicinal purposes, and its use has grown quickly in recent years. As more states approve it, an increasing number of alcoholics and addicts in recovery and medical professionals are grappling with the question of whether the substance is safe for people in recovery. Currently, 28 states and the District of Columbia allow the use of medical marijuana for a variety of conditions, including chronic pain, anxiety and nausea from chemotherapy. Like anyone else, alcoholics and addicts in recovery suffer from these and other conditions that medical marijuana is used for.
Unlike other patients, people in recovery have a history of substance abuse -- and using a potentially addictive substance could be disastrous for those who are essentially in remission from their drinking problem and/or drug addiction, several addiction specialists say. Using medical marijuana could wreck an alcoholic's or addict's recovery, they explained.
Alcoholism and addiction can be arrested but not cured, says Warren Zysman, chief executive officer and chief program officer at ACI, one of the largest providers of chemical dependency services in New York City. For an alcoholic or addict, using an addictive substance -- such as marijuana -- "is like turning that light switch on," Zysman says. In almost all cases, Zysman says he would not recommend people in recovery use medical marijuana. One exception would be someone suffering from a terminal illness who is seeking pain relief. "In that instance, the primary focus for someone who is dying is to keep them comfortable, and we wouldn't necessarily look at their addiction issues," Zysman says.
A Relapse Threat
Even if marijuana isn't someone's drug of choice, using cannabis can trigger a relapse. "People are more likely to seek their primary drug or alcohol when they are intoxicated or high," says Anne Lewis, clinical psychologist and licensed addictions counselor with Indiana University Health. "It lowers your inhibition, so you don't care. We don't make good decisions when we're drunk or high."
The consequences of a relapse can be catastrophic, leading to job loss, hospitalization and death, Zysman and other addiction experts say. An addict or alcoholic who has not been using drugs or alcohol and relapses does not pick up where he or she left off in their addiction, but in a far worse place, as if they had continued using while their addiction grew, they say.
Alcoholism and addiction are progressive, so that means an alcoholic or addict who relapses will not resume using the amounts of alcohol or drugs they were consuming when they stopped, but will take larger amounts, as if they had never stopped, says Beth Kane-Davidson, director of the Addiction Treatment Center at Suburban Hospital in Bethesda, Maryland. "For the addict, one drink [or dose of a drug] are never enough," Kane-Davidson says. She also warns that marijuana is addictive. Alcoholics and drug addicts in recovery who did not use marijuana could become addicted to the substance, she says.
Potential Medical Marijuana Uses
Some physicians, however, believe medical marijuana does not pose a danger to people in recovery from alcoholism or drug addiction and use it to treat patients for issues such as pain or anxiety or to try to help wean them from opioids. For example, Dr. Mark Hashim, a board-certified anesthesiologist based in Hudson, Florida, says he believes medical marijuana can help addicts with withdrawal from opioids. "I've given it to patients who are in recovery and haven't had an issue," Hashim says.
A study published in 2014 in the peer-reviewed journal Neurology found that amyotrophic lateral sclerosis patients who were using marijuana reported the substance helped treat their symptoms. In the survey, 21 percent of 102 ALS patients reported current or prior use of medical marijuana to treat their symptoms. Within the group, 80 percent said it helped relieve anxiety, 75 percent said it helped stimulate their appetite, 70 percent said it helped relieve depression and 65 percent said it helped them sleep.
The Abstinence Model
Still, Kane-Davidson and many other alcoholism and drug addiction treatment counselors adhere to the abstinence model, which calls for addicts and alcoholics in recovery to generally avoid mind-altering or potentially addictive substances except for unusual circumstances. For example, an addict or alcoholic in recovery who has undergone painful gum surgery or is suffering traumatic injuries from a bullet wound or car crash could use a painkiller such as Percocet under a doctor's care.
A Need for Clinical Studies
Sheila Shilati, chief operating officer of Seasons Recovery Centers based in Malibu, California, urges people in recovery to be cautious when it comes to medical marijuana. Use of the substance for medical purposes is new, she says, adding that she would like to see further clinical studies on its effects on patients, including surveys that explore whether the substance can trigger a relapse. "I don't think we would go blindly into it and make recommendations [to use medical marijuana] at this juncture," Shilati says. "We have a responsibility to fully understand its implications."
What to Consider
Addiction experts say people in recovery should consider multiple factors when deciding whether to try medical marijuana to help treat a serious condition. They offer these three tips:
Tell your doctor you're an alcoholic or addict in recovery. A primary care doctor or specialist may ask whether you drink or smoke but may not inquire specifically if you are an alcoholic or addict or if you are in recovery, Zysman says. If you volunteer to your physician that you are in recovery from alcohol or drugs, you can talk with him or her about non-addictive alternative treatments. For example, to treat pain, 800 milligrams of ibuprofen could be a good alternative to painkillers such as oxycodone, which is addictive.
If you've abused prescription drugs in the past, write a letter to your doctor describing that episode. Doctors will flag this on their charts and avoid prescribing prescription medication that is addictive, Zysman says.
Do your research, and talk to an addiction therapist. People in recovery from alcohol or drugs who are wondering whether medical marijuana is right for them should consult reputable sources like the National Institute on Drug Abuse and the American Society of Addiction Medicine, Kane-Davidson says. Patients should also research cannabis use disorder -- which is defined by several symptoms, including disruptions in functioning due to cannabis use, cravings for cannabis, the development of a tolerance for the substance, the inability to sleep, restlessness, nervousness, anger or depression within a week of heavy use, according to the Substance Abuse and Mental Health Services Administration. Based on a 2014 national survey, 4.2 million people ages 12 and up met the criteria for the disorder.
Patients can also talk to professional addiction specialists about their concerns. Don't hesitate to ask questions. "The addiction field is a specialty, we are trained to deal with addiction issues," Kane-Davidson says.
If you decide to use medical marijuana, beef up your recovery program. Patients in recovery who use medical marijuana or another addictive substance should recognize the risk of relapsing and take steps to mitigate that threat, Zysman says. That would entail increasing the number of support-group meetings, such as Alcoholics Anonymous or Narcotics Anonymous gatherings, that the patient attends. "They should be going every day, as if they were new in recovery, and continue going every day for at least 30 days after they have stopped using the substance," Zysman says.
Patients can also consider additional help, such as sessions with an addiction treatment counselor or licensed psychologist or psychiatrist.
Ruben Castaneda is a Health & Wellness reporter at U.S. News. He previously covered the crime beat in Washington, D.C. and state and federal courts in suburban Maryland, and he's the author of the book "S Street Rising: Crack, Murder and Redemption in D.C." You can follow him on Twitter, connect with him at LinkedIn or email him at firstname.lastname@example.org.