Using marijuana to treat alcoholism or drug addiction has been a rising feature in the media lately, but this is anything but news. In fact, it’s called the Marijuana Maintenance Program; a controversial practice that has been used to treat alcoholism since the early days of A.A., and to treat other addictions since the 1800′s. (1) However, it’s precisely the controversy in question that’s forcing this topic into the news, because while there are many in recovery who protest marijuana addiction treatment as a blatant disregard for abstinence, there are credible reasons to support the idea that for some people, marijuana may be a life-saving alternative to active alcoholism or drug addiction.
Crack or Cannabis?
Would you rather your twenty-something child smoke meth, or pot? For most people the answer is obvious even if begrudgingly, and this is the idea behind the Marijuana Maintenance Program. By switching from a dangerous addiction like intravenous opiate or meth use to a considerably more benign substance like marijuana, a major goal of harm reduction is achieved.
What is Harm Reduction?
Harm reduction refers to the fact that while heroin addiction can lead to crippling disease, overdose and death, marijuana will not do so. This is just one example of harm reduction, which generally occurs in stages. For instance, consider the following harm reduction plan for a 33 year old man who is severely addicted to heroin:
Each step of this plan generally results in less harm being done to the man, with the eventual goal of complete and permanent abstinence. Society benefits from these harm reduction efforts, as a step down program like this often results in fewer drug-seeking behaviors/crimes that negatively impact families and their communities.
The Capital of Cocaine switching to Cannabis
In Bogotá, Columbia – widely regarded as the cocaine capital of the world, drug addiction is a severe problem. But the city government is doing something about it: the mayor is taking steps to set up clinics and corresponding clinical studies where addicts are transitioned from the region’s surplus of cocaine to comparatively harmless marijuana. (2) Reports indicate that these plans could be implemented in as little as 2 months.
In the United States, a number of groups exist to publicly support treatment of alcoholism or addiction with marijuana. This includes New York based HAMS, which advocates harm reduction for alcohol (3) based in part on the work of Tod H. Mikuriya, M.D., whose 2004 study of alcoholics on the “marijuana maintenance program” concluded that;
“All patients reported benefit, indicating that for at least a subset of alcoholics, cannabis use is associated with reduced drinking.” (4)
However, a 2009 study indicates that this information should be taken with at least one major caveat.
Moderation of Cannabis Use
One problem with the marijuana maintenance program is that it may offer benefits only when used intermittently. In a study published in the American Journal of Addiction, addicts taking the opiate replacement therapy drug Naltrexone were significantly more successful in treatment when they smoked marijuana intermittently as opposed to consistently or not at all. (5) This poses a serious problem for addicts, who often cannot moderate their drinking or drug use at all without supervision. This means that if the above-referenced study is an accurate depiction of marijuana substitution overall, then most addicts will not be able to meet the requirement of “intermittent” use in order to receive the maximum benefit.
Ultimately, the argument stands that a severe meth/heroin/crack/cocaine addict is at far greater risk of disease, overdose, death, imprisonment, etc. than someone who smokes marijuana – even if they smoke the plant “chronically,” as the cannabis culture might say. Of course, we must take into account that marijuana is also addictive, but with far less damaging effects the 9% of users who become dependent (6) are likely to fare better than if they were dependent on a more dangerous substance.
But even with documented rates of addiction to cannabis, we can be sure of one thing: it’s better to have a neighborhood full of pot-heads than crack-heads. So while it may be true that anyone using the marijuana maintenance plan to get clean isn’t fully abstinent, the dangerous effects to their lives can be significantly reduced or even eliminated by switching to cannabis, with the goal of a step-down program to 100% abstinence in time. After all, isn’t this the same exact principle as methadone, naltrexone and suboxone treatment and the entire opiate replacement therapy industry?
The unfortunate truth of the matter is best summed up in an article by Dr. Bruce Charlton of the University of Newcastle upon Tyne:
“The drug-substitution strategy is based on an assumption that most people use lifestyle drugs rationally for self-medication purposes, to achieve specific desired psychological effects, especially enhanced well-being. When there is access to an equally effective, but safer, alternative drug, then people would tend to switch to it (especially when the substitute is legal and socially-acceptable).” (7)
Of course, life experience and common sense tell those of us in recovery that any substance we are addicted to must be cut out of our lives completely in order to be successful. According to some experts this even includes caffeine, nicotine and sugar – although many people in recovery will protest this idea as staunchly as many marijuana supporters deny the existence of cannabis dependence. So while it could at times seem natural to condemn anyone taking part in the “marijuana maintenance program,” it might help to keep in mind that they’re killing themselves a little less than they were before, and in time they just might get clean for good.
(1) Mikuriya, T. H. Marijuana in Medicine: Past, Present and Future Calif Med. 1969 January; 110(1): 34–40. pp36 PubMed/National Center for Biotechnology Information http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1503422/
(2) Wallace, Arturo Bogotá quiere de aliada a la marihuana Lunes, 25 de marzo de 2013 BBC Mundo, Bogotá http://www.bbc.co.uk/mundo/noticias/2013/03/130322_colombia_marihuana_combate_adicciones_bogota_aw.shtml#reports
(3) HAMS Harm Reduction Network, Inc. Harm Reduction for Alcohol: Switching Your Drug of Choice: Marijuana Maintenance as a Treatment for Alcohol Dependence http://hamsnetwork.org/mm/
(4) Mikuriya, Tod H. Cannabis as a Substitute for Alcohol: A Harm-Reduction Approach Journal of Cannabis Therapeutics, Vol. 4(1) 2004 http://hamsnetwork.org/mikuriya.pdf
(5) Wilfrid Noel Raby, PhD, MD, Kenneth M. Carpenter, PhD, Jami Rothenberg, PhD, Adam C. Brooks, PhD, Huiping Jiang, PhD, Maria Sullivan, MD, Adam Bisaga, MD, Sandra Comer, PhD, and Edward V. Nunes, MD Intermittent Marijuana Use Is Associated with Improved Retention in Naltrexone Treatment for Opiate-Dependence Am J Addict. 2009 Jul–Aug; 18(4): 301–308. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2753886/
(6) Jann Gumbiner, Ph.D. Is Marijuana Addictive? December 5, 2010 The Teenage Mind | Psychology Today http://www.psychologytoday.com/blog/the-teenage-mind/201012/is-marijuana-addictive
(7) Charlton, Bruce G. Ph.D. Diazepam with your dinner, Sir? The lifestyle drug-substitution strategy: a radical alcohol policy QJM (June 2005) 98 (6): 457-459.doi: 10.1093/qjmed/hci067First published online: May 6, 2005 http://qjmed.oxfordjournals.org/content/98/6/457.full