Cannabis is increasingly being considered a means of managing addictions, particularly since traditional treatments are often unsuccessful and relapse often occurs. Additionally, cannabis is associated with less risk than other substances.
Addiction is a significant issue in Canada. In the last Canadian drug survey in 2012, more than 21% of Canadians met the criteria for a substance use disorder – that is, almost 8 million people.
The cost to Canadian taxpayers is approximately $20 billion a year, with roughly $3.3 billion of that from healthcare costs – this is only a couple billion less than the entire value of the Canadian pharmaceutical industry. The most common addictions in Canada are tobacco and alcohol. However, opioids result in the most substance-related deaths in Canada; in 2018, approximately 12 deaths per 100,000 people.
Characteristics of Substance Use Disorder
The DSM-5 has changed their language related to addictions and substance dependence to now defining substance use disorder. Substance use, dependence, and addiction have often been used to describe the severity of a person’s substance problem, but they were sometimes used interchangeably, making things challenging.
Substance use becomes a disorder when it fits the DSM criteria. Moreover, when substance use is associated with a negative impact on a person’s day-to-day functioning or desire to stop.
The DSM criteria are as follows:
- Taking the substance in larger amounts or for longer than you’re meant to.
- Wanting to cut down or stop using the substance but not managing to.
- Spending a lot of time getting, using, or recovering from the use of the substance.
- Cravings and urges to use the substance.
- Not managing to do what you should at work, home, or school because of substance use.
- Continuing to use, even when it causes problems in relationships.
- Giving up important social, occupational, or recreational activities because of substance use.
- Using substances again and again, even when it puts you in danger.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Needing more of the substance to get the effect you want (tolerance).
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Treatment for addictions is complex as they impact many aspects of a person’s life and result from several different causes. Traditional treatments tend to focus on medication to interrupt cravings and manage withdrawal symptoms, psychotherapy to address underlying psychological issues and encourage behavioural change, and social support, which often includes both family and friends and support groups such as AA and NA. In some cases, people are hospitalized or admitted into inpatient treatment programs.
Cannabis and Addictions: Cannabis as Treatment
Cannabis helps individuals reduce or eliminate the use of other problematic substances – here, we will focus on alcohol and opioids, including prescription painkillers.
Not only have studies shown that cannabis users are less likely to consume other substances, but cannabis can help manage some of the underlying issues that lead to substance use, such as pain management and reducing anxiety, depression and stress.
Cannabis for Managing Alcohol Addictions
The most challenging aspect of moving toward abstaining from alcohol for those struggling with alcohol addiction is the withdrawal symptoms. Not only is alcohol withdrawal incredibly uncomfortable, but it can be fatal.
Withdrawal symptoms typically include anxiety, headaches, nausea and vomiting, shaking, insomnia, and sometimes seizures. Studies have shown that cannabis can effectively manage most, if not all, of these symptoms. Additionally, preliminary studies suggest that cannabis is a good management tool for alcohol addictions. Participants in this study not only noted a reduction in alcohol consumption but experienced less problematic side effects and were able to function more easily day-to-day than with other treatments.
Cannabis for Managing Opioid Addictions
When talking about opioids, we are discussing prescription and illicit substances aimed at pain management, including codeine, oxycodone, fentanyl, morphine, hydromorphone, and heroin.
Although opioids are legally prescribed for pain management and are effective for this use, there are several ways use can be problematic. Tolerance and dependence are easily developed, which can increase need and dose, which, in turn, increases the risk of overdose.
Additionally, there are numerous problems associated with the traditional treatments for opioid addiction, particularly opioid agonist therapy using methadone or buprenorphine. These treatments are also addictive, and they must be taken as prescribed, or it could increase the likelihood of accidental overdose. Of course, as with many prescription medications, they have a long list of side effects.
We know that cannabis is well established for pain management, but preclinical research is beginning to look at the specific impacts of cannabis on opioid withdrawal and help manage cravings.
Research suggests the CB1 receptors in the endocannabinoid system play a critical role in opioid reward pathways. Therefore, cannabis has the potential to reduce the rewards associated with the use of other drugs and reduce cravings (source). As a result, cannabis can help in reducing opioid use and the chance of relapse.
A 2015 report of a small double-blind study found a single administration of CBD, in comparison to a placebo, decreased cue-induced craving of opioids and feelings of anxiety in opioid-dependent individuals. A 2019 double-blind placebo-controlled study also demonstrated cannabis, specifically the FDA-approved Epidiolex, can reduce cue-induced craving in individuals who were former heroin users. Furthermore, Epidiolex reduced reports of anxiety and blood levels of cortisol (a hormone known to increase under conditions of stress and anxiety). Additionally, initial studies verified that CBD, when co-administered with fentanyl, is safe and well-tolerated in healthy, non-opioid-dependent individuals.
As research continues, we get more evidence to support the use of cannabis to help with opioid addictions, withdrawal, and cravings.
Final Thoughts
Many people may worry about the long-term implications of switching one substance for another. While it is significantly less likely to develop a physical dependence on cannabis, it’s possible to form an addiction. However, the potential harms associated with cannabis are considerably less than the other substances we have discussed here, and there is no risk of overdose. Cannabis is also a safer alternative to many traditional treatments for addictions, though that does not mean that cannabis should be the only treatment method.
Cannabis should be used in conjunction with other treatment methods and social change.
This article was written for information purposes only and should not be considered medical advice. If you are struggling with addictions, speak to your doctor or other health professionals to discuss a treatment plan.
If you want to speak to someone, or are at risk of an overdose, reach out to your local helpline, present to your nearest emergency room, or call 9-1-1.
If you want to read more on the possible health benefits of cannabis, read our piece on cannabis for weight loss.