Dr. Frankel's Journal

CANNABIS MAY BE AN IMPORTANT PART OF OUR NARCOTIC PROBLEMS

July 21, 2017
Allan Frankel, MD
narcotic problems

Copyright : lightwise

I was recently listening to a radio show on our nation’s opiate nightmare. While they had many suggestions for dealing with the crisis, I waited for them to discuss using cannabis as a therapy for narcotic problems. That topic never came up.

Their suggestions included more in-patient rehab facilities, using Methadone and needle exchanges and the use of Suboxone as appropriate solutions.

All evidence and data shows the following:

• Rehab generally has a twelve-month success rate below 20%, at a very high cost.
• Methadone and needle exchanges define success as remaining on methadone and using clean needles. Not all bad, but a very low bar indeed.
• Suboxone contains buprenorphine, a fairly powerful narcotic that patients are becoming addicted to more and more. The theoretical benefit of Suboxone is that it can prevent fatal overdoses from heroin or other powerful narcotics. However, a patient has to take it for it to be effective. In addition, people are becoming addicted to Suboxone.

So rehab, Suboxone and Methadone are not very good solutions as they do not have high success rates and do not provide the patient with a method to control their narcotic use.

As an alternative solution, cannabis medicines offer the following benefits:
1. No withdrawal effects
2. Not a narcotic
3. Minimizes narcotic withdrawal
4. Readily available in most situations
5. Feelings of comfort that replace narcotics in many situations

Combinations of CBD and THC, adjusted for the individual, can virtually eliminate the narcotic withdrawal syndrome. I have treated a number of patients in this situation. I have also found that appropriate cannabis dosing also virtually eliminates alcohol withdrawal.

To this point, we can help the patient get off the narcotics and generally do it at home, assuming there is an adequate support system in the home.

The second, and more challenging, issue using cannabis to treat opiate abuse is to find a dose of cannabinoids that can give the patient a feeling as close as possible to their narcotic craving. In my experience, perhaps we cannot do this perfectly, but we can often get pretty close. If the patient is given a support medication that is NOT a narcotic itself, it is more likely they stand a chance of staying off the narcotic “spin cycle”.

As an interim solution, Narcan and Naloxone have been around for decades. Most physicians have used them when the patient received too much of any narcotic, and they minimize the chance of fatal overdoses.

Narcan or Naloxone, are cheap and do not require a prescription in many states, including California. Any adult can go to pretty much any pharmacy and purchase a two-dose pack of nasally applied Narcan. It is trivial to administer, has no down side, and Public Health Departments should determine an aggressive and widespread distribution program.

Now for the exciting part. I am working with a very well respected local rehab center. We are launching a trial program with four patients. The basic idea is how can we best use cannabis to help a patient have a more smooth recovery as well as how can we provide a form of comfort for the patient to help minimize cravings. In other words, how do we help make the patient comfortable within their skin with minimal use of pharmaceuticals allowing the patient to ultimately leave rehab on a healthy cannabis regimen in place of a half dozen pills. I have seen this work very well on several occasions.

I will see these patients a week before they go into rehab and start them on a cannabis regimen pre-rehab, that will help them taper off their substance of choice before entering rehab. Or, at least decrease the amount of the substance. Once the patient is admitted, I would see them again and perhaps a couple of more times while they are inpatients. Their regimen could be adjusted and perhaps a decent percent of these patients will do better. As the success rate of rehab is only 20%, it seems likely we can do better.

In Conclusion

While many may have never considered cannabis to be a viable alternative treatment, my experience in recommending dosed cannabis therapies over the past 11 years has shown it to be a very effective medicine. Making it a medicine that should be seriously considered on our fight to save lives and help those with addiction issues.

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