Pubdate: Mon, 17 Apr 2017
Source: Ottawa Citizen (CN ON)
Copyright: 2017 Postmedia Network Inc.
Contact:  http://www.ottawacitizen.com/
Details: http://www.mapinc.org/media/326
Author: Jacquie Miller
Page: A4

FIGHTING FIRE WITH FIRE

Medical marijuana may assist in keeping addicts off dangerous
opioids.

The patients at Dr. Mark Ujjainwalla's methadone clinic are trying to
beat their addiction to heroin, narcotic painkillers and other opioid
drugs, but most of them still smoke pot.

He estimates that 90 per cent of his patients at the Recovery Ottawa
clinic on Montreal Road already use marijuana, and he's begun writing
prescriptions so they can buy it legally.

Medical marijuana, used appropriately, can reduce insomnia, anxiety
and cravings for opioids, says Ujjainwalla. Marijuana cannot replace
methadone or suboxone, the drugs he uses to treat addicts, he says.

But in some cases patients on marijuana can reduce their dose of
methadone, he says.

"They see (marijuana) as positive, and I agree with
them."

Ujjainwalla, who estimates he's written a couple of hundred
prescriptions for medical marijuana, also wants to eliminate the need
for his patients to put themselves in danger by buying weed on the
street.

Many of them are homeless or vulnerable.

"People are living on the streets. They have to deal with horrible
people with guns and knives . ... They're prostituting themselves,
they're stealing, they're in jail, they're out of jail.

"We get them on methadone, they start doing better. But they're using
marijuana. They're using marijuana because they feel better on
marijuana. I'm not saying that's good or bad. I'm just saying that's
what they tell me. So now they're on methadone and marijuana, and
they're doing pretty well, considering where they were at.

"But now guess what? They gotta go on the street to the same idiots
they used to buy their pills from, they used to buy their crack from,
(who) are selling their weed. They have to go back into the red zone
area to buy weed from these same idiots. So that's an issue around
relapse."

Some of the marijuana bought from dealers is contaminated with cocaine
and other drugs, says Ujjainwalla, putting patients at risk of failing
urine tests for drug use and being removed from the methadone program.

Ujjainwalla is among those working with addicts who believe cannabis
can be a useful harm reduction tool.

Activists in the cannabis community go further, often referring to
marijuana as an "exit drug " and offering anecdotal evidence of people
who ditched their OxyContin for weed.

As Canada struggles with a growing number of opioid overdoses, the
question arises: Can marijuana help addicts to reduce or quit using
more harmful drugs?

There is no proof, just some tantalizing suggestions.

One American study in 2014, for instance, found that in states where
medical marijuana was legal, the rate of opioid overdose deaths was
nearly 25 per cent lower.

Despite such indirect evidence, there is no clinical evidence that
would support the use of cannabis in addiction treatment, says Dr.
Bernard Le Foll, the head of addiction medicine service at the Centre
for Addiction and Mental Health in Toronto.

Research on animals suggests that some components in cannabis may have
"anti-addictive properties," he said.

"We don't know for sure how it would work in human populations. It's
possible that adding cannabis to the mix would reduce the use of
opioids and then maybe (that would create) less risk . ...

"Some users may substitute one drug for another. But we still don't
have enough clinical information to know if this is a suitable
treatment approach."

Cannabis could also make things worse, he said. "It could have
negative consequences. You may end up an individual addicted to two
drugs instead of one."

Like many others, he says more research needs to be done. "We have a
lot to learn on cannabis. What are the medical properties of cannabis?
The research is still in its infancy. It has tremendous potential."

It's easy to find addicts, though, who say marijuana helps them,
whether a doctor prescribes it or not.

Kyle Esford, 23, was buying some pot recently at an illegal marijuana
dispensary on Rideau Street a few blocks from the methadone clinic
where he is being treated.

After a couple of years addiction - he ingested "anything, really,
fentanyl, heroin, hydromorphone ... " - Esford said he "just got sick
of it" and sought help.

Esford believes marijuana helped with his opioid withdrawal because it
"numbs your body a lot." Marijuana also improves his mental state,
says Esford. "It just makes it bearable, all the problems in my life."

Esford didn't start using marijuana to help ease himself off harder
drugs - he has been smoking pot since he was 13.

"It keeps me calm and relaxed and focused," explains Esford, who has
ADHD and says his mind is always racing. "And if I'm smoking a joint,
I'm not spending time doing other drugs.

"This substance doesn't damage me as much."

That story is familiar to Philippe Lucas, the vice-president of
patient advocacy at Tilray, a legal producer of medical marijuana in
B.C.

Before joining Tilray, Lucas founded a "compassion club" marijuana
dispensary in Victoria that served many customers who had HIV-AIDS and
hepatitis C they had contracted through injection drug use.

"These folks would come in and they'd have a doctor's script for the
use of cannabis to help their (disease) symptoms, but they would
openly tell me, 'Look, I'm really just using this because if I have a
cannabis cookie or smoke a joint I don't have a craving to go out and
look for the opioids, to look for heroin, to look for crystal meth,"
Lucas says.

"They would say I'm either replacing it completely or using is less.
For them, it was a harm reduction tool. To me, this really flipped the
switch ... because it suggested that, at least for some individuals,
it was actually an exit drug for problematic substance abuse."

Lucas now researches the "substitution effect" and is doing a
doctorate at the University of Victoria Centre for Addictions
Research. He has co-authored two studies published in health journals
that found cannabis users report substituting marijuana for alcohol,
illicit substances and prescription drugs.

There is evidence that cannabis can help treat chronic pain, according
to a comprehensive review of the medical literature on the health
effects of cannabis by the U.S. National Academies of Science,
Engineering, and Medicine. However, the report concluded there is
limited evidence of any statistical association between cannabis use
and changes in the rates and patterns of other licit and illicit substances.

So while cannabis may have a role in replacing or reducing opioids for
some pain patients, it's not known whether it can also help people who
are addicted to opioids.

Random clinical trials are needed, says Lucas.

In the meantime, patient surveys, data on opioid overdoses in medical
marijuana states and anecdotal reports from patients should not be
discounted, he says.

"So much of what we know about the medical use of cannabis has not
come through the traditional clinical trial model of drug development
because of the prohibition on cannabis that has been imposed so long.
So much of it comes from the patient experience . ... When you hear
one thing from one person, you can say it's an anecdotal report.

"When you hear it from a thousand, or 10,000 or 100,000 patients, and
you hear consistent messaging, at that level I think it rises up well
beyond anecdotal."
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MAP posted-by: Matt