For many years, people thought of cannabis as a gateway drug. However, as many states start seeing a reduction in opioid overdose deaths once medical or recreational cannabis is legalized, this view is being challenged. Science has started to see cannabis as an exit drug instead, and some have started to integrate cannabis and cannabidiol (CBD) into their drug treatment programs.
However, the effectiveness of cannabis treatment for addiction depends very much on the drug you’re trying to reduce intake of or quit. Here’s where medical cannabis can come in useful for drug addiction, and which drugs it can reduce or replace.
Using cannabis and CBD instead of opiates and opioids
Using cannabis in place of opioid-based painkillers (e.g. oxycodone, hydrocodone) for chronic pain is where medical cannabis has made its mark over more recent years. There are several good reasons for this as well, including:
- Cannabinoid receptors are found in the same areas of the brain as opioid receptors. Cannabinoid receptors can “talk” to and influence opioid receptors and reduce the pain signals being sent to the affected areas.
- CBD can reduce anxiety.
- Both tetrahydrocannabinol (THC) and CBD can reduce cravings.
- THC and cannabinol (CBN) can be useful for treating insomnia.
- THC can reduce nausea and increase appetite.
So, when people say that they use cannabis to reduce their painkiller intake and avoid addiction, it’s not just an excuse to get “high” or “stoned” – the science supports their medical needs! Cannabis can be very effective at reducing an individual’s reliance on opioid-based painkillers.
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Cannabis to replace benzodiazepines and other sedatives
Opioids aren’t the only types of medication people want to reduce. Physically addictive substances such as benzodiazepines are also medications many people want to reduce or stop taking. A study in the Journal of Health Economics found that, in Italy, the availability of “cannabis light” – flowers from high-CBD hemp plants with up to 0.6% THC – was connected to:
- An 11.5% decrease in dispensed boxes of anxiolytics (anti-anxiety medications).
- A 10% reduction of dispensed sedatives.
- A 4.8% reduction of dispensed antipsychotics.
There are other studies showing similar results. It is suggested that CBD amplifies the inhibitory neurotransmitter, gamma-aminobutyric acid (GABA). Basically, excitatory “go” signals are inhibited, which can be very useful in the treatment of conditions like epilepsy.
Important note: you have to taper off of benzodiazepines slowly, as sudden withdrawals can be dangerous. Please notify a doctor and tell them of your wish to reduce benzodiazepine use using medical cannabis to set up an appropriate treatment plan.
Cannabis instead of alcohol
Alcohol is the most popular recreational substance worldwide, and alongside tobacco has the greatest impact on human health. However, even though many manage to use alcohol moderately, binge drinking is still a problem. Those unfortunate enough to suffer from alcohol use disorder (AUD) may become physically addicted to alcohol. As with sedatives, you cannot just stop using alcohol, either, as this is physically dangerous.
Science has shown that there is cross-tolerance between alcohol, opioids and sedatives, because all three substances act in a similar manner to each other on the endocannabinoid receptors (in particular CB1 receptors) and dopamine receptors. Both opioids and alcohol bind to CB1 receptors, leading to central nervous system (CNS) depressant effects. This is because binding to CB1 receptors can increase GABA (the “stop” signal) and decrease glutamate (the “go” signal).
Cannabinoids like THC and high doses of tetrahydrocannabivarin (THCV) also antagonize CB1 receptors, but do so in a far safer way than alcohol or opioid receptors, which have a tendency to “overload” the dopamine receptors if too much is taken. This can lead to overdose. Cannabinoids, meanwhile, manage to influence dopamine and serotonin receptors in a way our bodies tolerate better.
There are some other good reasons why cannabis can be used to replace alcohol, including:
- The terpene-cannabinoid, beta-caryophyllene. Beta-caryophyllene is also found in black pepper, and has anti-inflammatory and pain killing effects, and has also been shown to reduce alcohol intake in several animal models.
- Both CBD and beta-caryophyllene have been shown to reduce liver damage.
- Myrcene, humulene and pinene are terpenes found in both hops and cannabis. Those seeking a flavor profile and effect similar to beer may find a suitable replacement in cannabis.
Many states that have legalized medical or recreational marijuana have seen reductions in the sales of alcohol. Therefore, it is reasonable to believe that cannabis can be used in place of alcohol as a potentially safer recreational alternative.
Cannabis in place of stimulants
There is less of a body of evidence that cannabis can be used to reduce intake of prescribed or recreational stimulants such as amphetamines or cocaine. Using cannabis for cocaine withdrawal has been met with mixed results. With this being said, there is some good quality evidence that CBD can reduce cravings for stimulants, and many people with attention deficit hyperactivity disorder (ADHD) have successfully used cannabis to reduce or replace prescription medications such as Adderall or Ritalin. More research is needed in this area, but there are certainly cannabinoids and terpenes in cannabis (e.g. CBD, THCA, THCV, beta-caryophyllene, limonene, pinene) that could prove immensely useful for those who wish to replace stimulants with something more natural.
Cannabis and addiction: how useful is it?
One way of learning which substances cannabis can be used to replace is to learn which medications cannabis interacts with. And, when it comes to replacing opioids, sedatives and antidepressants, cannabinoids and medical marijuana have proven immensely useful. Cannabis could be an ideal recreational alternative to alcohol as well. There is less evidence for using cannabis in place of stimulants, but there are some promising studies showing that there are some uses in this area, too. Overall, there’s less evidence of cannabis being a gateway drug, and more evidence that it’s an exit drug.