Ask me Anything about Cannabis as an exit drug. Is it the next treatment for substance abuse?

Amanda Reiman
Jan 29, 2018

Cannabis has always been described by prohibitionists as a "gateway" drug that leads the user down a path from pot to heroin. This belief about cannabis has plagued the argument for legalization, until now. With accidental overdose from opiates now the #1 cause of accidental death in the US, what do we know about the use of cannabis as a substitute for opiates in pain treatment, and a treatment for substance dependence in its own right. Dr. Reiman has been studying this issue for 10 years and has conducted numerous studies on the use of cannabis as a substitute. 

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What made you select the medical marijuana the focus of your career?

Feb 5, 1:15PM EST0

There has been a small amount of research suggesting that cannabis can also help treat cancer. What’s the state of that research? Is it believable?

Feb 5, 11:20AM EST0

Do you think strict laws help benefit growers who are already in the market by helping them limit their competition?

Jan 31, 4:36PM EST0

I think that regulation is a balance between consumer and market protections and barriers low enough for innovation and entry into the system. Because of the stigma around cannabis, the barriers to entering the market will be artificially high at first. Because it will be a while until the dust settles, I think the most important thing is to work locally to reduce barriers.

Feb 1, 1:11PM EST0

Hi Amanda, I am in Canada but would like to know your thoughts about one-nation, one-law on cannabis in US? Is that possible?

Jan 30, 4:52PM EST0

Hi Ryan,

Given that in the US we regulate alcohol on the federal, state and local level, it is likely that the same will be said for cannabis. Even though alcohol prohibition has been over in the US for over 100 years, Tennessee was a dry state until the 1950's. If federal cannabis prohibition ever ends in the US, there will likely be a removal of criminal penalties at the federal level, and states will be left to decide how/if they want to participate in a commercial access program.

Jan 30, 4:58PM EST0

You mentioned cannabis can be used in children. What are the recommended precautionary measures for use in children?

Jan 30, 4:45PM EST0

As with any medication, it is best if cannabis use by children is supervised by a knowledgeable medical professional. That being said, in states where it is still illegal or for some conditions, there might not be a doctor with the knowledge to help. The thing about cannabis is, there is no fatal overdose and it is not toxic to organs. Therefore, it is already safer than the myriad of drugs these kids are on. With kids the same rule applies as adults, start low, go slow. You can always add more. And keep good notes.

Jan 30, 4:55PM EST0

What do you think about one-nation, one-law on cannabis? Is that possible?

Jan 30, 4:45PM EST0

I think it is possible for some countries. Uruguay, the first country to legalize cannabis, is small and has one set of laws for the whole country. In the US, we have a patchwork of laws. This is partially because of how our country makes laws and partially because of the controversial nature of cannabis. In the US, we regulate aspects of alcohol on the state and even the county/city level, so it will likely be no different than cannabis.

Jan 30, 4:53PM EST0

Which country or state, according to you, is too good at cannabis? Why?

Jan 30, 4:45PM EST0

Hmmm....I'm not sure I understand your question. Too good at it? Well, Canada is probably the farthest along when it comes to regulations and industry and Israel leads the way with research. I guess they would be the leaders at this point.

Jan 30, 4:51PM EST0

How are opioid-dependence patients comfortable in using cannabis as an exit drug?

Jan 30, 4:45PM EST0

For folks dependent on opiates, a big fear is the pain of withdrawal. These fears can support continued use, even if the person wants to slow down or cease using. Cannabis can assist during the withdrawal process. I think that is the first step for using cannabis as an exit drug.

Jan 30, 4:50PM EST0

Is losing weight with THCV healthy? If so, what’s the best way to use it for weight loss?

Jan 30, 4:45PM EST0

THCV can suppress appetite, but it is not to be used as a solo tool. THCV use should be in conjunction with a healthy eating plan with whole foods and regular excercise. 

Jan 30, 4:49PM EST0

What are your future plans for cannabis research? How would you look to expand your research?

Jan 30, 4:45PM EST0

I would like to look further into this issue by setting up clinical outcome studies that compare similar groups given different types of treatment. That is the best way to tell whether a treatment is effective.

Jan 30, 4:48PM EST0

How difficult is it for a cannabis worker or seeker with the changing laws and regulations?

Jan 30, 2:31PM EST0

The transition for illicit to licit comes with a lot of changes. I think the group that has seen the most change is law enforcement. The rapid change in laws, plus the variability of the laws and the stigma around cannabis has left law enforcement very confused over what is legal at any given time. 

Jan 30, 2:38PM EST0

Why do you think there are so many varying thoughts and stigma about using cannabis?

Jan 30, 1:57PM EST0

Prior to the early 1900's, cannabis was a very widely accepted medicine. It was used to treat a wide variety of ailments across cultures. After Mexico gained independence in the early 1900's, many folks came to the U.S. This influx of Mexican immigration scared the white folks here at home. The government started a smear campaign against these new visitors by demonizing their chosen form of relaxation and medicine, "marihuana". Very few Americans had even heard the term "marihuana" but they knew cannabis as a medicine. The government played on this by spreading false information about the impact that "marihuana" had on Mexicans, making them violent and hard to control. By making cannabis illegal, it gave the government legal standing to stop, search and detian Mexican immigrants. Since that time, cannabis has been used to control other populations as well, Beat Poets and Jazz Musicians in the 40's and 50's, hippies and anti-war protestors in the 60's and 70's, etc. The reason the stigma is there is because the government created it. It was (and still is) a useful tool to control those in society that they deem "objectionable" or a threat to their strategy of power.

Jan 30, 2:36PM EST0

How do you think cannabis could change the pharma industry forever?

Jan 30, 10:56AM EST0

Yes. I think that cannabis policy and science are shifting at a time when the public is increasingly suspicious of the pharma industry. Like the move against industrialized agriculture, the natural shift away from pills and towards plants is intersecting with the greater availability of cannabis.

Jan 30, 12:32PM EST0

How do you think people’s opinion can make cannabis legalization possible?

Jan 30, 10:53AM EST0

Part of reducing the stigma around cannabis is talking about it. Similarly to the LGBTQ movement, the more folks who were willing and able to be open about who they were, the less the public relied on stereotypes. Coming out of the cannabis closet is the best way to move legalization forward. That being said, because of the racial predjudices in policing, it might not be safe for some people to come out as cannabis consumers, so it is up to us who do not face the same risk (because we are white), to come forward.

Jan 30, 12:31PM EST0

I'll be here for another 15 minutes if there are any more questions!

Jan 29, 7:44PM EST0

Hello Doctor, I just wanted to ask if ingesting it has the same effect as smoking or vaping? 

Jan 30, 8:46AM EST0

Yes and no. It has the same effect in terms of how quickly a person feels the effects. Inhaling cannabis, whether through smoking or vaping is the fastest way to feel its effects. This can be useful for those who need immediate relief and for those who are worried about ingesting too much. The difference is, vaping heats the material to a temperature that releases the active ingredients without burning the product. Smoking burns the product and releases the active ingredients through smoke. While it might be safer for the lungs to inhale vapor rather than smoke, there is no evidence to show that smoking cannabis contributes to lung cancer.

Jan 30, 2:41PM EST0

Hi folks, there was a scheduling error and this was supposed to be at 7pm PT tonight. I will answer as many as I can in the short time I have and then schedule another one when I can fully participate :)

Jan 29, 7:09PM EST0

Thanks for AMA, great read.

Jan 29, 8:23PM EST0

My pleasure!

Jan 30, 12:32PM EST0

What age can cannabis be used from? If you ware to replace opiates treatment for kids, is it less harmful to use cannabis than opiates?

Jan 28, 12:37AM EST0

Cannabis has been used with very young children who have serious medical conditions such as epilepsy and cancer. If a child had a pain condition that required opiates, then YES, cannabis would be a safer choice.

Jan 29, 7:44PM EST0

What are the studies and on the ground statistics of the use of cannabis for replacing opiates?

Jan 27, 3:36AM EST0

Here is a good list of studies: 

Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D

http://content.healthaffairs.org/content/35/7/1230.abstract

Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers?

http://www.nber.org/papers/w21345

Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010

http://archinte.jamanetwork.com/article.aspx?articleid=1898878

The opioid crisis in America’s workforce

http://www.castlighthealth.com/typ/the-opioid-crisis/

Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain

http://www.ncbi.nlm.nih.gov/pubmed/27001005

The Effect of Medicinal Cannabis on Pain and Quality of Life Outcomes in Chronic Pain: A Prospective Open-label Study

http://www.ncbi.nlm.nih.gov/pubmed/26889611

Substituting cannabis for prescription drugs, alcohol and other substances among medical cannabis patients: The impact of contextual factors

http://onlinelibrary.wiley.com/doi/10.1111/dar.12323/abstract

Medical Cannabis in Arizona: Patient Characteristics, Perceptions, and Impressions of MedicalCannabis Legalization

http://www.ncbi.nlm.nih.gov/pubmed/26317379

Profiles of medicinal cannabis patients attending compassion centers in Rhode Island

http://www.ncbi.nlm.nih.gov/pubmed/25715068

Who are medical marijuana patients? Population characteristics from nine California assessment clinics

http://www.ncbi.nlm.nih.gov/pubmed/21858958

Among veterans, opioid prescription requests down in step with rise in medical pot

http://www.theglobeandmail.com/news/national/among-veterans-opioid-prescription-requests-down-in-step-with-rise-in-medical-pot/article30285591/

Relevant studies finding great adherence to treatment among opioid-dependent subjects who use cannabis/cannabinoids moderately as an exit drug:

The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone

http://www.ncbi.nlm.nih.gov/pubmed/26187456

Intermittent marijuana use is associated with improved retention in naltrexone treatment for opiate-dependence

http://www.ncbi.nlm.nih.gov/pubmed/19444734

CONCURRENT SUBSTANCE USE AND OUTCOME IN COMBINED BEHAVIORAL AND NALTREXONE THERAPY FOR OPIATE DEPENDENCE

http://www.tandfonline.com/doi/abs/10.1081/ada-100104511

Jan 29, 7:43PM EST0

Opiates are a huge industry, do you think big pharma will ever allow cannabis to take a share of the market?

Jan 26, 9:02PM EST0

Not if they can help it! The makers of Fentanyl donated $500,000 to keep cannabis illegal in AZ in 2016. However, they are likely fighting a losing battle as not only is cannabis a better choice in most cases, but many young people are distrustful of the pharmaceutical industry, with good reason!

Jan 29, 7:41PM EST0

Are there actually any official statistics on cannabis users turned heroin users?

Jan 26, 8:23PM EST0

Over half of the adult population in the US has tried cannabis at least once, that number drops below 1% for heroin, so you can see that very few cannabis consumers use heroin as well.

Jan 29, 7:40PM EST0
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