Cannabis as a Solution to the Opioid Epidemic- Treatment Guidelines

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The following is a transcript of Dr. Sulak’s Opioid Event:

Now that you understand the science behind my claims that cannabis can be used to reduce and replace opioids, treat the withdrawal, and prevent dosage escalation, I’m going to show you how to do it. 

We’re going to start with some general dosing terminology around cannabis. And I’m going to show you a few caveats that are unique to medical cannabis compared to other medications. And we’ll go straight into what I recommend for people who are new to cannabis and for people that are experienced with cannabis, and then we’ll go to specific guidelines for cannabinoid opioid combination treatment. Finally, we’ll wrap it up with case studies and patient narratives.

Dosing Terminology

So clinical dosing terminology – it’s important to have a language to talk about this stuff, especially if you’re new to cannabis. So here is a pipe with herbal cannabis in it. That’s for smoking. A lot of you probably recognize it. When we talk about dosing with smoking we’re usually referring to how many puffs a person is taking a certain number of times per day. And you’ll find people that are smoking a whole joint which might be 20 or 30 puffs, and you find people that are taking just one puff off of a pipe. So there’s quite a range in how people use it. And also quite a range in how big those puffs are or how much of the actual medicine is absorbed versus is exhaled.

Here we have a liquid extract of cannabis, often called a tincture, which by definition is an alcohol extract, but also people call other liquid cannabis medicines tincture as well, even though that name isn’t exactly right on for it. Often these are being made with oils. And these can be dosed by the drop. So someone might know with this particular potency of the liquid medicine I’m going to take five drops or eight drops.

Dosing by the Milligram

Over here we have a tube of cannabis concentrate, actually in a syringe, you’ll notice there’s no needle (which is a good thing) because that syringe can be squeezed to express just a small amount of this very potent concentrate. These concentrates can be up to 50 percent cannabinoids by weight. So even something the size of a pinhead can be a really substantial dose when you’re dealing with this stuff. And for people that aren’t prepared this can cause some overdose reactions, which are safe, but quite uncomfortable. And here we have a close up of the cannabis flower.

So as a physician, when I talk about dosing medications, I usually like to talk about milligram dosing. And right now, in cannabinoid medicine we’re talking about milligrams of THC and milligrams of CBD, primarily. There’s other trace cannabinoids and acidic cannabinoids that we refer to in certain cases, but in general we’re talking about how many milligrams of THC and CBD.

Biphasic Dose-Response

So, when I look at the dosing range, the effective dosing range in my practice, it’s unlike any other medication. We’ve seen when dosing by body weight – just to orient you – we’ve seen responses as low as .015 mg per kg of body weight per day, all the way up to 30mg per kg of body weight per day. Now it doesn’t make a lot of sense to dose and adult by their body weight, but I wanted to put it into this perspective for you. This means someone about my size might do well at the very low end taking 1mg of cannabinoids per day versus somebody taking over 2,000mgs. That’s the safe, effective dosing range. It’s an incredibly broad range but it’s still well below the lethal dose – if there even is one. Now, some of you know that researchers have really tried to kill animals with incredibly high acute doses of THC; they haven’t been able to do it. So here we have 300 times the maximum dose I see in my practice, and monkeys are still surviving. But I don’t think they’re having a pleasant experience.

Now within that broad dosing range, we have non-linear dose response curve. So this is unlike the dose response I showed you of morphine and pain earlier. This is, on the bottom here, we have a low dose to high dose and on the side, low benefit up to high benefit. What we often see (not always, but often) in cannabinoid medicine is that if someone starts at a low dose and gradually increases, they get more and more benefit up until a certain point. Beyond that point, as they increase their dose, they actually start getting diminished benefits and when they use high doses, sometimes they’re barely feeling anything at all. Often, when they use ultra-high doses, this curve will come back up again, way at the other end of that extreme.

Now, this has been shown in animal studies, not just my clinical observation. So here’s loco-motor activity in rats. This is how much the rats are running around basically. And here’s there’s baseline level. Given a very low dose of THC, so this is .2mg per kg, the activity is going down quite a bit. This activity level could be analogous in treating a human to something like spasticity or anxiety. Then, as the dose of THC increases the activity level actually goes up. Then as the dose increases even more, the activity level goes back down again. But you’ll notice up here, at 5mg per kg, they didn’t get as strong of a result as they got at 0.2mg. What they did get was the emergence of a side effect, in this case catalepsy, which means remaining still in an unusual position.

So what this shows is that at the very low doses – doses that are so low that some rats or some humans might not even start that low, they might overshoot it, and start up here and think they’re getting an efficacy at an optimal level by the time they get up to the high doses. We’ve been finding in our practices, that ultra-low doses can work very well for some people. And this has been shown in humans. So here was a study on 263 people that were already receiving opioids for the treatment of chronic pain, and they were given that standardized cannabis preparation I mentioned … which is about a 1:1 ratio of CBD: THC. Here’s their baseline pain level at the top. Here’s how much pain relief they got from a placebo, which I’d like to mention is really powerful. So, our bodies have an internal pharmacy. If we use the power of our mind and the power of our belief to make ourselves better, we actually get better. It’s not just that we think we’re better – we don’t just think we’re better – we actually do get better. We can change our physiology, we can change the structure and function of our bodies, or our brains, just using our mind-power. And it’s been shown that endocannabinoids, the molecules that we make that are very similar to the substances in the cannabis plant that are therapeutics, cannabinoids have an important role in the placebo effect.

But anyway, back to the study, the 20mg group had this much reduction in pain. The 52mg group had just a little bit better than placebo. And the 83mg group really didn’t do much better than placebo. So this clearly shows that with cannabis, less can be more; lower dose is often more effective, a higher dose can be less effective.

So now you know some of the basics. I just want to walk you through how we approach our patients, both patients that are new to cannabis and patients that have experience with cannabis.

Dosing Guidelines

New to Cannabis

So starting off with new to cannabis: I have a picture here of my grandmother, Elaine Sulak. She just passed away a couple of months ago at age 91. But for the last six or so years of her life, she was using a cannabis tincture quite effectively. And during that time, her mind became clearer; she had reduced pain, improved function, and better mood, her entire quality of life changed. It was really incredible. And she didn’t know what she was getting the whole time. She didn’t have any side effects from it because we were very careful with our dosing strategy. We were able to achieve this incredible improvement in quality of life without any side effects. So what do we do if someone comes that’s brand new to cannabis? The trick is to start sub-therapeutic, and this requires a little bit of patience on the part of the patient because some of them want instant results. We say, we want you to intentionally start at a dose that’s below your optimal dose, obviously. And then we increase very gradually to the minimum noticeable effect. So you start sub-therapeutic, you gradually work up until you can just feel a little bit of something, a little pain relief, a little anxiety relief, and then you hang out at that dose for three days. During those three days something really interesting is happening. And I’m not going to bore you with the science behind it, but the body is actually getting more sensitive to cannabis. And patients will find that staying at the same dose, on day three, they’re actually getting more relief then they got on day one. But then on day four, go ahead and increase to the dose that you find most effective. And we give instructions on how to do that, especially something that I call the “inner inventory,” which is a very quick self-awareness technique for checking in and figuring out how am I feeling right now, how have I responded to that dosage of cannabis that I just took. You can find all of this on healer.com, free patient education with videos that will literally walk you through step-by-step or walk someone through who’s brand new to cannabis. We have a shopping guide that helps them figure out how to get the right cannabis when they go to the dispensary or when they talk to a caregiver. We really want to make it easy for people to have great results – like my grandmother – without the side effects.

Experienced Users

With experienced users we have a few other strategies. So the first is what I call the “sensitization protocol.” And the purpose of that six-day protocol is to take people from here and get them back to here. And the thing is, everyone has a different optimal dose. I can’t pick you out and say “here’s your optimal dose,” I’m going to tell you what it is, you can dose cannabis in that way and you’re going to do just fine. But what I can tell you is a methodology for how to find that optimal dose. And almost – not almost all – but quite a few of the patients that are experienced cannabis users coming into our practice, they want to use cannabis for symptom relief or real medical treatment figure out that they’re actually here, and by reducing their dose they’re able to get more benefits, they’re able to spend less money on the cannabis, they’re having less side-effects from the cannabis. If they’re inhaling, they’re saving their lungs from that exposure. It’s just better for everyone when they do the sensitization protocol.

And on the next slide I’ll show you some of the results. But before I go there, a lot of patients that are experienced users have only inhaled cannabis via smoking or via a vaporizer. In switching to a liquid extract, and oral mucosa absorption, so the medicine is actually getting absorbed through the blood vessels in the mouth and tongue, and then some of it’s getting swallowed and being absorbed through the digestive tract, that’s a really wonderful delivery method that can often be used to prevent symptom instead of chasing symptoms around. And when patients figure out how to best use the oral mucosa delivery, they’re often having improved quality of life, less symptoms, better function. And finally, a lot of experienced cannabis users haven’t explored CBD yet. CBD, as I mentioned earlier, is that sister molecule to THC. It’s non-psychoactive but it tends to enhance the benefits and reduce the side effects of THC. They work really well together. So for people that haven’t tried it, we recommend that they do try different ratios of CBD and THC, perhaps to find something that works well during the day so that they can get symptom relief without having any impairment. And then they can use something else at night or weekend that might create a little bit of a psychoactive affect, which I’ll cover later in this talk because there are some real benefits to the psychoactivity of cannabis as well.

So here is the sensitization protocol, again it’s just six days, and it’s basically two days of cannabis abstinence followed by four days of very specific dose titration. The program is free on healer.com/programs. We surveyed 48 of our patients that did it a couple of years ago: 90 percent of them successfully reduced their dosage, and the ones that did, reduced their dosage on average 56 percent. So they’re using less than half the cannabis they were using previously and getting equal or greater benefit, usually with less side effects.

Specific guidelines for cannabinoid-opioid combination treatment

Those are the basics. Now let’s talk specifically about what to do for people that are using opioids that want to try combination cannabinoid-opioid therapy. So, the first rule is to take a small amount of oral or oral mucosa cannabis with every single dose of opioids. Don’t allow those opioids to pass your lips unless you’re taking some cannabis at the same time. It’s really basic from a scientific perspective. It makes sense. We know these medications synergize with each other. We know that the cannabis can widen their therapeutic index and prevent tolerance building. But so many people approach this in the exact opposite way. They think they’re going to use their cannabis or they’re going to use their opioids, that it has to be one or the other. No. Please use them together, and it can be as little as 1mg of THC. So a dose of THC that’s not high enough to reduce pain, that’s not strong enough to cause any psychoactivity, can still potentiate the opioids. I also mentioned that “inner inventory,” so use the inner inventory in healer.com to find the minimal effective dose. Again, you don’t have to do a lot of cannabis. Figure out what you’re minimal effective dose is and then combine that with every single administration of the opioid. If you’re doing a long-acting opioid like a fentanyl patch, for example, then you’ll probably going to want to do an oral or an oral mucosa dosing every four to eight hours, depending on how long the effects last for you, which can be highly individualized with cannabis.

So that’s the mainstay of the treatment, is this oral dosing. Then you can use inhaled cannabis for breakthrough symptom management and to reduce cravings. So you’re doing the opioids, you’re doing the cannabinoids, if a craving comes up and you get that thought “man I wish I could take that next pill right now instead of waiting four more hours, that’s something I’m considering doing”; don’t do it. Reach for the cannabis. You can inhale cannabis. It has such a rapid onset when it’s absorbed through the lungs, that one minute later you’ll be feeling better. It’s a great solution to problems with craving. It can really change your mindset, reduce your pain, and take you off that track, shift you to something else. Now you’re suddenly looking at where you were two minutes ago, and realizing, wow that’s how I was thinking, that’s how I was feeling just two minutes ago, I was considering taking an extra pill when I knew I’d be out at the end of the month (or whatever). Cannabis patients always tell me, cannabis can change that, shift their perspective and help them see themselves in a new light.

If it is available, I’d recommend selecting some combination of CBD and THC, again, to enhance the benefits and decrease the side effects. A 1:1 ratio, so equal parts of CBD and THC, works very well. It’s broadly effective and well tolerated. It’s still a little bit psychoactive, but it’s not very strong. And I just want to mention, because I know a lot of people with opioid addiction also have Hepatitis C, that’s been contracted through IV drug use, there’s some information that high doses of THC in people that have liver fibrosis or inflammation – when the liver disease is active – high doses of THC can potentially make that process worse. We have evidence that suggest this. So for those people, I recommend more CBD than THC, at least a 2:1 ratio. We also have evidence that CBD will do the exact opposite, it actually protects the liver in some situations where there is inflammation or scarring going on, and it can prevent progression of liver disease. So CBD is a great choice for people that have Hepatitis C and other liver conditions.

A lot of people don’t have the luxury that some of us have where we can just go shopping and figure out, I’m going to get something with a 1:1 ratio and I know how many milligrams per millimeter it has and that’s how many drops I should take to follow my doctor’s advice. It’s not always that easy, but it’s getting easier and easier all the time. I just want to point out for people that are dealing with herbal medicine, you can’t just look at it and smell it and know what it has in there. You can’t just look at the morphology and recognize it as a THC strain or a CBD strain. You actually have to get it analyzed and that’s what we’ve been doing in our lab.

So here’s a few examples: here’s a cannabis flower that’s really just THC dominant and barely has any CBD or any of the other cannabinoids in it. Here is a cannabis flower that looks almost identical. I’m not sure how it smells in comparison but you wouldn’t be able to tell the two apart. But the contents are actually vastly different. So this strain has a little more CBD than THC. This would be an excellent choice for someone that’s working with recovering from addiction. And then here’s another strain that looks very similar. This is almost all CBD with barely any THC at all in it. So these three cannabis flowers are going to have vastly different effects if they were prepared in a liquid form, than those three different oils or tinctures would have different effects. And you need to know what’s in there before you can get optimal results in most cases.

So continuing on, on how to combine these two medicines. So cannabis can be used to enhance other health-promoting activities. I strongly recommend this, our patients come back telling us it really enhances the effects of exercise, meditation, prayer, journaling and reflecting, and psychotherapy. And there’s actually some experimental evidence that suggests both CBD and THC, in two separate studies, can improve the response to fear extinction training, which is basically a model of how to get out of that PTSD reaction mode, and no longer be afraid of something that’s not present in front of us. I put these on the slide because these are really important things, a very effective lifestyle approaches to managing both chronic pain and addiction, or both. So, exercise is huge, even if you’re in pain I’m sure there’s something you can figure out how to do that you can tolerate with the body that you have. On healer.com I have a whole page of wellness activities, very simple breathing exercises that will actually get your heart rate going, simple Qigong and yoga-based practices that I make very accessible. The videos are short, two to five minutes, and I promise that everyone can find something that they can do for exercise. And if you’re going to be healthy, if you’re going to recover from opioids, you need exercise in your life. You need a time to reflect. And I really recommend journaling. It’s amazing. It’s not about what’s going into the journal, it’s about what’s going on up here while you’re holding the pen. And that process of reflecting and thinking about what’s important about my day today and then getting ready to write that down helps us gather information, helps us learn from our experiences, and really can help us literally turn the page on our limitations, and start the next day in a new way.

Finally, use cannabis to promote regular sleep patterns – using sedating strains only in the evening. Those of you who know cannabis, know that there’s different strains that have different effects. Some cannabis is better for pain. Some is better for muscle spasms. Some is better for anxiety. All these different strains have different ratios of the various components. So there’s the cannabinoids, there’s the terpenoids (which are molecules that give cannabis its smell, its aroma), and all of those have physiologic effects. So the unique blend from each of these different varieties gives it a different effect in the body. There’s some strains that will clearly keep people awake. And they might be great for late-night creativity sessions, but don’t do it if you’re trying to recover or if you’re dedicating yourself to a healthier life that’s free from opioids or if you’re working to reduce and stabilize your opioid dosage, trust me getting regular restorative sleep is going to be one of your best assets. So you can use cannabis to promote great sleep.

Now we’ve seen clinically when patients are cannabis-naïve, they have excellent responses to starting this combination treatment. So “cannabis-naïve” means they haven’t used cannabis ever or haven’t used it in a long time. They come in on a bunch of opioids, their pain is not well controlled, we get them started on that approach I showed you for the new user – sub-therapeutic, work up slowly, stay there for three days, and then work up a little bit more – they use that approach and they come back and they say within the first two weeks I reduced my opioid dosage by 50-80 percent. It’s just incredible when they get they right dose of cannabis how much they can reduce the opioids in the first couple of weeks. Progress after that first couple of weeks continues, but it’s a bit slower. Really there’s no rush. This is a long-term change. We’re not trying to rush people off their opioids. But really, take advantage of that therapeutic window in the first couple of weeks. When I first started this, before I even knew what was happening, before I recognized these trends in my patients, people were coming back saying I just started cracking those tablets in half because they felt too strong. They literally, when I was taking them with cannabis, they were too strong for me. I couldn’t tolerate the dose that previously wasn’t enough.

For experienced cannabis users that are currently using opioids, before you start to decrease your opioids dose, I recommend first going through the cannabis sensitization program – that six-day protocol. And what this will do is tonify your cannabinoid system, it will up regulate your cannabinoid receptors, it will get your body to start creating cannabinoids and make you more sensitive to the medicine, so that the cannabis can have the optimal effects in helping you with your opioid taper. Stay at the optimal dose to avoid building tolerance throughout the taper, which means if you get to the point where you notice, well I’m needing more and more cannabis to get me the same results, you might consider doing another sensitization round to reset your sensitivity to cannabis. And for people that are only inhaling cannabis, I really will strongly encourage you to try the oral and oral mucosa delivery routes, figure out what your optimal dosage using those delivery routes, before you start tapering the opioids. So you want to really arm yourself with the best tools to be successful in reducing or discontinuing opioids.

Now, I’m describing using cannabis to slowly reduce opioids, and this is what works best for everyone. But I’ve also seen a number of patients that are so fed up with their addiction, they don’t want the slow process, they’re ready for a rapid change. And that’s probably just a personality thing. It could be better for some people to have an abrupt change that. Maybe they’re changing a lot of things in their life all at once, which has been shown scientifically to promote lasting changes. So for those people, they can just get everything ready on the cannabis side, go cold turkey on the opioids, use cannabis at probably than their maintenance dose to treat the opioid withdrawal symptoms, and then after the withdrawal symptoms are gone they can reduce their cannabis dose and use it for maintenance to prevent cravings, to treat pain, to help with whatever reason they have for getting into opioids in the first place.

For some patients, low dose cannabis is not effective. But for most patients, it is. I have had several reports of people that are using extraordinarily high doses of cannabis concentrate to help them reduce and discontinue the opioids. And it seems to me that for the patients that don’t respond well to the low-dose approach this actually works well and it can be safe if you do it carefully. So, as I mentioned earlier, one pinhead of this would probably be a very strong dose for most people in this room. But if you start at a tiny dose of this cannabis concentrate, most people would just put a small amount in between their gum and their cheeks to gradually absorb through the oral mucosa, and do that two or three times a day. Over the course of a month and gradually work up to a bigger and bigger amount, up to even 100-500mg of cannabinoids per dose – this is expensive, but if you access to it, it can be very effective and people can use this to get through those really challenging times with opioid taper and opioid abstinence.

More and more in the clinic, we’ve had people coming in that are brand new to cannabis who not only want to try cannabis cautiously, they don’t want to get high. They want no psychoactive experience with their cannabis use. And as I mentioned, that’s totally achievable. You can do that with CBD, in combination with THC. You can do that using THC alone, in very controlled doses. And we have a whole program on that on healer.com, the non-psychoactive strategies for using cannabis. But I want to just mention that the psychoactivity can be quite beneficial and not to fear it, but to embrace it. It’s one of the gifts of cannabis. And when people experience that psychoactivity, this is what they’re reporting – positive mood, relaxation, laughter, socializing, distortion of time (which can be quite helpful for people that have had trauma, that are always thinking in the past about that trauma or worrying about the future), it brings people into the present moment. Intensification of ordinary experiences, things like eating, listening to music, watching films, having sex – these things can feel better under the influence of cannabis. People have reported this from separation of symptoms and suffering, where prior to using cannabis all of their suffering was like in one big ball and they just saw it as this thing that was nagging them or destroying their life or limiting their function. And then after they used cannabis, they can start to separate it out. Here’s the signaling of pain from this area of my body, but at first it’s a neutral signal, it’s coming from, say, an arthritic knee up to my brain, but then my brain is perceiving it as pain and then it’s actually judging that pain as a bad thing, and then I’m attaching some suffering to it because I’m experiencing a bad thing and having anxiety about having more pain in the future. And then all this behavior that goes into how I deal with the pain and what I want to do to treat the pain. That’s all one big ball, separating it out into these different levels is incredibly helpful for patients and that’s another one of the gifts of the psychoactive aspect of cannabis, which again is mostly dependent on the THC. People report increased self-awareness, a sense of connection to the universe, viewing oneself from a different vantage point, fostering acceptance, helping people find creative solutions to their problems – people have these ideas that they never would have thought of without the help of cannabis, so they report. And promoting mental, emotional, and physical flexibility and capacity to change. I put it like that “mental, emotional, and physical flexibility” because they often go together. And as people start feeling more loose and relaxed in their body, as they start maybe doing a bit of yoga or some of the exercises on healer.com, and getting greater range of motion in their body and literally in their nervous system, their thought starts changing, their emotional flexibility increases. So the other things about these gifts from cannabis consciousness, is that they outlast the acute effects of cannabis. I was speaking with a patient recently who told me that under the influence of cannabis she suddenly had this realization that everything in the universe is connected to everything else, and she saw the underlining fabric of reality. And after the cannabis wore off, she took that lesson with her and was able to relate to people in a new way, to connect with nature in a new way, to accept that everything is connected, and that gave her great peace in her life. So some of these lessons will stay with us.

Case Study and Patient Narratives

So let’s move on to a case study. This is kind of the bread and butter of our practice at Integr8 Health, we see a lot of different conditions, but about 70 percent of our patients have chronic pain. And I chose this case because it’s fairly typical of what we see, and I think a lot of you can relate to it. So, a 43-year-old man with chronic pain, a victim of a hit and run motor vehicle-pedestrian accident at age 25, resulting in spinal disc herniation. When he first came in he had already tried cortisone injections, chiropractic, physical therapy, and prescription medications. (I’ll show you his medication list on the next slide.) He did not have satisfactory improvement. He saw an orthopedic specialist who recommended surgery based on the patient’s physical exam, which included weakness in one of his legs, and that is an indication for surgery. But the patient didn’t want surgery at age 43; he wanted to postpone it as long as possible.

He was a high school graduate and worked at an electronics store and at the time he had a 15-month old, first-born child. He came in with an average pain level, 6-7 out of 10. He had a little cannabis history, tried it at age 16, but hadn’t used it in 20 years. He didn’t have any history of adverse affects with cannabis. He simply wasn’t using it. And here’s his medication list: He was on muscle relaxants, two anti-inflammatories, tramadol (which is an opioid pain reliever), hydrocodone (which is another opioid pain reliever), an anti-nausea drug because the pain relievers cause nausea, blood pressure medication, and cholesterol medication. He had previously tried gabapentin (which is an anti-convulsant medication and often used to treat pain and Lyrica, which is in that same category).

So he came back in six months, after cannabis certification. He started using edible cannabis in the form of cookies – not something I typically recommend, I like standardized dosing better where you know how many drops you’re taking or you know how many milligrams – but he was able to access cookies. And then he was also smoking cannabis, not every day, but two to three times weekly, just taking two to three puffs for breakthrough symptoms. Initially he had an adverse affect from the edible, from the cookie, again because it’s really hard to know what the dosage is, but once he adjusted the dosage he was able to use the cookie without any side effect.

At six months, he had stopped hydrocodone and tramadol, the two opioids, and also stopped one of the anti-inflammatories. The anti-muscle spasm medication that he was using daily, he was now using around once a month, just when he needed it. His average pain was 3-4 out of 10, instead of 6-7 out of 10. He had a significant decrease in muscle spasms. And, his physical exam improved. He was actually walking normally, when the first time he came in he had weakness in his leg that made the surgeon want to schedule him for surgery. Now he had normal strength in his lower extremities. Perhaps that’s because he had improved function, perhaps that’s because the muscle spasms had been under control for so long his spine was able to get back into alignment, perhaps it’s because cannabis has anti-inflammatory properties itself and reduced the inflammation that was pressing on that nerve root – probably all of the above. He reported that he was able to carry his son, was able to enjoy fatherhood. And that’s an incredible result!

When I was in my medical training, if I would have seen that happen, I would have thought I was in some alternate reality. How did this patient get such good results? How did he actually come off of all his opioids and medications? This is normal for us now. We see this all the time.

As part of the survey data that I showed earlier, we also invited patients to submit their narratives. We received over 100 very compelling narrative reports of what patients were doing with combining cannabis and opioids. I chose three to share with you, but there is many more that I wish I could share with you, and sometime maybe we’ll compile all of that and give you an overview.

So here’s one of them. I’m just going to read it. “I was in a car accident about 13 years ago. I had a hip injury that was deemed permanent and a severe head injury. I was immediately placed on 24-hour opiate painkillers. Throughout the 12 years, I’d been prescribed just about every different type. I was also on several other mediations ranging from nerve pain meds to blood pressure meds. I became determined to get off the opiates because they truly never eliminated the pain. I use medical cannabis to help me withdraw. It was quite a substantial process due the length I’d been taking them, 24-hours a day for 12 years. It made the withdrawal much easier. I’ve been in much less pain and was able to eliminate all the other medications I was on at the time. It gave me my life back. It was amazing. I credit cannabis for much of my success.”

“I am 38-years-old and I struggled with opiate and alcohol addiction for about 15 years, long hours as a chef and a couple of minor surgeries where I was prescribed opiates, led me to become dependent on them to get through my day. Pretty soon I was fully consumed by addiction. Even after going to two detoxes and a 28-day rehab in 2010, I still struggled to stay clean for the next two years. The 12-step meeting that I was going to several times a week discouraged cannabis use, so I tried to do it their way and didn’t use any. That didn’t work, and it led me to several relapses. In 2012, I decided to start using a little bit of cannabis before bed to help me get a good night sleep and when I was getting stressed, angry, etc. It was very effective in keeping me centered and on the path to recovery, although I didn’t feel comfortable – and still don’t – sharing this with fellow addicts at meetings. I had been a cannabis smoker on-and-off since age 18 and always enjoyed the effects. In the throes of my opiate addiction, however, I got out of the routine of regular cannabis using. I believe that this is because cannabis use tends to magnify my own problems and shortcomings in my mind when I use it, and no drug addict wants to take such an honest look at themselves. As of right now, I have been free of active addiction from January 2012. I’ve also been a patient of Interg8 Health since 2012. Cannabis is the only thing that I am currently prescribed, and the only substance I use for pain, stress, etc. I don’t know if I would be here today, and sober, if it wasn’t for cannabis. I use cannabis throughout the day and before bed, and live a happy, healthy, and productive life with my wife and two daughters.”

I just want to comment on a couple of great issues that he brought up. The acceptance – or non-acceptance of cannabis in recovery circles – Martin touched on this earlier, it’s really important that we start bringing this out in the open because for those of you that are in recovery, and you look around the room at the meetings, there’s probably several other people there that are either using cannabis secretly or have an idea that cannabis could be helping them. It’s time to bring that conversation out into the open. I’ve heard it called the “green recovery treatment” option. It’s something that’s becoming more well-known and more talked about in recovery circles. We have a long ways to go. Meanwhile, people are drinking coffee and smoking cigarettes, let’s replace even some of those things with cannabis – healthier option, cannabis. And then this part where he was looking at himself. Yes, cannabis forces us to do that. And it can look really ugly sometimes. But if we don’t take a solid look at ourselves then we can’t change. That inner awareness, that connection with who we really are – because people that are addicted to opioids lose track of who they are. I’ve seen people go from very strong and capable to very weak and very limited. You know, their whole lives changed. And, some people that used to be able to help others, and get a lot done, and feel like they were in service to their community, suddenly find themselves in the situation where they’re dependent on others, where they feel like they’re sucking the energy and the time from the people around them, and they’ve changed that dynamic. Yes, we need to look at that. And if you use cannabis, even if you use it in the way that I’ve described in this presentation, it might show you something that you don’t want to see. But trust me, you need to see it to make that change.

I’m going to offer one more narrative. “I took opiates for 15 years, along with various forms of benzos [again those are the anti-anxiety and anti-muscle spasm medications like valium]. I had legitimate pain. I fractured my back in three places when I was 19. I healed from the initial injury, but the pain got worse over the next few years, to the point where I was drinking to get by. I had an uncanny knack for being able to walk into a doctor’s office and get almost anything I asked for, due to my injury. Anyway, I took opiates to the tune of two Oxycontin 80s and 12mg Dilaudids for PRM [which means as needed, that’s quite a high dose]. At some point, it wasn’t just about the pain anymore, it had become more about the addiction. In retrospect, the opiates were only working on the emotional pain, not the physical pain. So to make a long story short, I’ve been to detox 27 times since I was 27. I’ve been in three 30-day rehabs from here to Ohio. I tried halfway houses, Suboxone treatment, etc. It’s been 21 months since my first visit to your office, and I literally have not used an opiate since. Thank you. P.S. I truly believe that medical marijuana has saved my life.”

That’s incredible. We’ve got a lot more of those, too. So, because I know that this information is now in your hands but it may not be in the hands of your doctor, and that’s an important next step to take, not just for yourself but for all the other patients that your doctor treats, on healer.com we have a free download that’s a succinct summary of what a healthcare provider needs to know if they’re taking care of a patient that’s using medical cannabis. I also want to promote the Society of Cannabis Clinicians, this is a professional organization for people that are practicing cannabis medicine, and I invite you to check out their website that’s full of great resources.

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