In the very center of Los Angeles, where both a homelessness crisis and the ravaging effects of the opioid epidemic have taken control, something hopeful is happening.
People who inject drugs —many homeless and hard-hit by addiction— are turning to an unlikely tool in their quest to reduce their use of opioids: cannabis.
A new study by University of Southern California researchers reveals a novel conclusion: cannabis use is part of a harm-reduction approach by some of society’s most vulnerable individuals.
Such findings defy longstanding assumptions made about drug users showing that a community-based response could save lives in the face of a national opioid crisis. This is not by any means the first research to suggest that cannabis can be used in this way.
From Street Corners to Dispensaries. How Legalization is Changing the Game.
The very idea of using any substance to limit addiction to another one seemed counterintuitive to many in the medical establishment over the years. But as legal cannabis has swept the landscape, it has opened new possibilities.
“It’s easy to get cannabis. Every other pretty much corner has a weed shop,” said one 31-year-old man interviewed for the study. “When I go into [a] dispensary, I know what I’m getting, I know what I want… Usually they just have better stuff.”
That improved access and quality control does translate into the real world. The same participant evaluated his own drug reduction, finding he significantly reduced his fentanyl use by almost half when he had access to cannabis.
Another relayed how visiting a dispensary led to a dramatic reduction in his opioid usage:
“When I went to the weed shop, it completely changed the game for me; I even stopped taking opioids—barely took anything.”
These are stories corroborated by a significant amount of emerging peer-reviewed literature. In fact, a series of studies, now several years in a row, have found states with legal medical cannabis have lower rates of opioid prescriptions and opioid-involved deaths.
The new study helps to qualify these figures somewhat, showing the actual lives of people who are still actively using cannabis to help modulate their consumption of opioids.
A Natural Relief from Withdrawal Agony
One of the more astonishing findings of the USC study was the effectiveness of cannabis is managing the infamously difficult symptoms of opioid withdrawal.
Participants said they used cannabis to relieve the physical and psychological suffering that had previously hindered their ability to abstain from opioid use.
“The first time that I stopped using heroin, my daughter was there,”
recalled a 48-year-old woman who has been living on the streets.
“I was in a lot of pain. I was under six different blankets, I could not regulate my temperature. It was really uncomfortable and I was throwing up and she’s like, ‘Here, you gotta eat something, smoke some weed.’
And it was amazing, how it just took like fifty percent of the uncomfortability away.”
This was a common sentiment across many of the experiences. A 67-year-old woman said that she used cannabis when her heroin supply was absent:
“My bones are starting to ache, my back hurts really bad.. . I smoke more pot, more pot and more pot to kill the pain.”
Although cannabis is not the panacea itself, the potential for relatively fast mitigation of withdrawal just may set the stage for it to make a real difference in this painful process.
Perhaps cannabis could facilitate the early stages of quitting opioids so people can then move forward into longer-term options.
Beyond Withdrawal. Cannabis as a Maintenance Tool
The study also demonstrated that cannabis is able to help not only in the acute stages of withdrawal.
Many participants described it this way, saying that they basically used it on an ongoing basis to manage their cravings and anxiety, even though the initial physical symptoms of withdrawal had stopped by this time.
A 26-year-old man reported:
“When you’re addicted, and you’ve got a habit, then you’ve got no alternative but to do opiates.
But when you’re not habituated to another drug, one that’s not making you sick every single day, it sure does allow you to get over that hump and let go of craving the first high. And that is what is so special about weed.”
Some participants reported using cannabis alongside medications for opioid use disorder (MOUD) like methadone or buprenorphine. One 32-year-old man shared how he was able to taper off methadone by incorporating cannabis:
“When I was clean with methadone, I tapered down [my methadone], but I was using [methadone] and marijuana only. And that helped me stay clean, then I used marijuana after I completely went off all opiates. And it did help me stay away from it.”
As such, these reports suggest that cannabis may have a role in maintaining adherence to full addiction treatment plans, and even possibly enhancing retention in regard to long-term success.
Community Approach Needed
While these findings are very promising in relation to treatment, they are also an illustration of great gaps in the present paradigms of treatment.
Indeed, many expressed frustration regarding a medical establishment that seemed unwilling to acknowledge the potential benefits of cannabis in addiction treatment.
This disinvestment in lived experience, as understood from the vantage point of medical orthodoxy, points to the need for greater community-based and harm reduction approaches toward addiction treatment.
The relative success of grassroots Cannabis Distribution Programs in other cities offers some potential model.
For instance, low-barrier cannabis access programs in Vancouver, Canada, have been powerful in helping people reduce their consumption of other more harmful drugs.
These peer-led initiatives are someday likely to have a distinct advantage in the face of traditional medical systems, which are recognized in the field as being indirectly cost-prohibited, requiring physician approval, and dependent on person identity.
More research needs to be done to understand the complex reciprocal action of the two substances.
However, the implications that may come out of this work are tough. With the opioid epidemic claiming tens of thousands of lives yearly across the United States, every potential tool for harm reduction must be seriously considered.
Participants in this study speak of the use of cannabis as an aid that is viewed as practical and attainable—not as a miracle cure—on a difficult journey away from opioid dependence.
For these people, living on the margins and very often sketching out cycles of different treatments, periods of relapse and despair, cannabis does appear to promise relief from that suffering, a means to lower the risks involved, and opportunities to recover.
As one participant put it: cannabis is what “helps them over the hump.” In the context of America’s ongoing opioid epidemic, that hump can be the difference between life and death.
