Can marijuana help people addicted to opioids? Some experts think so

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An employee at Prime ATC (now GraniteLeaf Cannabis) in Peterborough, seen here in July, trims marijuana buds for medicinal use in New Hampshire. Photo/Hannah Schroeder, Sentinel Staff

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When people come to Anew Behavioral Health in Keene for opioid use disorder treatment, they often say they’re using marijuana to stay sober from opioids.

“There are a lot of people managing a job, building their family, going to school and going to work because of the assistance they receive from alternative substances,” including cannabis, said Jayson Pratt, CEO of Anew.

Pratt

Members of the local recovery community say they’re increasingly accepting marijuana use as an important harm reduction strategy for people with opioid use disorder (OUD). Harm reduction is an approach to treating substance use disorder that aims to keep people who use drugs alive and as healthy as possible.

As of October, there had been 271 confirmed fatal opioid overdoses in New Hampshire, including nine in Keene. The state has never seen a known marijuana-related overdose, and a fatal overdose on cannabis is ”unlikely,” according to the Centers for Disease Control and Prevention.

The stark difference in likelihood of overdose has led doctors, researchers and people who use drugs to consider the benefits of cannabis for people with OUD. Research in this area is limited, but a September study published in the International Journal of Drug Policy found that using cannabis reduced craving for opioids in people who used unregulated opioids, or those not prescribed by a doctor.

In 2021, the N.H. Legislature added OUD as a condition that can qualify someone for medical marijuana, and currently seven people around the state are approved for that use, according to Jake Leon, a spokesperson for the Department of Health and Human Services. However, far more are using marijuana obtained illicitly in New Hampshire or legally from neighboring states to manage opioid use disorder, local recovery professionals say.

Shelley Janiczek Woodson, director of recovery services at Reality Check in Jaffrey, said some patients even ask for guidance on how best to use cannabis while staying in recovery from opioid use disorder.

“They don’t want to have another problem on their hands,” she said.

While Reality Check doesn’t endorse marijuana use outside the medical cannabis program — because non-medicinal marijuana is illegal in New Hampshire and federally — Janiczek Woodson said her staff listen to people living with opioid use disorder about what’s best for their recovery.

“We don’t tell people a certain path is the correct path, because it depends on the person and what’s going to work for them,” she said.

Pain, relief and recovery

Federally, cannabis is classified as a schedule 1 drug — one with “no currently accepted medical use and a high potential for abuse.” The classification makes it difficult for researchers who receive federal funding to study cannabis, even as 38 states, including New Hampshire, have medical marijuana programs, and 24 states allow recreational use.

A well-established body of evidence shows marijuana use can help manage chronic pain that otherwise may be treated with opioids. Research has found people who are on prescription opioids to manage pain who start using cannabis will often reduce their dose or stop taking opioids altogether — which, in turn, may reduce their risk for opioid use disorder, since higher doses are linked to increased risk of OUD.

“We know therapeutic cannabis is indeed excellent for treating pain,” said Dr. Jerry Knirk, chair of New Hampshire’s Therapeutic Cannabis Medical Oversight Board and a retired orthopedic spine surgeon.

What’s less clear is whether and how cannabis can be used as a maintenance regimen to help people with opioid use disorder stay in recovery. In recent years, medication-assisted treatment (MAT) has become widely accepted as the most effective treatment for OUD. MAT uses substances, including suboxone and methadone, alongside counseling and behavioral therapies to manage OUD long-term.

New Hampshire’s medical marijuana program allows people with OUD to use cannabis for a similar purpose. Research in this area is ongoing, but it’s “nowhere near as definitive,” as that showing cannabis can reduce pain patients’ opioid use, says Paul Armentano, deputy director of NORML, a national organization that advocates for the legalization of marijuana.

The lack of available research posed a problem in 2019 when the state first considered adding OUD to the list of qualifying conditions for medical cannabis, Knirk said. Faced with “poor” data, the cannabis oversight board considered anecdotal evidence in favor of using cannabis to manage OUD, including testimony from a person who had used cannabis this way.

In the absence of definitive research, listening to the lived experience of people with opioid use disorder can be powerful.

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Van Gundy

Karen T. Van Gundy, a professor of sociology at the University of New Hampshire and author of the book ”Marijuana: Examining the Facts,” said data show cannabis is very good at providing pain relief. But she also thinks about the ways in which emotional pain from trauma — oftentimes at the root of substance use — is seen differently than physical pain is.

“If someone is struggling with addiction, they’re in pain,” she said. “If someone is struggling with mental health problems, they’re in pain. But somehow physical pain that’s not related to those things is seen as more legitimate pain.”

Just like some types of pain can be seen as illegitimate, so too can some kinds of pain relief, including cannabis, she said.

“That kind of can come into play here in thinking, ‘Are people deserving of pain relief?’ ”

Ultimately, the state Therapeutic Cannabis Medical Oversight Board decided that yes, people were.

The board recommended allowing medical marijuana for OUD. That was adopted by the Legislature and took effect in 2021 with “tight guardrails,” Knirk said. In order to receive approval to use medical cannabis for opioid use disorder, a person must be under the care of a provider who is board-certified in addiction medicine or addiction psychiatry. As of last year, there was only one practitioner in the state working with the therapeutic cannabis program that had either of those qualifications, according to state data.

The fact that only seven people in the state have been approved for this use of medical cannabis “either … means our guardrails are way too tight, or the word hasn’t gotten out yet about it being an option,” Knirk said.

Pratt, of Anew, added it could also be that with illicit cannabis widely available, as well as legal marijuana from dispensaries in surrounding states, people don’t go through the sanctioned state channel.

A personal (and professional) perspective

Dr. Peter Grinspoon, an instructor at Harvard Medical School in Boston, had only recently started practicing medicine more than two decades ago when he developed a “vicious” addiction to opioids.

Grinspoon

His opioid use disorder temporarily derailed his career, and caused him to lose his medical license for three years. However, he’s been practicing again for 15 years, as a primary care physician and cannabis specialist at Massachusetts General Hospital.

In addition to navigating his own recovery and working with patients who have substance use disorder, Grinspoon is a member of the Massachusetts Medical Society’s Physician Health Services, a board that provides support and oversight to doctors with substance use disorder.

“I’ve seen opioid addiction from every possible angle,” said Grinspoon.

The doctor said he has “absolutely” used marijuana to support his recovery, and he has counseled patients about how to do the same.

“There’s nothing better than cannabis for withdrawal symptoms,” he said.

Grinspoon — whose recent book, “Seeing Through the Smoke,” examines the medical impact of marijuana — concedes that some people who use cannabis will become addicted to the drug. The CDC estimates about 30 percent of people who use marijuana will develop marijuana use disorder. Even so, he said, using marijuana to scale back on or stop opioid use is “harm reduction at its best.”

Pratt agrees, and said some of Anew’s clients and even recovery professionals credit cannabis with helping them stay away from opioids.

“There are a lot of people who are here with us today because of the safe use of these alternative substances,” he said.

The recovery community’s embrace of MAT has paved the way for a more widespread acceptance of cannabis and other alternative substances, Pratt said. He added that it would be “somewhat hypocritical” to prescribe drugs to manage addiction, but then tell people the cannabis that helps them could undermine their recovery.

People need to “try to suspend those moral judgments…” he said. “We really support anything that brings people peace and stability.”


Funding for the Monadnock Region Health Reporting Lab comes from several sources, including The Sentinel and several local businesses and private donors. We continue to seek additional support. The newsroom maintains full editorial control over all content produced by the lab.


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About this Author

Kelly Burch

Kelly Burch is a New Hampshire-based freelance journalist whose work has appeared in The Washington PostThe Independent, Oprah magazine and more. Kelly covers personal finance, mental health and other topics. She's currently working on a memoir about traveling the United States by RV with her husband and two young children.