Ottawa doctor pioneers use of cannabis to help opioid addicts

By Jaquie Miller | Ottawa Citizen | April 16, 2017

The patients at Dr. Mark Ujjainwalla’s methadone clinic are trying to beat their addiction to heroin, narcotic painkillers and other opioid drugs, but most of them still smoke pot.

He estimates that 90 per cent of his patients at the Recovery Ottawa clinic on Montreal Road already use marijuana, and he’s begun writing prescriptions so they can buy it legally.

Medical marijuana, used appropriately, can reduce insomnia, anxiety and cravings for opioids, says Ujjainwalla. Marijuana cannot replace methadone or suboxone, the drugs he uses to treat addicts, he says. But in some cases patients on marijuana can reduce their dose of methadone, he says.

“They see (marijuana) as positive, and I agree with them.”

Ujjainwalla, who estimates he’s written a couple of hundred prescriptions for medical marijuana, also wants to eliminate the need for his patients to put themselves in danger by buying weed on the street.

Many of them are homeless or vulnerable. “People are living on the streets. They have to deal with horrible people with guns and knives …  They’re prostituting themselves, they’re stealing, they’re in jail, they’re out of jail.

“We get them on methadone, they start doing better. But they’re using marijuana. They’re using marijuana because they feel better on marijuana. I’m not saying that’s good or bad. I’m just saying that’s what they tell me. So now they’re on methadone and marijuana, and they’re doing pretty well, considering where they were at.

“But now guess what? They gotta go on the street to the same idiots they used to buy their pills from, they used to buy their crack from, (who) are selling their weed. They have to go back into the red zone area to buy weed from these same idiots. So that’s an issue around relapse.”

Some of the marijuana bought from dealers is contaminated with cocaine and other drugs, says Ujjainwalla, putting patients at risk of failing urine tests for drug use and being removed from the methadone program.

Ujjainwalla is among those working with addicts who believe cannabis can be a useful harm-reduction tool. 

Activists in the cannabis community go further, often referring to marijuana as an “exit drug” and offering anecdotal evidence of people who ditched their OxyContin for weed. 

As Canada struggles with a growing number of opioid overdoses, the question arises: can marijuana help addicts to reduce or quit using more harmful drugs? 

There is no proof, just some tantalizing suggestions.  

One American study in 2014, for instance, found that in states where medical marijuana was legal, the rate of opioid overdose deaths was nearly 25 per cent lower. 

Despite such indirect evidence, there is no clinical evidence that would support the use of cannabis in addiction treatment, says Dr. Bernard Le Foll, the head of addiction medicine service at the Centre for Addiction and Mental Health in Toronto.

Research on animals suggests that some components in cannabis may have “anti-addictive properties,” he said.  “We don’t know for sure how it would work in human populations. It’s possible that adding cannabis to the mix would reduce the use of opioids and then maybe (that would create) less risk…

“Some users may substitute one drug for another. But we still don’t have enough clinical information to know if this is a suitable treatment approach.”

Cannabis could also make things worse, he said.  “It could have negative consequences. You may end up an individual addicted to two drugs instead of one.”

Like many others, he says more research needs to be done. “We have a lot to learn on cannabis. What are the medical properties of cannabis? The research is still in its infancy. It has tremendous potential.”

It’s easy to find addicts, though, who say marijuana helps them, whether a doctor prescribes it or not.

Kyle Esford, 23, was buying some pot recently at an illegal marijuana dispensary on Rideau Street a few blocks from the methadone clinic where he is being treated.

After a couple of years addiction — he ingested “anything, really, fentanyl, heroin, hydromorphone … ” — Esford said he “just got sick of it” and sought help. 

Esford believes marijuana helped with his opioid withdrawal because it “numbs your body a lot.” Marijuana also improves his mental state, says Esford. “It just makes it bearable, all the problems in my life.” 

Esford didn’t start using marijuana to help ease himself off harder drugs —  he has been smoking pot since he was  13.

“It keeps me calm and relaxed and focused,” explains Esford, who has ADHD and says his mind is always racing. “And if I’m smoking a joint, I’m not spending time doing other drugs.

“This substance doesn’t damage me as much.”

That story is familiar to Philippe Lucas, the vice-president of patient advocacy at Tilray, a legal producer of medical marijuana in B.C.

Before joining Tilray, Lucas founded a “compassion club” marijuana dispensary in Victoria that served many customers who had HIV-aids and hepatitis C they had contracted through injection drug use.

“These folks would come in and they’d have a doctor’s script for the use of cannabis to help their (disease) symptoms, but they would openly tell me, ‘Look, I’m really just using this because if I  have a cannabis cookie or smoke a joint I don’t have a craving to go out and look for the opioids, to look for heroin, to look for crystal meth,” says Lucas.

“They would say I’m either replacing it completely or using is less. For them, it was a  harm reduction tool. To me, this really flipped the switch … because it suggested that, at least for some individuals, it was actually an exit drug for problematic substance abuse.”

Lucas now researches the “substitution effect” and is doing a doctorate at the University of Victoria Centre for Addictions Research. He has co-authored two studies published in health journals that found cannabis users report substituting marijuana for alcohol, illicit substances and prescription drugs.

There is evidence that cannabis can help treat chronic pain, according to a comprehensive review of the medical literature on the health effects of cannabis by the U.S. National Academies of Science, Engineering, and Medicine. However, the report concluded there is limited evidence of any statistical association between cannabis use and changes in the rates and patterns of other licit and illicit substances.

So while cannabis may have a role in replacing or reducing opioids for some pain patients, it’s not known whether it can also help people who are addicted to opioids.

Random clinical trials are needed, says Lucas.

In the meantime, patient surveys, data on opioid overdoses in medical marijuana states and anecdotal reports from patients should not be discounted, he says.

“So much of what we know about the medical use of cannabis has not come through the traditional clinical trial model of drug development because of the prohibition on cannabis that has been imposed so long. So much of it comes from the patient experience … When you hear one thing from one person, you can say it’s an anecdotal report. When you hear it from a thousand, or ten thousand or a hundred thousand patients, and you hear consistent messaging, at that level I think it rises up well beyond anecdotal.”

jmiller@postmedia.com

twitter.com/JacquieAMiller

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