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Can cannabis replace opioids? | Leafly

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In 1995, the president of the American Pain Society called for pain to be added as a fifth vital sign evaluated and managed by physicians—body temperature, heart rate, respiration, and blood pressure are the original four. Measuring pain subsequently became a widely accepted practice among clinicians. With 20% of adults experiencing chronic pain, prescription opioids soon doubled and Americans began consuming 80% of the global opioid supply.

President Trump officially declared the opioid crisis a “public health emergency” in October 2017. By then, the United States was approaching 50,000 opioid overdose deaths total and nearly 60% of them were due to illicit synthetic opioids such as fentanyl or tramadol. The problem has continued to escalate. Last year, there were more than 80,000 opioid overdose deaths with roughly 90% resulting from highly potent synthetic forms. This crisis is not getting better, and new strategies are needed to solve the problem.

Does legalizing cannabis reduce opioid use?

There are several reasons why legalizing cannabis seems like a promising strategy to combat the ongoing opioid crisis. For one, early population reports found that states that legalized medical cannabis saw a reduction in opioid overdose deaths. However, those findings no longer hold when the timeline of analysis is extended to the present day; any benefit that cannabis legalization has on reducing opioid overdose seems to be short lived.

States that legalized recreational cannabis saw an initial reduction in opioid-related emergency room visits by 7.6% compared to states that did not legalize cannabis, but this difference was gone within 6 months. It remains possible that cannabis may serve as a substitute for common prescription opioids like oxycodone, codeine, or hydrocodone, but can’t overcome the severity of dependence to more potent illicit opioids like fentanyl or heroin that are being abused at escalating rates.

Some studies point to notable reductions in prescription opioid use among patients who also use cannabis, but this benefit disappears in rigorously controlled clinical trials. These clinical trials fail to find consistent results on cannabis co-use with prescription opioids, despite most patients saying that they prefer cannabis over opioids.

Related

How Cannabis Enhances the Effects of Opioids

How might cannabis replace opioids?

There are currently 15 ongoing clinical trials investigating the ability of cannabis to reduce opioid need. These clinical trials are driven by hard-to-ignore evidence from animal studies that look at the pain-relieving interactions between the endocannabinoid system, which is stimulated by cannabinoids like THC, and the opioid system.

Pain experiments in rodents have consistently found that THC reduces the need for opioids. Across seven different studies, THC reduced the effective dose of morphine by 3.5 times. This beneficial effect is supported by three key pieces of evidence:

  1. Many cannabinoids, such as THC, stimulate CB1 receptors in the endocannabinoid system, which are found in the same pain-processing brain areas as opioid receptors and may also contribute to pain reduction.
  2. CB1 receptors in the body interact with opioid receptors to boost their pain-relieving effect in rodent studies.
  3. CB2 receptors, another cannabinoid target, can stimulate the release of the body’s own opioids which activate pain-relieving opioid receptors.

So why is there inconsistency between these ongoing clinical trials and the population studies mentioned above?

A direct reason is unclear. Some argue that a sense of control over pain management, as one experiences when they choose to use cannabis, can promote better outcomes. This effect could explain why patients who could choose to co-use cannabis in certain trials, as opposed to randomized clinical trials, reduced their need for opioids.

Related

What is the endocannabinoid system and what is its role?

It’s also possible that these benefits result from the placebo effect, where people can boost their opioid levels without drugs and dampen pain simply because they think they’re receiving an active pain medication.

Adding confusion to results, cannabis’ opioid-reducing effects may go away with the prolonged use of high-potency THC products, which are increasingly common in legal markets. Rodent studies of THC’s opioid-reducing effects are often short in duration, usually lasting only several days, whereas human use is often chronic—people use for weeks or longer. Repeated use of high-potency THC leads to tolerance, which often results from a reduced number of CB1 receptors and weaker overall endocannabinoid signaling.

The development of THC tolerance would therefore hinder the ability of CB1 and opioid receptors to work together to reduce pain. This could explain why short-duration rodent studies show opioid-reducing benefits of THC, and how these effects are often lost in long-term human clinical trials.

Further, this phenomenon could explain the initial drop in opioid overdoses when states legalize cannabis, but with the eventual onset of tolerance over several months, the opioid-reducing effects of cannabis in the population disappear.  

Considering all the current evidence, there’s no clear consensus over whether cannabis can replace or reduce the need for opioids in pain management.

Are there risks of using co-using cannabis and opioids?

In some cases, the combination of cannabis with opioids was associated with worsened mental health, and this combination may be worse for those over 65 years old. Yet other safety issues, like opioid’s suppression of breathing, were not made worse with co-use of cannabis, at least alleviating some concern.

And in most cases, co-use of cannabis does not increaseopioid use, dispelling the idea that cannabis is a gateway drug, a warning spouted by many anti-drug campaigners.

Can CBD help with opioid dependence?

Despite the lack of clinical evidence that cannabis can replace opioids, CBD is emerging as a potential strategy to help those trying to overcome from opioid use disorder.

Italy unintentionally legalized CBD-rich cannabis in 2017 (essentially “hemp” by United States legal standards), and saw a reduction in opioid use, suggesting that CBD-rich cannabis may replace opioids in the short-term.

Several clinical studies have found that CBD reduces cues that trigger opioid cravings, and dampens the increased stress response that accompanies cravings. Insight from rodent studies shows that CBD diminishes many of the negative changes in behavior, anxiety, and genetic expression that accompany opioid withdrawal and lead to relapse.

These studies have set the stage for additional clinical trials (for example one that’s to take place at the Tarzana Treatment Center in Los Angeles) to study CBD’s potential as an adjunctive therapy for opioid use disorder.  

Related

The complete guide to CBD (cannabidiol)

Can cannabis replace opioids?

The jury is still out. Most patients report that they’d prefer to use cannabis over opioids for pain relief and believe it to be an effective alternative. However, the range of use patterns, product options, cannabinoid and terpene content, and reasons for needing pain medication make this a particularly challenging research question to empirically study.

Control over the types of cannabis products being used together with optimized formulations for pain management (with moderate THC potencies!) will lead to a clearer picture of cannabis’ potential to replace opioids.

Josh Kaplan's Bio Image

Josh Kaplan

Josh Kaplan, PhD, is an Associate Professor of Behavioral Neuroscience at Western Washington University. He is a passionate science writer, educator, and runs a laboratory that researches cannabis’ developmental and therapeutic effects.

View Josh Kaplan’s articles



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Journeymen Collective: Magic Mushroom Retreat – Cannabis | Weed | Marijuana

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What is the Journeymen Collective magic mushroom retreat? Contemporary shamans Gary Logan and Rob Grover sat down with CLN the other day to discuss what really happens in a psychedelic treat.

Is it a type of psychedelic therapy? Not really, says Rob. 

It’s more along the lines of personal development. We recognize that there are clinical uses, there are recreational uses, and we’re in somewhat of the middle. What we’ve done is we’ve combined about sixty years of experience in personal metaphysical, spiritual teachings, and professional development as well. And we bridged all of those realms together to create what we know as the Journeymen Collective.

This B.C.-based collective uses psilocybin mushrooms to help guide executives, entrepreneurs, and other professionals. The goal? “We want to help people move from business to conscious business,” says Rob. 

But what does that mean?

Journeymen Collective: Magic Mushroom Retreat

Journeymen Collective

Magic mushroom wellness retreats are becoming more mainstream. But there’s still a lot of stigma to plant-based medicines like psilocybin. As well, not every psilocybin retreat is created equal.

Rob and Gary use their decades of experience to ensure a safe and secure environment. Since 2018, when they founded the collective, the results have proven it.

The success stories from the Journeymen Collective range from business executives who were unhappy with their careers to artists and performers who felt lost and anxious.

“A lot of the time it’s people are looking for a deeper level of connection,” says Gary. “And they don’t know how to access it because the cultural paradigm that we live in hasn’t granted them the opportunity to go into that aspect of self.”

Rob agrees. The people who’ve come through their retreat always leave “more consciously aware of who they are.”

They’re more deeply connected to who they are. They’re more passionate and purposeful with the work that they’re providing the world. And as a result, they’re actually making a greater contribution to the people that they work with… Basically, they’re more aware of how they can actually make a greater impact in another person’s life, whether that be in their company, and their relationships. We see it, taking place whereby people come and work with us and they’re not quite sure how it fits into the business. But then once they come through an actual Journey with us … one of the things that happens is they start to see opportunities to help their people at work.

Fostering a deeper connection with the people you work with can only have positive benefits. Indeed, the success stories Rob and Gary recount lend credence to the benefits of magic mushroom retreats.

What’s the Purpose of a Retreat?

What’s the point of a luxury magic mushroom retreat? If one is feeling down and wants to try psychedelic plant-based medicine, why not visit one of the many illegal psilocybin dispensaries popping up all over Canada?

The answer, of course, is that you need a guide. If you’re feeling depressed and take mushrooms to alleviate the depression, without proper set and setting, you could make your depression even worse.

However, some critics contend that psychedelic retreats like the Journeymen Collective aren’t the proper set or setting. Only white coats with PhDs in sterile medical clinics should provide psychedelic plant-based medicines – if they do so at all.

One argument against psychedelic retreats is that the experience may intensify your feelings of depression or anxiety. But Rob says that’s kind of the point.

“Maybe you actually do have to feel the depth that intensely and that’s what’s actually going to help you.” Adding that he and Gary have nothing but “respect and professionalism for the people that we work with.”

“If someone’s skeptical,” Rob says, “Chances are, they won’t be our client.” Both men emphasize that interested parties should do their due diligence.

“I think the biggest thing is that people aren’t skeptical,” says Gary, “They’re scared.”

Another common misconception is that psilocybin retreats don’t require any work on the client’s part. Sometimes, you get a sudden shift in thinking or concepts that benefit you. But other times, the conscious change is subtle. It requires you to be an active participant, not merely a passive observer.

But even without a big psychedelic-induced breakthrough, Gary says, “you’ll have the tools moving forward to deal with whatever comes up in your life because the old habits of thinking and doing and being are being addressed.”

What the Journeymen Collective is All About

Journeymen Collective
Rob (left), Gary (right)

The Journeymen Collective luxury magic mushroom retreat is about addressing your fear head-on and watching it run the other way. And even though Rob and Gary provide a safe location with proper set and setting, the power remains in your hands at the end of the day.

“You can create greater anxiety or depression or you can create greater well-being from that fear,” says Rob.

The problem, says Rob and Gary, is that culturally, we “haven’t been given the permission slip to step into the unknown and create something from the unknown.”

Rob adds, “The only permission you need is the permission from yourself and the permission to create.”

The fear people have – whether going to a retreat or clutching their pearls at the thought of a psychedelic retreat even existing – is tied back to how we structure our society.

Rob rattles off how fear and control begin right from our childhood. “Raise your hands to go to the bathroom; stand in line. You’re only allowed to colour inside the lines.”

Education will change public perception, which is why Rob and Gary emphasize education more than any other aspect of the retreat.

“That’s one of the reasons why we do interviews like this,” says Rob. “So that we can educate people that you are not going to lose your mind. You’re going to find your mind.”

But it also means education on what to expect from a retreat. Rob and Gary recount horror stories of other less-reputable retreats where multiple people are in a single room, and you must share your guide with others.

“And as a result,” says Rob, “They’re leaving more traumatized than they were when they walked in.”

Education is Important

This is not the case at Journeymen Collective, where Rob and Gary prepare you for a personalized journey and stay with you for the entirety of the experience.

“Education is a massive, massive thing that we are committed to,” says Rob.

I never thought that that would be something that we’d be stepping into when we started the Journeymen Collective. However, it’s becoming increasingly clear that we have to step into that and educate people. This is what an actual psychedelic Journey needs to include. It needs to include the personalized aspect. If there are 20, 30, 40, or 200 people in an actual ceremony, I would step away and find another way.

Gary echoes this sentiment. He lambasts the 60s and 70s narrative that magic mushrooms could cause you to lose your mind. “We have to change that narrative. That’s what needs to be done because it is a paradigm people get stuck in, and that’s all they know about.”

Rob and Gary agree that many old stories stem from inexperienced people tripping in their backyard with friends. This differs entirely from a guided journey, where Rob and Gary recall some people sitting and meditating for hours.

Rob says, “Sure you can do it on your own, but what is the set and setting and are you able to work through the stuff that’s coming up for you?” He warns of negative thinking loops that may make your problems worse.

Hence, Rob and Gary suggest a guided journey. “It’s not about looking at trippy pictures,” says Rob. It’s about an experience where “you can actually trust the person that you’re with and allow yourself to go deeply within and unearth some of the uncomfortable places within the self.”

Journeymen Collective: Magic Mushroom Retreat

Of course, some people want proof beyond testimonials. They want studies and papers and peer-reviewed research. As mentioned, if you’re genuinely skeptical of plant-based psychedelic medicine, odds are, you won’t be a client of the Journeymen Collective.

But if you’re on the fence, the story of one client and his Apple watch may persuade you to check it out further.

“He got a notification on his Apple watch to say that your heartbeat has dropped eight beats per minute,” says Rob. “What’s going on? It was after his journey. Well, his resting heart rate decreased eight beats per minute.”

Likewise, another client had a benign brain tumour that prevented her from being able to smell or taste. But one morning after her journey, “she was sitting having breakfast with us and basically was like naming every single ingredient in the omelette,” says Rob.

Evidence-Based Plant Medicine

This may not be scientific proof everyone accepts, but it’s clear something beyond the placebo effect is happening. But greater scientific and clinical acceptance is a double-edged sword.

Rob and Gary are concerned that clinical regulation could downplay the spiritual connection that makes psychedelic plant medicines successful. But they remain hopeful.

Says Rob, “My hope is that people who are guiding have the depth of knowledge and understand the science and the mind. And the mystical side, the spiritual side of what’s actually taking place here.”

You can learn more about the Journeymen Collective here and how to connect with Rob and Gary.





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Is Cannabis Addiction a Treatable Medical Condition? – Cannabis | Weed | Marijuana

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Is cannabis addiction a treatable medical condition? According to one doctor, “cannabis addiction is a real and treatable medical condition.”

She claims the “cannabis legalization movement” has successfully pushed back against this narrative due to the drug war.

Fortunately, Dr. Salwan is not one of these old-school drug warriors. She knows cannabis doesn’t turn people into criminals and that cannabis prohibition has led to the mass incarceration of peaceful (mostly black) Americans.

Dr. Salwan represents the new school of drug warriors. The kind that promotes more opioids to wean people off opioids. That labels drug use as a “treatable medical condition” rather than an activity.

To her credit, Dr. Salwan recommends cognitive behavioural therapy as a solution to “cannabis use disorder” since that’s where the evidence leads her. (But not without mentioning the “promising” FDA medication that will “reduce cannabis cravings.”)

However, Dr. Salwan is on the education faculty for the American Society of Addiction Medicine. In other words – it is tough for Dr. Salwan to see substance use as anything but a medical condition.

What is Cannabis Use Disorder (CUD)?

Is Cannabis Addiction a Treatable Medical Condition?

Is cannabis addiction a treatable medical condition? What is a “cannabis addiction,” anyway? “Cannabis use disorder” (CUD) is a topic we’ve covered before. It’s a myth that refuses to die.

The belief that outside forces determine our thoughts, behaviours, and actions is only becoming more prominent in the culture where neuroscientific theories of consciousness are accepted as “science” despite their philosophical shallowness.

But let’s get to the crux of Dr. Salwan’s argument. “To shake the collective disavowal of cannabis addiction,” she writes, “It helps to understand the clinical paradigm of all drug addictions, or substance use disorders (SUDs).”

So, whether we’re talking about cannabis, alcohol, or opioids, the hallmarks of SUD are always the same, categorized as the three Cs.

Craving: A strong desire to use the substance 

Consequences: Negative consequences of using the substance 

Control: A loss of control when consuming the substance (or in the pursuit of). 

Other residual SUD “symptoms” include developing a tolerance and experiencing withdrawals. But by this definition, nearly every American suffers from caffeine use disorder and a refined sugar addiction.

Is Cannabis Addiction a Treatable Medical Condition?

Is Cannabis Addiction a Treatable Medical Condition?

Of course, “cravings” are just thoughts. Perhaps you’ve “craved” ex-partners when visiting areas that remind you of them. It’s a common human experience. You don’t have to associate your stream of consciousness with your ego and attach yourself to each and every thought.

Especially if you’re breaking a long-term drug habit (or trying to get over an ex).

Likewise, determining whether the consequences of your actions are negative is up to you. So-called “addiction experts” are supposed to be neutral, value-free scientists.

You could drink a case of beer every night. Destroy your liver, your marriage, turn your kids against you, lose your job and house, and end up living on the street. These all sound like negative consequences of drinking.

But if you frame the experience as positive, then who the hell are “addiction experts” to tell you otherwise? It may seem irrational to us, but many prefer to live on the street and use drugs like fentanyl.  

This fact of life is lost on many advocates of taxpayer-funded supply of “addiction medicine.” They want to dehumanize someone’s choices and consider them “mentally ill” because they don’t conform to specific social values.

I find it hard to believe that the left-wing advocates making this argument have ever read (or understood) Foucault. Although they’ll claim him as one of their own.

As for the loss of control – despite the persistence of this myth, it remains just that. A myth. No research worthy of the label “science” supports a loss of control.

Some Real Science to Drive Home the Fact 

Is Cannabis Addiction a Treatable Medical Condition?
Gordon Alan Marlatt. 1941 – 2011

G. Alan Marlatt was an American-Canadian clinical psychologist and researcher in the field of addictive behaviours.

One of his most well-known studies helps answer whether “cannabis addiction” is a treatable medical condition.

Dr. Marlatt took a group of heavy drinkers who qualified as having alcohol use disorder. He separated them into two groups in two separate rooms.

He gave one group cocktails without alcohol. But the cocktails tasted as if they contained booze. He told this group the cocktail did have alcohol in it. Obviously, the participants reported cravings for more, kept drinking, and some even began behaving intoxicated.

He gave the other group cocktails that contained alcohol. But the drinks didn’t taste like alcohol, and he told the group there wasn’t any in the beverage. This group did not report cravings for more and did not binge drink to excess.

Others have replicated Dr. Marlatt’s study. The 3 C’s of addiction are not scientific concepts. They are a belief system of “public health” masquerading as scientific knowledge. 

Contradictions in Dr. Salwan’s Article

Dr. Salwan doesn’t seem aware of the contradictions in her article. For example, she writes it’s “heartening that the prevalence of cannabis addiction among U.S. adults remained below 2 percent from 2002 to 2017, even as cannabis use increased from 10 to 15 percent.”

But how does that make sense? Especially since the THC potency has increased. If the drug itself is causing addiction, shouldn’t higher use rates also increase addiction rates?

Dr. Salwan solves this issue by recognizing that cannabis has – more or less – been destigmatized. If you’re not losing your job or falling behind on the bills, who cares if you engage in wake-n-bakes or smoke weed every night after work? 

Destigmatization, says Dr. Salwan, is a “desired social outcome.” However, she believes it comes “at the expense of engagement in treatment,” where only 4 percent of people received CUD treatment in 2019 versus 9 percent in 2002.

Think about that. The number of people who have sought treatment for problematic cannabis use has dwindled, and she believes that’s a problem. 

If you make your money from “addiction medicine” and by promoting rehabs and treatment centres – then yes, people not viewing themselves as helpless addicts who need your paid expertise is a problem.  

This phenomenon of people viewing their cannabis habits as habits instead of an addiction is a step in the right direction. Only ideologues believe “cannabis addiction” is a treatable medical condition. 

FDA Drugs vs. Changing Your Mind

As mentioned, Dr. Salwan pays lip service to “promising” FDA drugs to remedy cannabis addiction or CUD. But, as she writes in the article, all evidence points to cognitive behavioural therapy (and others) being more helpful.

And it’s obvious why. These therapies tend to challenge an individual’s thought process and patterns of thinking rather than affirm how they feel and look for a “root cause” somewhere in their childhood.

Cannabis addiction is not a treatable medical condition because addiction is not real, and problems of the mind are not medical conditions.

Addiction is a social construct that feeds into itself.

Much like race. We’re all homo sapiens. But you can divide people by skin colour, create cultures based on these skin tones, and then propagate and control populations according to the beliefs and values of the various “in” and “out” groups you’ve created with this social construct.

Addiction is the same way. Whether it’s cutting back on cannabis, social media or trying to create positive habits like exercising and eating right.

You can recognize your free will and autonomy or believe your habits and preferences are a “disease” or “disorder” of the brain. That you’re masking some underlying cause that only years of therapy and a cocktail of pharmaceuticals will cure.

Dr. Salwan worries that people have been denied access to CUD treatment because of its illegality or because their “symptoms were trivialized.”

And indeed, we’re not trying to trivialize someone who feels addicted. It’s incredibly frustrating. But, like poor race relations stemming from government policy, school indoctrination, and media coverage, this poor relationship between drugs and consumers results from “addiction experts.”

Dr. Salwan’s framing of the issue does not help.

Is Cannabis Addiction a Treatable Medical Condition?

Is Cannabis Addiction a Treatable Medical Condition?

“Cannabis use disorder” is a concept created and reinforced by these so-called experts.

But what about people (i.e. “cannabis addicts”) who strongly prefer the herb with their actions but not in their speech?

It could be they think cannabis helps them cope with some traumatic past.

And it could be that some people just like to get fucked up. For whatever reason, they want to feel numb. And drugs are an effective way of bringing about that state.

But it’s a leap in logic to blame the substance. It confuses cause and effect. It’s putting the cart before the horse in every sense of the term.





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5 Ways To Become More Empathetic

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Empathy is a word that’s thrown out a lot. It’s a word that specifically means to feel something with someone (i.e. put yourself in the other person’s shoes). While pitying someone else’s struggles is easier, understanding their pain is a skill that’s needed in all aspects of life.

According to Psychology Today, empathy is a vital trait for maintaining all sorts of relationships, ranging from friendships to marriages. It’s a trait that takes time, practice and personal growth in order to flourish.

Here are five things you can do in order to become a more empathetic person:

Think of it as a skill

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RELATED: Why Does It Feel Good To See Someone Fail?

While there are people who are better at empathy than others, everyone has it in them and it’s never too late to develop it. Make it a conscious decision to try to understand other people and to listen to them without interrupting, even if they’re completely wrong.

Don’t focus on the positive stuff

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If someone is coming towards you with a personal experience that has hurt them, avoid looking for the silver lining. While it might make you feel better to be positive, this habit erases people’s feelings and invalidates their struggles. While listening to someone discuss an awful situation is hard and uncomfortable, it might just be what that person needs.

Have contact with people that are different than you

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If you surround yourself with like minded people you’ll have a hard time exercising your empathy. Go out of your way to have conversations with people who think and act differently than you. Commit yourself to listening to others and to trying to understand their position. It’s also important to know that understanding someone and having empathy for them doesn’t mean that you have to agree with them or condone their actions.

Don’t try to one up people

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RELATED: Study Shows The Paw-sitive Effects Of Watching Cat Videos

Human beings are self-centered by nature but it’s important to rein in this impulse when you’re trying to be empathetic. If someone is telling you something sad that happened to them don’t pitch in with a darker story of your own. When people open up and are vulnerable, they’re expecting you to listen. There’s no need for you to become the protagonist of this conversation.

Be kind to yourself

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Forgive yourself when you can’t understand some people’s thoughts or when you’re unable to suffer through their losses. Mashable reports that people who punish themselves over feelings of guilt can diminish their desire for helping and listening to others in the long run. In order to sustain high levels of empathy, it’s important to ground yourself in your reality and to manage your emotions.



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