There has been some recent interest in the use of smoking marijuana as a harm-reduction strategy to treat opiate/heroin addicts. To further evaluate this issue, we conducted clinical interviews with 10 opiate/heroin severe substance abuse use disorder patients being treated in an Enthusiastic Sobriety Intensive Outpatient Program.
Ten patients between the ages 14 to 19 years were interviewed; eight males and two females; all met DSM 5 criteria for severe substance use disorder, opiates/heroin. They had been sober between five days to nine months when they relapsed by smoking marijuana. All ten were motivated by the belief that smoking marijuana would help them not to return to opiate use; however, within the range of a few days up to six months, each resumed opiate use.
Patients described the following: “marijuana use was not enough-made me want to use heroin;” “smoking weed make me not care and I went back to opiates;” “the weed made me want more;” “each time I relapsed on weed, I would immediately think heroin is so much better;” “weed just didn’t cut it. I’m smoking weed to get high, but heroin is so much better;” “The weed was just not enough and accelerated my need for a better high.”
All of these patients relapsed by smoking marijuana, which they thought would help them not to return to opiate use. In each case smoking marijuana was not sufficient, and they all returned to heavy opiate/heroin use. Since they all smoked marijuana which contains THC, these case reports are not helpful as to whether just CBD would have a beneficial effect.
In summary, 10 young opiate/heroin severe substance use disorder patients tried to smoke marijuana as a way not to return to opiates/heroin use. In each case this failed.
Steven L Jaffe, MD
Professor Emeritus of Psychiatry, Emory University, Clinical Professor of Psychiatry, Morehouse school of Medicine