Harm Reduction and Medical Marijuana
For a few years I worked in a large 800 client clinic as a clinical social worker in medically assisted treatment, MAT, for those struggling with opiate use disorder (heroin, fentanyl, and prescription opiates like OxyContin and Percocet). They were maintained on methadone at this clinic and occasionally suboxone.
In that setting, I was a substance abuse counselor meeting with clients individually and in groups of 5-10. It had its ups and downs – I helped my clients through some of the most difficult struggles of their lives. Sometimes they relapsed, sometimes they succeeded. Small successes were always celebrated, and a relapse was never treated as a defeat, but a learning experience. My clients had amazing resiliency and strength in the face of a deadly epidemic – many had lost loved ones to overdose, or to the bridges they had burned during their hardest “run”. Many of them had been cat aside by a society that believed their disease was a choice.
As a front-line clinical social worker and later as a social work administrator at a methadone clinic, I tried to align my work with the principles of harm reduction. The premise is that marijuana users are less likely to relapse on other drugs (like opiates, which was what brought them to treatment in the first place). Using the software available to me as an administrator, I ran queries of data in our electronic medical records. It was quite clear that clients who used marijuana were far less likely to be positive for other drugs like opiates, cocaine, and Benzodiazepines. One client of mine described marijuana as a “way out” from opiate use, the opposite of it’s label as a “gateway drug” during the time of Nancy Reagan’s “just say no” campaign and after. Another described it as a safer way to manage her pain and live a better quality of life. This anecdotal evidence is powerful stuff in the face of an epidemic of opiate use that kills thousands.
Now that marijuana has become much more mainstream – medicinal marijuana I legal in 22 states and recreational marijuana legal in 10 – we have powerful evidence about the benefits of marijuana as a “way out” for opiate use. It is a life saver: states with a medical cannabis law had a nearly “25% lower mean annual opioid overdose mortality rate”. This data comes from the study Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010 (Bachhuber, Saloner, Cunningham, et al, 2014), where the researchers analyzed medical marijuana status and mortality data from all 50 states.
From the perspective of greater public health, the use of medical marijuana is a harm-reduction approach that offers a positive alternative to the opiate problem that is causing so much death and destruction in its path.
What are your thoughts on medical marijuana? What is your experience with clients experiencing issues with substance use, particularly opiate use? Has marijuana helped your clients with pain relief, abstinence from “harder” drugs? What are the harms you have seen from it?