Q&A with Uwe Blesching: Breaking the Cycle of Opioid Addiction Using Cannabis
It’s not news that opioid use, misuse, and addiction have reached epidemic proportions. In 2012, 259 million prescriptions were written for opioids—more than enough to give every American adult his or her own bottle of pills. In the U.S., drug overdose has become the leading cause of accidental death, surpassing gun violence and even car accidents. With statistics like these on the rise, it’s particularly shocking that people struggling with addiction often fail to receive specialized treatment, even in some places at rates as high as 90%.
As cannabis edges more and more mainstream, it’s time that we explore the profound healing benefits it can offer to those struggling with addiction or chronic pain. Breaking the Cycle of Opioid Addiction, by Uwe Blesching, PhD, makes the case for responsible cannabis use to help alleviate physical, mental, and emotional pain and addiction. Check out our exclusive Q&A with Blesching below.
In your book, you talk about your experiences as a paramedic. How did working in emergency services affect how you think about addiction? How you think about cannabis?
Of course, as students we all learned about drugs and their addictive potential. Stanford University had a rigorous program that taught about addiction potential and, more importantly, the various treatment protocols in cases of overdoses and the often severe long-term adverse effects associated with the various addiction scenarios. In other words, the prime directive for us was the immediate survival of the patient. However, as I found out in the years that followed, theory and practice can significantly diverge.
In practice, I quickly learned to judge the danger of a drug by the harmful impact it had on the people I treated, and the frequency with which people needed to call 911 due to drug use. It may surprise you to know that the number-one drug responsible for generating 911 emergency calls is nicotine, contained in tobacco cigarettes, due to the lasting and serious damage that smoking causes. This was followed closely by alcohol abuse and sugar consumption-related mortality trends. Next came heroin, stimulants like cocaine, crack, methamphetamine, and diet pills, and PCP in roughly that order.
In 18 years of working the streets of San Francisco, I don’t remember a single 911 call that I responded to where cannabis was a true, single-drugs-use emergency. As such, especially when compared to the harm potential of other recreational drugs and a great number of legal pharmaceuticals, I always considered it relatively safe.
Let me give you a couple of practical examples. In cases of alcohol, methamphetamines, or PCP, for example, violence was a common adverse effect that required calling for police back-up. This resulted in restraining a patient who otherwise would harm us, others, or themselves. In contrast, on the rare occasion that a cannabis-using person was feeling anxious enough to call 911, it usually required reassurance and ‘hand holding’ that frequently produced a smile and interesting conversation in turn.
Another example would be the presence of withdrawal symptoms. In pre-hospital emergency settings, no withdrawal was more instantly and clearly visible as opioid withdrawal, with its intense dysphoria, opiate craving, nausea, depression, and agitation or muscle pain and cramping. In contrast, while cannabis addiction potential and withdrawal symptoms are recognized, they tend to be limited as a psychological phenomenon and as such don’t exist in the world of 911.
You’re obviously an advocate for responsible cannabis-based healing methods. When did this interest develop?
Friends would always ask me if I thought cannabis would work for their insomnia, anxiety, or pain, for example. At first, I had to say I don’t know. I had not been taught that in school. But I began looking into it. I delivered an informed opinion and I left it at that. However, I began to notice two things. One, more and more people would ask me the same kind of questions. And so I began taking notes on what I learned, where the information came from, and if it was reliable, so I could share my process of learning and discernment and my friends could make more informed decisions about how to proceed. Secondly, people would tell me how it worked for them, and it was mostly positive feedback piquing my curiosity. In short, this is how I began to become a researcher of all things connected with this new emerging field in medicine: the cannabinoid health sciences.
The abstinence-only model of addiction recovery still reigns supreme. Please speak a little bit to this—to the person who might be in a 12-step program who doesn’t want to jeopardize his or her sobriety. Can cannabis still work for them? What about non-psychoactive CBD?
I think the 12-step program for narcotics anonymous can be a very helpful process in addiction recovery; however, its strict adherence to sobriety may prevent a number of recovering addicts from benefitting from some of the plant’s non-psychoactive constituents. For instance, a cannabis chemotype III flower or product (one that doesn’t have psychoactive properties or produce a “high”) that has clearly demonstrated an ability to reduce a number of withdrawal symptoms and to gently shift affect (emotion) into an expansive, positive, or therapeutic direction and thus assist in fortifying against relapse potential.
Now, having said this, here is something interesting to note. Once a patient has reached a stage of relative balance that is void of the more severe withdrawal symptoms, continuous weekly sharing in a group setting such as 12-step has been known to be cathartic, helpful, and therapeutic, especially in the long-term. Recent evidence suggests that many of these beneficial effects are modulated (either partially or significantly) by the regulatory system of the human body named after cannabis. In a nutshell, the endocannabinoid system is the biological basis for mind-body medicine, and as such, ‘sharing’ in an environment of trust, closeness, and humility increases the presence of natural “feel good” molecules such as serotonin, oxytocin, or anandamide. It can reduce stress hormones such as cortisol or adrenaline, the biological counterparts to many of the psychological realities front and center of addiction relapse or avoidance.
How can increasing access to cannabis potentially help democratize healing, or access to quality healthcare?
The fact that cannabis-using people can grow their own or easily access cannabis or cannabis-containing products for their own needs is an extremely self-empowering reality. When else in the history of democracy did patients have this much agency in terms of how they address their own ailments, especially in states or countries where it is legal?
What advice do you have for people who might live in restrictive states, who don’t have access to cannabis?
Consider that cannabis produces many of her therapeutic effects by various pathways or mechanisms. This may mean that you could potentially produce therapeutic effects for what ails you by means of cannabis constituents that are non-psychoactive, and as such, legal in many areas where cannabis is prohibited.
Don’t be discouraged—change is on its way. The days of prohibition and the misinformed and biased narrative on the war on drugs are on their way out. Stay informed, get involved in change if possible, and if all else fails, consider making a little trip to the nearest area of legal access. However, don’t put yourself at risk or get into trouble with the authorities charged with enforcing the current laws of the land.
Is hemp-derived CBD just as effective as cannabis-derived CBD?
From a chemist’s point of view a molecule such as CBD is identical no matter what its source. However, here is a difference that may matter to you: hemp produces only a very small variety of CBD, while certain strains of cannabis produce much more. As such, it takes a much larger amount of hemp to produce a similar quantity of CBD. If we consider the fact that cannabis species detoxify soil by a process called bio-accumulation, many of these toxins may still be present at unhealthy concentrations. These unwanted materials need to be isolated and removed to make sure the isolated CBD is healthy. So, if you’re choosing to use a hemp derived oil, make sure the end product is tested and judged safe for human consumption.
What changes would need to happen (small-, large-scale, or both) for cannabis as an addiction treatment/recovery aid to go mainstream?
Here is a small change I noticed to constructively address this question. Cannabis-assisted psychotherapy has arrived on the horizon. The herb’s ability to help patients—such as those dealing with PTSD, for example—to be in the presence of otherwise intolerable emotional material can indeed be harnessed for the benefit the patient. I am encouraged to see more and more therapists utilizing the plant for such avenues of healing.
When is it appropriate to try cannabis for pain relief? When is it appropriate to use opioids or opiate-based treatments?
Opioids are a godsend when it comes to dealing with short-term acute pains, such as from injury or surgery, for example. The scientific evidence clearly supports that practical reality. However, when it comes to chronic pains, especially those of certain neuropathic or inflammatory conditions, the evidence for the use of opioids is relatively thin, while more and more evidence suggests that that a specific chemotype of cannabis may be a better alternative.
Say you’re going in for a surgery, and are being prescribed an opioid for the recovery period. How can you safeguard against becoming dependent?
Take the opioids as prescribed and in conjunction with your prescribing physician. Reduce the amount you are taking in proportion to the healing injury. That is as the pain becomes less over time. Together, reduce the amount accordingly, typically taking just enough to be below the threshold of pain until healing is complete. Beyond these biological basics there are a number of means by which to shore up your defenses against developing addiction. To mention them all is beyond the scope of this interview but here are a couple of examples.
Don’t fall into the trap of thinking that your pain is an isolated physical symptom. Pain is physical and emotional, and as such, for complete healing to occur it helps to address both. The physician usually does not have the time or training to deal with the non-physical part of pain. To fortify against addiction potential requires conscious participation and sustained effort on the part of the patient. That does not mean we have to go it alone as the evidence from multi-disciplinary approaches to healing pain demonstrate (i.e. a team of a physician, physical therapist, and occupational therapist, for example).
Falling victim to difficult emotions or negative self-talk has been identified as a contributing factor in developing opioid addiction. Developing the skill of emotional self-regulation may fortify you against addiction potential. There are a number of mind-body techniques you can learn to develop a tendency for positive affect. In fact, you can learn from your short-term opioid experience.
If you are experiencing a sense of euphoria or an altered state of consciousness, don’t be alarmed: try to go with the flow and enjoy it. Consider making a mental note of what it feels like in greater detail, so you can recall it or even recreate enough of it on your own if or whenever you feel like you could benefit from it. If you can reproduce enough of the feeling on your own, you don’t need the opioid.
And, it certainly helps to shore up your defenses by fostering meaningful connections with another person, nature, or a spiritual practice of your choice.