Opioid addiction and overdose deaths are at epidemic levels in the US, as many of you are aware. Medical cannabis usage as a treatment option to reduce and replace opioids for pain management has been shown to be extremely effective. One of the foremost authorities on medical cannabis is Dr. Dustin Sulak, licensed osteopathic physician. He is a practitioner and advocate of integrative medicine. He has long been fascinated by mind-body medicine, spirituality in healthcare, and natural approaches to promoting health and healing. He is a clinical hypnotherapist, Reiki Sensei, practitioner of chi kung and yoga, and has studied with numerous conventional and alternative healers and physicians.
Dr. Sulak is the founder of Integr8 Health with 3 locations in Maine and Massachusetts. His team of 16 healthcare providers see over 18,000 patients. He speaks extensively on the effects of medical cannabis and the endocannabinoid system. He observed, first hand, the myriad of benefits that medical cannabis provides for his patients. Dr. Sulak is so committed to medical cannabis as a safe and effective treatment option that he has set up a website of information for patients and providers where he shares his enormous wealth of expertise. Healer.com He and his team have helped hundreds of patients wean themselves off of harmful medications using medical cannabis. Here is his protocol for doing that.
How To Use Cannabis To Reduce and Replace Opioids
- Take a small oral or oromucosal dose of cannabis with every single dose of opioids. Place between gum and cheeks. It should be below the psychoactive threshold and can be as little as 1mg THC
- Use inhaled cannabis for breakthrough symptoms, management and to reduce cravings
- Select cannabis strains that contain CBD:THC to enhance benefits of opioids and decrease their side effects
Check out Healer.com to find your minimal effective dose
- In general 1:1 ratio CBD:THC or
- 2:1 ratio if you have Hepatitis C with active liver inflammation or fibrosis
Use cannabis to enhance other health promoting activities such as exercise, meditation, prayer, journaling, reflecting, psychotherapy and fear reduction. Getting regular sleep is crucial to success. Utilizing wellness activities is a critical part of the process in managing chronic pain and addiction.
- The oral dosing range is from 0.015mg/kgbodywt/day – 30mg/kgbodywt/day
- 1mg – 2,100mg daily; there is no need to worry about overdosing on cannabis.
- Start with a very low dose until you find your optimal dose. Increasing beyond your optimal dose can cause side effects and nullify the benefits.
- A low dose treatment of 10-20mg of cannabis 3 x daily is effective for most people. Some require a medium to high dose; gradually increasing to 100-500mg 3 x daily, if affordable.
Cannabis-naive: New to cannabis or have not used it for a long time
- Start sub-therapeutic (below your optimal dose)
- Increase to minimal noticeable dose for 3 days. You should feel more relief on day 3 than on day 1 as your body is getting more sensitive to the effects of the opioids in conjunction with cannabis.
- Increase to your effective dose on day 4
- 2 week therapeutic window of usage results in a reduction of opioids by 50-80%
- There is no rush in successfully weaning off of opioids unless you want to go “cold turkey”
For Seasoned Users:
- Sensitization Protocol: 6 days
- Switch from inhalation to oromucosal
- Before starting your opioids taper, stay at an optimal, lowest effective dose to avoid building tolerance but where you still feel the effects.This tonifies your cannabinoid system and upregulates your cannabinoid receptors, making you more sensitive to cannabinoids.
To mitigate side effects/enhance benefits, adjust CBD:THC ratio in your strains, using different strains for daytime and night
- 2 days abstinence from cannabis
- 4 days of very specific dose titration
- 90% of patients decreased their dosage of opioids by 56%
Cannabis for Harm Reduction
- Cannabis makes opioids safer by preventing opioid tolerance and dose escalation
- Cannabis treats the symptoms of opioid withdrawal
- Cannabis has a low risk for abuse and diversion, making it the safest treatment option
- Most people who use cannabis can stop using it without a treatment program
- Cannabinoids can change the plasticity of the brain to override the patterns of addictive behavior of using opioids
- Opioids stimulate brain stem cardiorespiratory centers while cannabinoids have no such receptors. Used together, cannabis increases the therapeutic effects of opioids at a much lower dosage.
176 patients who each used 20g of cannabis (smoking, cookies, olive oil extract) on a monthly basis for 7 months, up to 3 x daily. They were encouraged to gradually decrease analgesics, especially opioids. 44% of the patients were able to completely discontinue opioids in favor of cannabis only.
In another study of 244 patients, 64% decreased their opioid usage; reduced number and side effects. They reported 45% improvement in their quality of life.
In states with medical cannabis programs, there is a 24.8% lower mean opioid overdose mortality rate. These are significant numbers and should be encouraging news for those who want to stop the opioids epidemic. Let’s raise awareness about this in the mainstream media which barely reports on medical cannabis as a treatment option.