A Sober Person's Guide to Medical Marijuana
Six things everyone in recovery from addiction should know about using medical marijuana.
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It’s a strange thing to obtain a medical marijuana card after nearly a decade of sobriety. My decision to quit drinking was less of a healthy life choice, and more the only way to stay alive. Though alcohol was my substance of choice, I learned in treatment and still largely believe that “mood altering” substances of any kind are very dangerous for folks who have struggled with addiction. So how, nine years after getting sober, did I find myself waiting outside a cannabis dispensary in California, with a prescription from a “weed doctor” clutched tightly in my sweaty hand?
A few things happened: First, a fellow recovering alcoholic told me about something called CBD, which stands for cannabidiol. CBD, a component of cannabis, offers many of the medical properties of marijuana, without the psychoactive effects. Figuring it was (literally) the pipe dream of a sober alcoholic, I didn’t think much of it. But then I read an article about Charlotte’s Web—a high-CBD strain of cannabis that was both non-psychoactive and very successful in treating a young girl’s seizure disorder. Further research indicated that my friend had indeed been telling the truth, and CBD was a real thing with real medical benefits.
If you’re in recovery and interested in exploring high-CBD treatments but are nervous about taking any potentially psychoactive medication, here’s a little advice based on how I went about it, and what I’ve learned over the past year.
Talk to your doctor.
Not the “weed doctor” but your general practitioner, who should know about your history of substance use and/or addiction. My doc knew all about my history of alcoholism; we had talked about it at length when she was deciding if she should prescribe Vicodin for my migraines. Prescribing opioids to someone who has a propensity for addiction didn’t make either of us entirely comfortable, but neither did leaving me in blinding pain. A few years later, when I started getting panic attacks, we talked about how a drug like Xanax might impact my recovery.
In my sober community, agreeing to take these drugs was highly questionable. Both drugs are known to have strong addictive properties and should be used sparingly, if at all, by those who have addictive tendencies. But both ailments, when they arose, were so debilitating that I didn’t feel like I had a choice. I was doing a lot of research and writing about addiction at the time, and I kept encountering articles about the dangers of taking an opioid (Vicodin) and a benzodiazepine (Xanax) at the same time. While I’d never actually had a migraine and a panic attack at the same time, the warnings made me apprehensive, so I jumped at the chance to replace one or both of the drugs with a less potentially dangerous alternative. I talked to my doctor about high-CBD alternatives, and she gave me the go-ahead to visit the weed doctor and talk about getting a prescription.
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Understand the difference between CBD and THC.
Put simply, both CBD and THC (tetrahydrocannabinol) are components of cannabis, but THC is what gets you high.
The longer explanation: We all have cannabinoid receptors in our brains, says Yasmin Hurd, professor of neuroscience, psychiatry, and pharmacology and director of the Addiction Institute at Mount Sinai. THC stimulates our cannabinoid receptors and, thus, produces a high. CBD, however, does not directly interact with the brain's cannabinoid receptors, and therefore does not produce a high.
Know yourself and reflect on your patterns.
Aside from a short, mild pothead phase in high school, weed was never really my thing. (Why smoke weed and feel sleepy and slow, I rationalized, when I could drink and spin wildly out of control?) “While it is less common,” Hurd reminds me, “marijuana addiction can happen.” Those who have struggled with cannabis use in the past should be cautious—today’s weed is stronger than the stuff from my high school years.
Carefully read the label of any product before you buy it.
Before you leave the dispensary with high-CBD gummies in hand, check the label for two things: the ratio of CBD to THC, and the overall milligram CBD/THC content.
Most products containing CBD will also have some THC in them. You can get products that are 100 percent CBD, but having a tiny amount of THC in there—even if it’s .09 mg of THC—tends to make it more effective.
As I write this, there’s a sublingual high-CBD strip in front of me. According to the package, in each strip the ratio of CBD:THC is 18:1; there’s 9.43 mg of CBD and 0.53 mg of THC. That amount of THC isn’t likely to get the average adult high. By contrast, the same brand’s 1:1 ratio of CBD to THC contains 5 mg of both THC and CBD. The more you increase the amount of THC in a product, the more of a high you’ll experience.
When I first went to the dispensary, I was very concerned about accidentally getting stoned. I told the person that I was looking for high-CBD products and he handed me a small tincture of CBD oil. It said “high-CBD” right on the bottle, so I figured it was the right stuff. When I got back to my car, I took a closer look at the label. The ratio of CBD to THC was 1:1, meaning every dose was going to give me just as much THC as CBD.
Also, the tincture had alcohol in it. Recovering alcoholics all have different standards around what I’ll call “non-drinking” alcohol (alcohol you might find in mouthwash, etc.), so for some people that might not be a problem. I stay away from all of it, so I brought the bottle back inside and switched it for something with an 18:1 CBD:THC ratio and a coconut-oil base. Check before you buy.
Emotionally prepare to be in a dispensary if that concept weirds you out.
One of the reasons I didn’t look closely at the bottle that first time is because of how fucking strange it is to go to a dispensary for the first time. If you’re like me, and the last time you purchased weed was before Facebook existed, you’re in for a surreal experience. The smell hit me, there was more weed than I’d ever seen (much less smoked) in real life, not to mention the colorful array of edibles. It’s just a lot. It’s easy to get distracted and overwhelmed—I simultaneously wanted to buy everything and get the hell out of there before I bought anything.
When you’re trying to be very careful about your purchases, a fight-or-flight response is not super helpful. So now, I do one of two things: Buy online and have it sent to me (I’m in California; access to this varies by state), or place an order on a local dispensary’s website and go pick it up in person. It gives me a chance to make sure I know exactly what I’m getting.
Know that you might not always have the most accurate information about what you’re getting.
Hurd tells me, “By all indications, CBD is safe and effective, but because of its legal status, quality control is difficult.” It’s derived from cannabis, which means the cultivation, sale, and consumption of it is against federal law in the United States. Thus, no medicinal cannabis product, regardless of the CBD-to-THC ratio has been approved by the FDA. In fact, in 2015, the FDA tested a number of high-CBD products and found that some of them did not actually contain the stated amount of CBD.
Still, as Andrew Tatarsky, a psychologist and harm reduction advocate says, that’s not terribly different from many other natural or alternative supplements. If a patient in recovery from alcohol or opioid addiction came to him asking about CBD, Tatarsky says he would “treat it just like they were asking me about melatonin [an over-the-counter herbal sleep aid]. I’d say it’s helpful for some people, not everyone, but give it a try and see if you experience some benefit from it.”
Start slow, evaluate regularly, and keep communicating with your doctor about how it’s going.
Both Hurd and Tatarsky stressed that no medication is a panacea, and what works for some might not work for others. Tatarsky says, “all substances have a risk and benefit ratio. Many prescribed drugs have much more serious risks than cannabis. As with those drugs, we should arm people with information, with skills and strategies for evaluating their use in an ongoing way.” That’s certainly what I try to do.
But I also know that I am really good at rationalizing whatever I want to rationalize, so it helps me to regularly talk to my doctor or therapist about my relationship with any medication or substance use. It forces me to think about it on a regular basis and it requires someone else hearing about it on a regular basis. I’m sure it’s unbelievably boring for my healthcare practitioners to hear all this information all the time, but that’s fine with me. I hope it stays honest and boring. It’s lies and excitement that tend to get me into trouble.
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