Chris Manley quit using heroin. Cold turkey.
The 28-year-old lost six years chasing the drug. Numbing the pain. He knew if he were to save his life, it wouldn’t be with methadone, an opiate used to treat withdrawal symptoms.
“I didn’t trust that route,” said Manley, a man with a southern accent and a thick, red beard. He treated his addiction with a relatively new remedy.
The drug? Medical marijuana.
Cannabis, now available in Florida for certain ailments, could potentially treat another crisis in the state: prescription drug abuse, specifically highly addictive painkillers.
It would be an understatement to say there is no universal agreement that marijuana should be used to treat addiction. Currently, medical marijuana is not an approved treatment for addiction in Florida.
But some researchers say patients in states where marijuana is legal are choosing the flowery herb over the use of more harmful substances.
However, medical professionals criticize the use of pot in a recovery world where success is measured by total abstinence. They say cannabis isn’t strong enough to battle the intense side effects of opiate withdrawals, but it may work in other cases, like alcohol addiction.
But both sides agree on one thing: There needs to be more studies on marijuana. Right now, it’s classified as a Schedule I drug, putting it in the same category as heroin, which restricts scientists from conducting legal research.
But for patients like Manley — who aren’t sure if they’re going to live another day — cannabis could be their saving grace.
Pain and withdrawal
In the late ‘90s, Gregory Gerdeman injected rats and mice with cocaine and watched the sensitized animals run around.
They became addicted.
But after ingesting molecules found in cannabis, the rodents’ withdrawal from cocaine was less severe, said Gerdeman, a pharmacologist and professor at Eckerd College in St. Petersburg, Fla.
“It's been done in humans,” he said. “In Jamaica, studies have shown individuals addicted to crack cocaine got off of it by using ganja.”
Over the last 20 years, Gerdeman has seen and heard of dozens of patients who have used cannabis to wean themselves off opioid medications.
“I’m not saying it would work for everyone,” Gerdeman said. “But the possibilities for marijuana as medicine could be therapeutic in Florida, especially for the elder population.”
He knows what opponents say about treating addiction with medical marijuana. They ask him, “‘we saw what happened with the opioid epidemic. Why open that up with cannabis?’”
“Cannabis is not anywhere near the dilapidating, life-threatening or addictive substance that Oxycontin is,” Gerdeman responds. “It’s medically rock solid that cannabis is not going to cause a fatal overdose.”
Treatment
Many who walk into Dr. Jamie Smolen’s clinic have the same story. They first get prescribed painkillers after a car accident or operation.
They feel energized from it. They ask for more. Their doctors stop prescribing it. They become sweaty, anxious. They can't sleep. They shake and vomit. Their only choice is to buy drugs on the street.
Smolen, an addiction psychiatrist, has been at the UF Health Florida Recovery Center since 2012. He’s seen an increasingly worse trend of opiate abuse in the last five years.
To treat it, he prescribes suboxone, also an opiate, which goes under the tongue and takes away cravings for heroin. Patients are also treated with another opioid, methadone, to reduce withdrawal symptoms. They can also choose to get a Vivitrol shot, which blocks users from feeling high.
Supervised access to these medications has been shownto help reduce relapse, overdoses and get patients through withdrawal.
Addiction psychiatrists are not in favor of patients using marijuana, as it exists right now, Smolen said. The plant-based substance has multiple compounds that have yet to be studied and made in a form that doctors can prescribe with precision.
Addicts are also unlikely to stop using opiates by switching to cannabis, because “they are always combing drugs to enhance the total effect,” he adds.
During their recovery, patients are encouraged to check in daily for random drug tests. After five years of monitoring, some of Smolen’s patients relapsed only once. Addiction treatment would have a higher success rate if that kind of monitoring were affordable for the public, he said.
Many of Smolen’s patients return to work — sober, healthy, smiling and taking care of their families.
“We know how to treat addiction,” he said. “When it's treated properly, the results are excellent.”
"An exit drug"
When Philippe Lucas contracted Hepatitis C in 1995, not much was known about the liver-attacking infection.
He asked his doctor, “Am I dying?”
“I don’t know, but you should probably quit drinking,” he told him.
So Lucas gave up alcohol and cigarettes at 25. He switched to cannabis, initially to deal with his cravings for alcohol and tobacco. The drug also reduced symptoms of the virus.
He remembers working at a dispensary in British Columbia the early 2000’s, where he met patients with HIV and Hepatitis C. They contracted the viruses through injection drug use and were prescribed cannabis for their conditions.
But they came to find out they were really using marijuana to stay away from other drugs.
Instead of a gateway drug, “it turned out to be an exit drug for problematic substance abuse,” Lucas said.
Recently, Lucas tracked more than 250 patients treated for conditions such as chronic pain, mental health and gastrointestinal issues, in a study spearheaded by The University of British Columbia.
Overall, 63 percent reported using cannabis instead of prescription drugs, which includes opioids. Patients also picked cannabis over tobacco and alcohol.
Lucas' study this year will focus on the impact of opioid-replacement therapy, such as using cannabis instead of suboxone and methadone to treat addiction.
Marijuana is not completely benign, but the potential harms associated with opioid dependence are much greater, Lucas said. At the least, cannabis can play a “harm-reduction role” in reducing negative impacts of alcohol, tobacco and opiates.
Kenneth Baker, a licensed pharmacist and lawyer, said when a patient has pain, it should “start with medication other than an opioid.”
Those who take more medication than prescribed don’t do so because of addiction, but because their medications are not sufficiently dosed, Baker said. Some patients have too high an expectation for the drug.
“It’s meant to make pain tolerable, so the patient can live their life and have a good life,” said Baker, who teaches an online pharmacy class in risk management at the University of Florida.
About those who may lessen their use of opioids with marijuana, he said he’s not sure how well it works.
“Some patients will tell you they are able to get off of the opioids because the medical marijuana alleviates their pain,” Baker said. “But we need real research. Real studies.”
Baker remembers practicing law in Indiana, where he saw a lot of problems with driving under the influence and alcohol-related deaths — issues he sees as a far worse problem than marijuana.
He recognizes some critics may say using marijuana replaces one addiction with another. But, no studies show that marijuana is addictive, he said.
It may be habit-forming, but true addiction is different: It’s a physiological need for a drug.
“For that reason, it seems to be, at least in some cases, a safer alternative,” Baker said.
Life saver
Sean Beeman had five years to live, at most. That was in 2010.
He had chronic Hepatitis C and tried every form of medicine, herbal and pharmaceutical. Nothing worked.
After hearing about the positive healing effects of cannabis, he made his first batch of oil and ingested it daily.
In the first 90 days, he lost 100 pounds. Eleven months later, Beeman’s doctor declared his liver cured.
Beeman, who now owns Genesis Pharms, a dispensary in Oregon, said he “sees miracles all the time.”
Over the last few years, he has served more patients with opiate addictions. A significant amount of the patients come from Florida, he said. Some of them go from getting Demerol shots three times a day to strictly using cannabis. Most don’t suffer withdrawal symptoms.
One of his customers, Thad Hamilton, comes from St. Augustine once a month to treat his post-traumatic stress disorder.
Hamilton, a Navy veteran, came to Oregon after doing research on the Rick Simpson Oil, a concentrated form of cannabis. Taking one capsule before bed provides him with no euphoric feeling, he said.
But he notices the difference. In Oregon, he gets out of the house more; he can have conversations with complete strangers; he has a full night’s sleep. In Florida, he has a fear of being in public. His constant thought process keeps him up at night.
A licensed drug abuse counselor, Hamilton has seen marijuana treat addiction time and time again.
“Now that I’ve experienced the quality of health that I can have,” Hamilton, 44, said. “I hope that Florida truly takes it for what it is, and its healing powers.”
"I’m not trying to be a stoner"
Beating heroin addiction was a life or death matter for Chris Manley.
He lived through the Iraq War. He survived multiple suicide attempts. At any moment, a heroin-infused needle could do him in.
So he hitchhiked 50 miles to Oregon and started to smoke a little weed. He was prescribed medical marijuana for PTSD, inflammation and pain. But, he said, using cannabis instead of opiates saved his life.
Before, he spent time and money not to feel. Now he feels everything.
"My pain is a gift," he said. "It lets me know where I've been and what I've been through."
He did relapse once, after taking painkillers following oral surgery. He ate the whole bottle the first day.
His addiction started after the army, when he was prescribed opiates for knee and back injuries. When Manley first tried a blue pill, he felt “like Superman.”
When his doctor retired and the medicine changed, he got his pills on the street. When they became more expensive and harder to find, he switched to heroin.
Manley finally beat his addiction, and he did it with cannabis. But he’s not taking it like he would heroin.
“I’m not trying to be a stoner; I’m trying to live my life,” Manley said. “I’m here for a reason.”
He’s getting married this year.