An excerpt from my upcoming book, “When It Hurts: The Secrets and Mysteries of Pain Management.”
Back in 1970, Dr. Tod Mikuriya, a Northern California physician, published an article entitled, “Cannabis Substitution: An Adjunctive Therapeutic Tool in the Treatment of Alcoholism.” A 49-
year-old patient of his, came to him with a long history of alcohol abuse. The patient happened to mention her use of marijuana as well, and the fact that she decreased her alcohol intake when she smoked.
So Dr. Mikuriya gave her advice that in 1970 was truly radical: “I instructed her to substitute cannabis daily—any time she felt the urge to partake in alcohol,” he said.
Several months later the woman’s health was ironically on the upswing. “Her appearance, complexion, posture and energy level had gradually improved,” Mikuriya noted. “She was afforded a new awareness and control over her life, instead of being continually sick and intoxicated and acting out in a maladaptive fashion.”
“I can in no way claim a total cure,” Mikuriya cautioned, “but for selected alcoholics, the substitution of smoked cannabis for alcohol may be of marked rehabilitative value.”
That was 1970. Years later, Mikuriya would become one of the most courageous—and persecuted—leaders of our nation’s medical marijuana movement.
In 2003, he published a paper entitled, “Cannabis as a Substitute for Alcohol.” In a harm
reduction regimen adopted by 92 alcoholic patients, Mikuriya found that all 92 reported some
“Even if cannabis is used is daily,” he wrote, “replacing alcohol with cannabis reduces harm because of its relatively benign side-effect profile.”
Cannabis doesn’t damage the liver, spleen, esophagus, or digestive tract, as alcohol does. “Sleep and appetite are quickly restored, the ability to focus and concentrate is enhanced, and energy and activity levels are improved while pain and muscle spasms are relieved.”
In response, an abstinence advocate mocked the idea as “cuckoo,” and held that total sobriety was “the only way to fully recover.” In our current culture, this is not an atypical response.
The vast majority of the institutional medical world agrees with Dr Mikuriva. Most public health
agencies still view any cannabis use as problematic. Sobriety is counseled as the one true path. Yet new thinking around harm reduction is slowly taking hold.
Public health officials now recognize that marijuana offers great hope to people struggling with
opioid use disorder. Methadone maintenance programs, born in the late 1970s, have long reduced heroin-related deaths. Now the next generation of opioid blockers, such as extended-release naltrexone, is allowing patients to use a single monthly injection to block the body’s opioid receptors, reduce cravings, and prevent relapse.
Some opioid treatment programs are also using cannabis as an exit drug, with research-proven
success. The controlled use of marijuana eases a patient’s withdrawal from opioids while providing relief from the conditions that led to opioid use in the first place, like chronic pain. Opioid prescription rates are six percent lower in medical and recreationally legal states for marijuana. Researchers began covering this phenomenon in 2019. In just two years, the concept
has moved from an idea mocked as stupid, to an increasingly accepted recovery strategy.
Beginning in 2017, University of Connecticut study found a 12 percent decline in alcohol sales
in states that legalized medical marijuana between 2006 and 2015. A 2018 report by Cowen &
Company found that legal adult-use states saw a 13 percent lower rate of binge drinking than
states that prohibit all cannabis.
“Going sober isn’t a panacea,” was stated in the words of the late Dr. Mikuriya. “The method
may be of marked rehabilitative value for some people, but not everybody. And that’s okay. In
medicine as in life, we too often demand one approved drug for all patients, one approved path to health and happiness. Human bodies don’t work like that, and neither do human lives.”
One thing absolutely doesn’t work. That’s belittling and punishing a person for taking a first step
towards sobriety. A few months ago, I heard a harm reduction worker explain that their work is best done when they meet people where they are.”
“We help them reduce harm from there—on the streets, in their homes and even in a house of
worship. We celebrate when we succeed in whatever form recovery takes. That means we
succeed a good deal of the time. What we don’t do is mock them.”
Small steps lead to great change. In 2021, moving from alcohol to cannabis has literally saved
thousands of lives.
Marijuana is about to become legal for recreational use in the state of New York. The deal
would allow delivery of the drug and permit club-like lounges or “consumption sites” where marijuana, but not alcohol, could be consumed, according to details obtained by The New York
Times. It would also allow a person to cultivate up to six marijuana plants at home, indoors or
outdoors, for personal use.
Once approved, the first sales of legal marijuana are likely more than a year away: Officials must
first face the daunting task of writing the complex rules that will control a highly regulated market of wholesalers and dispensaries, to the allocation of cultivating and retail licenses, to the
creation of new taxes and a five-member control board that would oversee the industry.
Spread the word!
One company in Colorado is aiming to become the first to examine the effects of marijuana on Alzheimer’s disease.
The Denver Post reported that MedPharm Holdings intends to apply for a research and development license “to test delta-9 tetrahydrocannabinol (THC), cannabidiol (CBD) and other
cannabinoids’ effects on Alzheimer’s and dementia patients.”
Albert Gutierrez, CEO of the Denver-based MedPharm, told the newspaper that research on cannabis’ ability to treat Alzheimer’s is a largely unexplored front.
“We haven’t yet tapped into what this plant can really do to help alleviate the symptoms,”
Gutierrez told the Denver Post. “We hear a lot of anecdotal evidence as far as helping with
epilepsy or helping with arthritic pain… now it’s time to put the cannabinoids to the test and really understand what cannabinoids and what doses and what delivery methods really help
deliver that relief.”
According to the Post, Colorado lawmakers introduced research and development licensing “in
2017 with the passage of House Bill 1367 but left it up to municipalities to individually decide if
they would offer it. So far only one company — MedPharm — has ever applied for an R&D
license, according to the Marijuana Enforcement Division.”
Cannabis research has been hamstrung by the fact that pot remains illegal on the federal level,
but that hasn’t stopped many in the science and medical community from pursuing weed-related discoveries — particularly its effect on patients.
Thorsten Rudroff, a professor in the department of neurology at the University of Iowa’s Carver
College of Medicine, is currently looking for volunteers between the ages of 50 and 80 to
participate in a study that will examine whether cannabis use creates a greater risk in them
falling. The study will feature two pools of individuals: those who do use marijuana, and those
who do not.
For Rudroff, it’s an opportunity to examine pot use among a group of people who may not be
the best equipped to dabble. “It’s self-medicated,” said Rudroff. “They don’t know how to use
medical cannabis. There are no guidelines, no recommendations out there. We want to find out
what is the best and safest product.”
A study published in March 2021, in the journal JAMA Internal Medicine found that cannabis
use among senior citizens jumped a dramatic 75 percent in just the last three years!