Cannabis to substitute crack

A step by step rehabilitation
22 April 2013
Article

The mayor of Bogota has recently proposed a pilot scheme with crack cocaine addicts to explore the substitution of crack made of cocaine base paste (or bazuco as it is called in Colombia) by marijuana. The substitution treatment plan will include 15 problematic users from the marginalized Bronx area who are already receiving health assistance of the CAMAD operating in that sector of the city. The treatment will last approximately eight months, after which the results will be evaluated.

Treatment options for crack-dependent users are limited, and a substantial proportion of the dependent population is not reached by the treatment system. Some Colombian toxicologists argue that there is no scientific evidence showing the benefits of marijuana to reduce crack cocaine addiction. That is not true. On the contrary, a few serious studies do indicate that the use of marijuana may serve as a substitute for crack. For example, a study published in 1999 in Brazil: Therapeutic use of Cannabis by Crack Addicts in Brazil. Throughout a period of nine months, the researchers followed 25 male patients in São Paulo aged 16 to 28 who were strongly addicted to crack. Most of them (68%, or 17 individuals) ceased to use crack and reported that the use of cannabis had reduced their craving symptoms, and produced subjective and concrete changes in their behaviour, helping them to overcome crack addiction.

Other study

Other available research on the issue is Crack Heads and Roots Daughters: The Therapeutic Use of Cannabis in Jamaica, an ethnographic study of women and drug use in inner city neighbourhoods in Kingston, Jamaica. The study revealed that cannabis was commonly used in conjunction with crack cocaine to minimize the undesirable effects of crack pipe smoking, specifically paranoia and weight loss. According to 33 current or former crack using women, who were followed for a period of nine months, cannabis cigarettes (“spliffs”) constituted the cheapest, most effective and readily available therapy for discontinuing crack consumption.

In the words of one of the participants in the study: “The … spliff is much better to me than the pipe. You can eat and drink at the same time because the herb opens the appetite. When it wears off, I feel like I want a fresh (bath) and sleep. When you smoke season spliffs, you don’t feel ‘paro.’ It is a different meditation. Crack and coke are like demons and devils, they are not good and to how dem see de pipe mash up people, dem a turn to season spliff and some a dem nah touch de pipe.” The findings of the study indicate that rather than serving as a gateway to crack, cannabis may be instrumental in both the prevention and treatment of crack addiction. Of the 14 women who succeeded in discontinuing crack use, 13 attributed their success to the use of ganja.

Cannabis for crack

The 'cannabis for crack' plan of the Mayor of Bogotá is part of broader programme of the city administration to provide treatment to marginalised problematic users and to address the problem of violent crime. "A typical crack addict spends between US$ 380 to US$ 550 per month to maintain his habit," says Julian Quintero of Acción Técnica Social. These figures reveal how marginalised addicts are the victims of a perverse logic of addiction and crime that is nearly impossible to escape on their own.

Juan Daniel Gomez, a drug treatment expert and one of the advisers of the Bogota pilot programme, said in an interview that in addition to traditional psychosocial methods, therapeutic communities and self-help groups, a trial with a "withdrawal attenuator," such as the substitution of bazuco by marijuana, would be valid. Again, this is not anything new, "in Colombia this type of attenuators have been used in specific consultations or private institutions. The most commonly used are anti-depressants; anti-epileptics, beta-blockers, vaccines and even progesterone. Outside Colombia substances like dexamphetamine or methylphenidate (Ritalin ®) have been used successfully because they act on most receptors in the brain that are activated by bazuco and cocaine as well." The main effect that can be obtained with the replacement of crack cocaine with marijuana is the reduction of anxiolytic effect. Marijuana is a substance that reduces stress and anxiety and increases the release of dopamine in the reward centre of the brain on which so-called hard drugs also act, he added.

However, these kinds of treatment should be handled by experts in the field and risk and harm reduction, according to Gómez, and should be based on the individual decision of wanting to reduce consumption. A debate between advocates of a model based on abstinence ideology and models based on harm reduction and risk prevention is not very useful in his opinion. Gomez prefers the use of "natural substances in Colombia and not with pharmaceutical drugs, without abandoning the necessary psychosocial support."

The State should provide cannabis for free

Hopefully the mayor of Bogota will get the support necessary to implement the “marijuana for bazuco” substitution project. The 15 participants of the project will not have anything to lose; on the contrary, this could be the beginning of the end of their problematic use. If the pilot with cannabis is approved and successful, eventually more problematic crack addicts could attempt the transition to marijuana in safe and controlled environments. A study on the effects of controlled consumption of marijuana by cocaine base paste addicts is now more relevant than ever given that its use is spreading across the hemisphere. Measures to solve problematic cocaine base paste (or paco) consumption are the subject of great concern in Brazil, Uruguay and Argentina as well.

In Uruguay, medical advisers to the Ministry of Public Health are considering systematizing the positive results of the use of marijuana to rehabilitate cocaine base paste addicts. Dr. Raquel Peyraube said that she knows from experience that "three to four puffs marijuana every four to six hours, in some severe cases more often, helps them to regulate and remain abstinent from cocaine base paste. This also benefits public safety because the person under the influence of marijuana is not out to steal, use violence and breaking the house apart, but is relaxed." In addition, the president of the Supreme Court of Justice (SCJ) of Uruguay, Jorge Pino Ruibal, said that "the state would have to provide marijuana for free" to help problematic base paste users “to escape their addiction."

In Brazil, the National Council for Drug Policy (Conselho Nacional de Políticas sobre Drogas - Conad), under the Ministry of Justice, is also considering the possibility to decriminalize marijuana for medical purposes, in particular for the treatment of crack.

To say, as some observers have said in Colombia, that there is no experience with this type of treatment is inaccurate and does not help in a rational search for solutions to a problem that has already spread too far in some neighbourhoods of Bogota, which has some 7,000 problematic bazuco users.

Monday, April 22, 2013