On addiction: An open letter from a prohibition mom turned medical marijuana pharmacist

Maitri Medicinals Director of Pharmacy, Terri Kroh, and her son, Ryan

A prohibition mom

My story is not unlike many in America today. I grew up with the war on drugs. My children were indoctrinated with the D.A.R.E campaign and there was no tolerance for drugs in my household. Just Say No, right?

As a pharmacist, I learned the mechanism of action of many drugs, and of the biochemical process of addiction. But I wasn’t taught in pharmacy school that opioids were addicting—and could kill you—or that the health of every individual depends on the endocannabinoid system working appropriately.

I would eventually come to understand these things first hand from one of my life’s greatest teachers, my son Ryan.

The drug war in my household began when Ryan was 15 years old. The local police department arrived at my home early one Saturday morning–dogs and all. Busted with a bong made out of a water bottle, Ryan landed in a 12-step program, and in and out of rehab. This was the tragic twist for Ryan—these programs were grounded in the philosophy that abstinence from all drugs was the path to recovery—an approach I now believe isn’t right for everyone.

It’s worse than you can imagine sleeping on the floor with your child while they go through opioid withdrawal. Hearing the words, “Help me, Mom,” but not the district attorney or the coroner felt extremely encouraging at the time. But when Ryan asked for marijuana to ease the pain, I refused. “I’ll get you some Pepto-Bismol instead to help with the nausea and vomiting.” I flushed his pot down the toilet more times than I want to admit.

Eventually, I’d find out that marijuana really does help battle addiction. That it’s not a gateway drug. That 7-14 days on an antibiotic isn’t going to cure it. That addiction is not a moral failing.

Addiction is a disease.

Harm reduction gave us hope

As a pharmacist working in the harm reduction community, I accepted that people used drugs of all kinds. My job was to keep them safe while using drugs. Though I knew it was less harmful, I couldn’t get past marijuana being a Schedule 1 drug. It helped our patients with HIV and cancer, but I didn’t really understand how or why.

The opioid epidemic had yet to become front page news. During those years, I was fortunate to work with an amazing team of harm reduction advocates. They were brutally honest with me that my son could die. Thanks to Prevention Point Pittsburgh, I was able to access Naloxone, the life-saving drug that can reverse an opioid overdose.

Ryan’s survival became our family’s focus. I taught his younger sisters how to recognize an overdose and how to use the vial of Naloxone to save their brother.

The counselors offered but one solution: “Tough love.” “Let him hit rock bottom.” “Don’t enable.”  “Kick him to the curb.”

It was tough love for me to teach my son how to use his drug of choice safely in order to stay alive, or how to prevent an overdose. To constantly be reminding him:

Don’t use alone.

Don’t share your works.

If you have no clean water, use the back of the toilet, not the bowl.

Keep Naloxone on your person.

Save your friends, don’t you dare walk away.

Call 911, perform rescue breathing.

This wasn’t permission from Mom to get high—it was survival training. It was for my son to know that I accepted and loved him despite his drug use.

The prescription for Naloxone didn’t stop him from using drugs, nor did it result in his overdose reversal, but it gave him a chance to keep fighting and to know there was no judgement. I felt his pain. I wanted to pull him out of the shame and stigma associated with drug addiction instead of pushing him further into it.

I couldn’t save him but damn, I tried. Ryan would sadly lose his battle with addiction at the age of 20 years old.

Ry is my Why

How did I end up working at a medical marijuana company seven years later? I’m now educated on the science behind why medical marijuana works for opioid use disorder. I see truly amazing success stories every day at Maitri. People who could barely walk because they were so overly medicated are opioid-free one month later and look like completely different people. Others are down to just one pill at night when the pain catches up with them.

I see with such clarity now what my boy was trying to tell me. Medical marijuana works, and it helped him! I just couldn’t wrap my head around it then.

I have the power of my voice back now. I’m ready, willing and strong. I know that I have found a way to create good from Ryan’s life. I am humbled and grateful to walk besides those who are overcoming these powerful drugs and thriving.

Terri Kroh in a patient consultation at Maitri’s Uniontown dispensary.

Medical marijuana therapy for opioid use disorder

Every patient has different goals, and we create custom tapering plans for everyone at Maitri. Here are some of the things we tell all our patients battling opioid use disorder:

• Maitri is a safe space.  We are real people who’ve gone through a lot of these same challenges. We’ll walk with you on your journey. We want you to feel zero shame about your disease.

• Focus on strains that are high in Beta Caryophyllene, because it’s a very potent anti-inflammatory agent, as well as Linalool and Limonene because they’re good for anxiety and depression.

• Consider starting with a 1:1 THC:CBD strain. Many patients trying to taper off opioids don’t want to feel high, and the CBD in a 1:1 will help balance the euphoria that THC can bring.

• Remember that as you taper, your opioid tolerance goes down. This is critical to keep in mind if you decide to increase your opioid dosage again.

• Always talk to your doctor and pharmacist before changing the dosage of your opioids or medical marijuana—all drugs have potential side effects, risks and benefits. We are fortunate to have many physicians who will collaborate with us on a treatment plan that gradually tapers their patients off opioids.

• There have been no reported marijuana overdoses resulting in death.

I know now that the endocannabinoid system has its own natural harm reduction abilities, and that medical marijuana can potentially reduce the harm caused by chemical imbalances in the body. If my son were here today, I’d offer him the following harm reduction tips for treating opioid use disorder with medical marijuana therapy:

• Don’t mix medical marijuana with other drugs, including alcohol, because it can potentiate the effects.

• Talk with your health care provider about how all your prescription medications—not just opioids—might interact.

• If sharing, clean your vaporizer to avoid infectious disease.

• Use caution with edibles because their effects can last longer and be more intense.

• Don’t inhale too deeply or hold the drawl too long. This can deliver more carbon monoxide to your brain.

Lastly, if you consume too much, don’t panic—you won’t die.

This bud’s for you Ryan! RIP – one love. 

RESOURCES

Click here to watch The Exit Drug, a documentary created by Weedmaps that investigates how cannabis could play a major role in ending the opioid crisis, a public health emergency that kills an average of 130 U.S. citizens a day.

Click here to learn about how to join the battle in removing the stigma associated with the chronic disease of addiction.

Click here to read the Pennsylvania Department of Health’s Response to The Heroin and Prescription Opioid Crisis. Medical marijuana is discussed starting on page 44.

Click here to watch a video produced by the Pennsylvania Department of Health demonstrating how to administer naloxone, a medication that can reverse an opioid overdose. Naloxone is available at all Pennsylvania pharmacies, and per the standing order issued by Dr. Rachel Levine, no prescription is needed to purchase it.