Rosie Rurka had a reputation as the frontline drugs worker who brought people back from the dead with naloxone after they had overdosed at the beginning of British Columbia’s overdose crisis. Now, she is better known for supplying people addicted to opioids with high-dose cannabis edibles, in a “cannabis substitution” approach.
“People need something to get over the hump in the post-acute withdrawal stage,” says Rurka, herself a former intravenous user on Vancouver’s Downtown Eastside. “When we only have other opioids like suboxone and methadone as replacement drugs, we’ve got a problem. We know cannabis is not addictive in the sense that you’re going to be dopesick without it. You can eat a high dose cannabis cookie and get through the withdrawal.”
Rurka, who lives in Surrey, just outside Vancouver and works for a non-profit as an addictions specialist, started baking the cookies in December 2022. She was inspired by cannabis activist Neil Magnuson, who in the mid-2000s trekked across Canada calling for legalisation. Magnuson later helped people get off methamphetamine and heroin with his Cannabis Substitution Project out of his unlicensed dispensary, The Healing Wave, where products were sold at a fraction of the prices elsewhere.
Magnuson was arrested in May 2022, however, with his supply of cannabis confiscated and his shop shut down. He died earlier this year, aged 67, ahead of his trial, still fighting for the right to supply cheaper, unregulated cannabis products to people in need.
“They raided him several times despite cannabis legalisation, saying that because he wasn’t using government produced marijuana, and because his edibles were high-dose, there was no way they’re going to give him a licence to run the compassion program,” says Rurka. “Legalisation did nothing for us. It just monopolised the market.”
Magnuson is credited locally as the man who discovered that high-dose cannabis edibles can help people get off of opiate-based drugs. Today, there are around 250 people who are part of the club he founded, which is run by his son and other activists, out of a van. Rurka has 20 members who pay CA$50 a month and another 60 who access her service more informally.
“Some need a huge dose”
“Every week, they meet me and I give them a care pack with 7g of cannabis flower and up to 500mg of edibles,” she says. Some need to take a huge dose at least 500mg to obtain the benefits and reduce the desire for drugs or alcohol. (For reference, 50mg would be considered a serious dose for many people). “When you’re on the hardest substances, you need to have something a little bit stronger to feel it,” says Rurka. “I know people who need 1,000mg.”
While there have been no registered cases of fatal THC overdoses, Rurka stresses that cannabis does not work for everybody. “Some people get really paranoid and go crazy,” she says. “That’s why I always say, ‘Low and slow, and work your way up.’”
The nature of the interaction between the opioid and endocannabinoid receptor systems when cannabis is consumed is still poorly understood, but experts have said, unsurprisingly, that your mood can affect the nature of the high.
Whatever the answer to the divergent experiences people can have with cannabis, Rurka says, many could benefit from expanded legal and medical access to the herb through a compassion programme, offering similar products at better prices to consumers. “Could you imagine if the government just gave me a licence for a compassion programme and supported it?”
Rurka highlighted that one of her members had been on methadone for almost 40 years, but was able to transition off it after consuming high dose edibles for several months. She now volunteers, assisting Rurka on the project. Others have told of recovery thanks to Magnuson. A 32-year-old from Burnaby, next to Vancouver, told The Tyee she had been addicted to opiates for six years but that high-dose edibles had helped her get off heroin and fentanyl completely over the course of a year.
“The program has saved my life in more ways than one,” a mother-of-three told the Vancouver Sun separately. “I’ve been able to see my kids. When I was using, I wasn’t in their lives at all, because my life was consumed by the drug. Now, when I wake up in the middle of the night in withdrawal, I take a cookie or gummy to get that fix. I also take capsules throughout the day. It’s been a lifesaver. I don’t want to suffer any more overdoses from opioids.”
Jeremy Klassen, another former Downtown Eastside resident, said cannabis helped him refrain from using methamphetamines for all of 2020. “Cannabis lets me lift the needle off the record. It takes it out of that groove,” he told The Tyree. “I get out of an ugly loop of obsession.”
How cannabis can reduce withdrawal symptoms
There is further evidence of this approach’s success across the Canadian border. In American states where medical cannabis was legalised, opioid overdose deaths fell by a quarter from 1999 to 2014, research suggests. Further data indicates that the use of cannabis for chronic pain leads patients to significantly reduce consumption of opioids, as cannabis helps reduce withdrawal symptoms. In a study released this month by the University of Southern California, academics interviewed 30 people who were using opioids, cannabis, and injecting drugs. They said cannabis helped them manage their drug use. Another study, which was conducted by British Columbia’s Centre on Substance Abuse with more than 800 people, reports that people with THC in their system are far less likely to consume fentanyl.
Further research is underway. “We’re talking about thousands of people in the study that we run,” says Michael-John Milloy, a research scientist at BC’s Centre on Substance Use . “In one study we have which is about to be submitted for peer review, we found that folks using cannabis compared to folks not using cannabis have significantly lower rates of non-fatal overdose.
“When it comes to the overdose crisis, what we’ve seen are really beneficial associations between various measures of cannabis use and some of the most important risk factors for fatal overdose.”
A new pilot safety feasibility study, publicly funded by the Canadian government, is currently recruiting participants who will receive medical cannabis alongside methadone. It will be the first study in which THC is administered for addiction, according to Milloy.
“The legal cannabis system is tremendously inefficient and ineffective. It works fine for me, a middle class consumer, and yet folks using it to stay alive really have no access to it, despite a situation where we have hundreds of thousands of kilograms of unused surplus cannabis sitting in warehouses,” Milloy says.
While people like Rurka have taken action, using cannabis as a form of substitution therapy for opiates, research is still developing in this field to better understand the science behind this displacement effect. It is true that the risk of fatality from drug use is reduced when people transition from opioids to cannabis consumption, but encouraging the use of large THC doses is potentially risky; the risk is exacerbated if people are not aware of any pre-dispositions to cannabis-related psychosis or other related harms.
