With the opioid crisis killing thousands of people every month, traditional 12-step approaches to addiction recovery are under scrutiny. Dismal success rates plague Alcoholics Anonymous, as a culture of shame looms over those who don't abide by AA's rigid guidelines. An abstinence-only approach to recovery, or therapy that ignores dual diagnoses (mental illness and substance abuse) won't work for everyone.
Because addiction is complex, and a one-size-fits-all approach doesn’t work, any viable alternatives to the conventional paradigm deserve consideration. Enter Greener Pastures Recovery (GPR), a rehab in Portland, Maine that practices plant-assisted therapy (PAT), which combines essential herbs and oils with cannabis and kratom, simultaneously. Kratom is a plant related to coffee that is helping many people transition off opioids and other drugs.
Through customized, holistic approaches to addiction recovery, GPR offers a counterpoint to what founder Roxanne Gullikson says are concepts of "tough love" or "rock bottom" prevalent in other programs like the 12 Steps. These attitudes can lead to shame or stigmatization for those who can't abide by the abstinence protocol.
And while medication-assisted therapy (MAT) works for some, suboxone and methadone can be highly addictive, and do not treat underlying issues like anxiety or depression. Using alternatives to MAT, GPR tackles addiction by teaching mindfulness and offering group, occupational and walk-and-talk therapies.
While Gullikson grants that suboxone and methadone can help save lives, her overarching goal is to put a dent in the opioid epidemic — and that was her motivation for opening GPR. In 2015, Gullikson was running a craft cannabis business, when her customers began confiding in her that they were dealing with substance abuse issues. Her cannabis boutique evolved into an addiction recovery practice when she and her husband Ron found that patients were self-reporting that they were tapering off pharmaceuticals as a result of consuming medical cannabis.
The couple began investigating science journals, PubMed abstracts, and online forums to find evidence of people using medical cannabis in addiction recovery. They found that another plant, kratom, could also be helpful.
“We learned that the leaves of the Mitragyna speciosa plant (kratom) could ease the harsh symptoms of acute withdrawal," Gullikson tells Civilized. "Unlike opioids or heroin, kratom only partially activates certain opioid receptors, but does not recruit beta arrestin, which is the cause of respiratory depression and addiction to opiates. With that knowledge in-hand, we felt confident to offer kratom as an option in a recovery plan.”
Kratom creates a mild euphoric feeling, and is used for pain relief, fatigue, mood disorders, and substance abuse treatment. Both kratom and cannabis are adaptogens that help the body resist different types of stress, Gullikson points out, and their effects are usually dose dependent. MAT increases the dosage of suboxone or methadone over time, while the idea of PAT is that a patient can eventually wean off cannabis and kratom if they choose to, or safely continue to use them with an approach like microdosing.
Most synthetic opioids like oxycodone, hydrocodone, and heroin are full agonist in their bonding to and activating the opioid (mu) receptors. In the binding to the mu receptors, breath respirations slow down and can stop which is often the cause of death during an opioid overdose. Kratom is a partial agonist upon the mu receptor and an antagonist upon the other opioid receptor — meaning that it can block the effects of opioids. Because it is only a partial agonist upon the mu receptor, it gives some of the effects of that receptor (euphoria, pain relief), but it doesn’t cause breathing to slow down or shallow, and it blocks the effects on the other receptors (delta and kappa).
Cannabis also works on completely different receptors than opioids, says Julie Holland, M.D., psychiatrist and author, making it a viable alternative for addiction therapy. Additionally, Holland points out that cannabis can help decrease pain or inflammation, which makes the “push” for prescription pain medication less insistent.
According to one cross-sectional survey, more than 60 percent of subjects who used medical cannabis reduced their opioid use; meanwhile, another study suggested that using medical cannabis concurrently with other substance abuse treatments doesn't negatively impact outcomes.
Yet, despite evidence that cannabis doesn’t impede substance abuse treatment, but can actually improve quality of life for a recovering addict, AA still views it as a harmful "drug." The medical community's understanding of addiction was still fairly underdeveloped when AA was founded in 1935; its rigid guidelines put into place back then have not been backed by modern science.
One meta-analysis of controlled studies around the efficacy of AA found that involvement in a 12-step program can be worse than no involvement in any program, while another study found that attending Narcotics Anonymous and AA frequently after receiving treatment can see better outcomes. Because of the anonymous nature, outcomes can be difficult to measure, but in the studies that do exist, the element of self-reporting and motivation play a strong role.
While a handful of alternative rehabs utilize PAT, to date Greener Pastures is the only one using a cannabis and kratom combination. High Sobriety, a cannabis-inclusive therapy program, stresses that abstinence and a strict 30-day timeline don't work for the majority of patients. Limited research exists about PAT, but it does show promise as a safe alternative to potentially lethal pharmaceuticals.
Gullikson says that GPR's gentle, PAT approach has seen success with a variety of conditions: alcohol use disorder, as well as methadone, methamphetamine, benzodiazepine and crack-cocaine abuse. Using their proprietary botanical blends which include broad-spectrum CBD-based tinctures, capsules and oils that are blended with herbs like kratom, chamomile, and kava, GPR created four substance-specific recovery programs for patients: Opioid Recovery, Meth/Cocaine Recovery, Benzo/Alcohol Recovery, and Pharma Recovery.
“We would have family dinners, [bon]fires, group conversations, group yoga, and art projects we did together," says Jordan Anderson, a patient who found GPR to treat severe opiate withdrawal following a series of painful surgeries. She says the customized approach made her feel at "home." Anderson says that kratom helped her greatly with withdrawals, and now she barely takes it because she tapered off over time.
But as with anything that challenges the status quo, GPR has its critics. Dr. Mark Publicker, who runs a medication-assisted addiction recovery clinic (focusing on suboxone and methadone) in Portland, Maine, referred to GPR's use of kratom and cannabis as “harmful nonsense” unfounded in valid substance abuse research.
In response to this type of criticism, Gullikson is partnering with research institutions like University of New England, University of Rochester, and University of British Columbia to launch a three-year human observational study to collect data on the effects, benefits, and long-term outcomes of PAT for addiction recovery. Moreover, she is working to make addiction recovery more accessible with an in-home service called Hope Chest (which, however, does not include medical cannabis).
The Hope Chest offers a patient the ability to get treatment at home, with a box offering their proprietary formulas (Halcyon, Zenbrine, Allay, Eunoia, Orenda) and wellness packs that include items like journals and yoga mats. Offering 30, 60, and 90 day options, this remote program offers a more affordable and accessible option for those who can’t take time off work. Additionally, GP offers Hope Chest subscribers telemedicine sessions, an online peer support group, a community support app, 24/7 telephone support, and one on one recovery coaching.
“To add to the confusion — this idea that addiction recovery and sobriety hinges only on complete abstinence from substance use — people who are struggling with addiction are prescribed cocktails of medication," says Marissa Fratoni, registered cannabis nurse. "So they've traded one set of drugs and substances for another that is prescribed. Often, these cocktails are just as debilitating and disabling as the patient's drug(s) of choice.”
Devoid of the same side effects that come along with pharmaceuticals, cannabis can sub in, while still treating the same indications. “One of the main aspects of cannabis that is different from conventional treatment substances is that, when used in a therapeutic way, it can actually empower a person to cope with stressors, improve awareness for one's condition, and improve motivation for healing," Fratoni says. "Such empowerment is necessary for a person to heal from addiction, thereby improving sobriety outcomes.”