LOS ANGELES — Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled.
All this took place in plain view of the clinic’s director.
“The rules here are a little lax,” Mr. Michaud said.
In almost any other rehab setting in the country, smoking pot would be a major infraction and a likely cause for being booted out. But here at High Sobriety — the clinic with a name that sounds like the title of a Cheech and Chong comeback movie — it is not just permitted, but part of the treatment.
Dr. Wallace is quick to note that his evidence is anecdotal and more study is needed. Research in rats, he said, supports the idea that the use of cannabinoids can induce withdrawal from heavier substances. But in humans?
A report published in January from the National Academy of Sciences on the health effects of cannabis “found no evidence to support or refute the conclusion that cannabinoids are an effective treatment for achieving abstinence in the use of addictive substances,” said Dr. Marie McCormick, a Harvard professor who was the chairwoman of the report committee.
“The concept on its face is absurd,” said Dr. Mark Willenbring, a psychiatrist who treats addicts and formerly oversaw research at the National Institute for Alcohol Abuse and Alcoholism. He said that alternative approaches are needed to traditional drug treatment, but not this.
The idea stems not only from the legalization of marijuana in several states, including California, but also from a broader reckoning taking place in the traditional addiction treatment business: Substance-abuse treatment often fails, costing families, the government or insurers tens of thousands of dollars per therapy. Many patients quit partway through treatment, or relapse time and again.
These failings have become more apparent owing to a handful of developments: a growing death toll from opiates and an increase in the death rate of young white adults caused by drug overdoses. There also is a growing conversation about whether some update is needed to the bedrock 12-step program: It demands total abstinence but many people fail and ultimately die.
Another paper, published this year in The International Journal of Drug Policy, found that 30 percent of the 271 respondents reported that they used pot as a substitute for opiates. (But the researchers noted that the sample could be unrepresentative and that it was not known if weed provided a partial or total substitute for other drugs, and how much other drug use was displaced.)