Is California sober an authentic path to recovery from opioid addiction or a dangerous form of denial?

A “kinder, gentler” alternative to total abstinence or just an “excuse to get high”?

Opinions run strong on California sober, the practice of abstaining from all drugs — opioids, meth, cocaine, alcohol — except marijuana or psychedelics.

The idea is to use cannabis in a way that enhances your life rather than consumes it, while avoiding the substances that so often lead to despair, overdose, and death.

If you’re struggling with opioid addiction, you may wonder: Could California sober work for me?  

The answer may depend on your addiction history, goals, reasons for using marijuana or psychedelics, and ability to control your use — all topics to evaluate honestly and with your provider.

But know this: If you continue to use marijuana while in treatment for opioid use disorder (OUD), providers at Ideal Option will support you.

“Patients who test positive for marijuana can still progress through the stages of recovery from OUD,” affirms Brian Dawson, M.D., chief medical officer at Ideal Option and an addiction medicine specialist.

While cannabis can be addictive and poses a number of health risks, it’s clearly less dangerous than opioids.

“Opioid use disorder is life threatening,” says Dr. Dawson. “Pot use, alone, is not.”

California Sober and Celebrities in Recovery

The California sober controversy has played out publicly, with dueling takes from celebrities who’ve ventured down that path.

It was music journalist Michelle Lhooq who first popularized “Cali sober,” back in 2019, when she moved to California and gave up opioids, cocaine, alcohol and all other drugs except pot and psychedelics.

She called California sober a “kinder, gentler” way to achieve spiritual fulfillment.

In 2021, singer Demi Lovato followed suit, three years after a fentanyl overdose nearly killed her. Lovato’s song “California Sober” calls this way of life “a beautiful and magical beginning.”

A few months later, Lovato changed her tune. “Sober sober is the only way to be,” she posted on Instagram.

In 2022, another celebrity proponent of California sober, pop singer Aaron Carter, insisted the “Cali sober method” had helped him after five stints in rehab had not.   

“I actually just hit five years clean,” he announced.

Five days later, Carter drowned in his bathtub, an accident caused by sedatives and gas he’d inhaled from a spray can.

Clearly, for some, California sober is a mirage. Others say using marijuana allows them to thrive in recovery.

Still, it’s important to understand the risks — of cannabis itself and of continuing to use one potentially addictive substance while abstaining from another.

For one thing, today’s marijuana is not your parents’ pot.

“Marijuana today has much higher THC concentrations than in the past,” says Dr. Dawson.

Today’s highly potent pot is more likely than earlier varieties to trigger psychosis, paranoia, and depression.

And these days, marijuana is sometimes mixed with other substances, even fentanyl or meth. “You don’t necessarily know what you’re getting,” Dr. Dawson cautions.

Anyone who uses marijuana should get it from a licensed dispensary, he advises.

Marijuana also can cause memory loss, impaired judgment, and gastro-intestinal distress.

“In the emergency department, we see people with vomiting and abdominal pain who are in denial that it was caused by marijuana,” Dr. Dawson says. “They’ll say, ‘I take pot for my abdominal pain.’”

Another concern about California sober is that patients will use marijuana or psychedelics to self-medicate for insomnia, anxiety, depression, or other mental health conditions.

Neither substance is FDA-approved for those conditions, and better medications exist. “We work with patients to find other treatments to replace marijuana,” Dr. Dawson says.

As for psychedelics, Dr. Dawson favors their use in controlled therapy and research settings, as some substances show promise for treating depression and anxiety disorders. However, he says, “Psychedelics are not something we promote at our clinic because we don’t have enough science on them, and I would not suggest them as a treatment for OUD.”

Hands down, the best treatment of opioid use disorder (OUD) is Suboxone, an FDA-approved medication proven to suppress withdrawal symptoms and cravings while dramatically reducing the risk of overdose and death.

Can you use marijuana while on Suboxone? Yes, the combination is not inherently unsafe. 

Some patients on Suboxone continue to use pot, whether for pain relief, to maintain a sense of calm, or because they fear they’ll return to opioids without it.

But many soon discover that while on Suboxone, it’s easy to give up pot.

“A lot of people who were self-medicating opioid withdrawal symptoms with pot find that once their OUD is managed, they no longer even need marijuana,” says Dr. Dawson.

When OUD patients do use pot, providers regularly check in, asking if patients feel marijuana is interfering with their jobs, relationships, motivation, or other aspects of life in recovery.

“Some people are able to use marijuana regularly and function in society and still feel like themselves,” says Dr. Dawson. “They’ll say, ‘Marijuana works for me. I’m thriving.”

Others find pot has overtaken their lives, derailing the progress they had made in recovery. “We treat a lot of patients with cannabis use disorder,” says Dr. Dawson.  

Still others realize marijuana use has led them back to opioids, and their next go-round in recovery needs to exclude pot.

California sober can be a slippery slope, especially for patients who live in states where marijuana is illegal. To buy pot, they may need to mix with the same crowd that deals and uses opioids or meth. Before they know it, they’re back where they started.

Michelle Lhooq described California sober as a way to “expand my mind, but without the selfishness and addiction.”

For others, California sober is simply a form of harm reduction.

“California sober is a catchy term,” says Dr. Dawson. “California is cool, and if California is cool with it, it must be OK. But that doesn’t tell the whole story. The term ‘harm reduction’ doesn’t sound as sexy as ‘California sober,’ but for many people, that’s what it is.”

Dr. Dawson emphasizes that Ideal Option patients will never be judged for using marijuana or psychedelics.

“If you embrace the California sober concept, and it works for you and you still need help with your opioid use disorder, we can help you.”