Marijuana For Psychiatric Disorders

Question 1

What are the main arguments for the use of marijuana and possible benefits?

Answer 1

1) People are already using cannabis successfully to treat psychiatric conditions
2) Dosage (including delivery method) and strain matter (just because some cannabis is stronger now than it was in the past doesn’t negate the positive implications of medical use)
3) Saying that cannabis is helpful for some people does not deny that it might be harmful for others
4) It is unethical not to include cannabis on the list of possible wellness tools (in states with legalized cannabis for medical use there was a 10.8% reduction in the suicide rate of men in their 20s and 9.4% of men in their 30s)
5) Legalizing alcohol reduced its incidence of usage; could marijuana legalization reduce alcohol usage further? Also, could marijuana legalization increase education and awareness about marijuana usage for youth (moderation not abstinence)?
6) There are risks to psychiatric pharmaceuticals as well
7) The human body has an endocannibinoid system that cannabis is uniquely suited to interact with

Question 2

What are some support and opposition to the argument that people are already successfully using marijuana to treat psychiatric conditions?

Answer 2

• the Heath/Tulane study (1974) proposed that marijuana kills brain cells, however, the rats actually died of asphyxiation from too much cannabis smoke
• Dr. Ken Duckworth states that approximately one-third of people in America with schizophrenia regularly abuse cannabis (but is this a case of marijuana causing psychosis, or that individuals more susceptible to psychosis are more likely to try marijuana?)
• Cannabis has demonstrated usefulness for anxiety, PTSD, depression, reducing psychotic symptoms, and helping people get off psychiatric medications and painkillers

Question 3

What are some supporting and opposing arguments around the argument that dosage and strain matter?

Answer 3

• Maureen Dow’s (New York Times columnist) wrote about her psychotic episode when consuming pot in Denver and it was considered proof that cannabis is a bad idea for anyone at risk for psychosis (however, she consumed a second edible when she didn’t feel the impact of the first and then felt the overwhelming effects)
• If a drug is useful at one dose and harmful at a higher dose, does this make the drug harmful, or a particular usage harmful
• Differences between cannabis strains is like taking completely different substances (there are 483 known compounds in cannabis and at least 84 different psychoactive cannabinoids of which THC is just one)

Sativa = more energetic high, prone to produce anxiety and paranoia in some people
Indica = more sedating

CBD = sedating effects
THC = more mind-altering, possibly anxiety/paranoia inducing

Question 4

What are the arguments against marijuana for the treatment of psychiatric disorders?

Answer 4

1) Marijuana use is connected with psychosis, anxiety, depression, and addiction and has harmful effects on cognition, psychosis, and motivation (Nora Volkow et al 2014)
2) There is no current evidence that marijuana is beneficial in the treatment of any psychiatric disorder (APA position statement)
3) Marijuana can produce cognitive deficits
4) Marijuana use by genetically vulnerable individuals correlates with emergence of psychotic disorder and ongoing use in patients with schizophrenia is associated with worse outcomes
5) Individuals with psychotic or conduct disorders who used marijuana had double the risk of addiction; triple the risk of mood, anxiety and ADD; quadruple the risk of personality disorders and alcohol dependence; and cocaine dependence increased by a risk factor of 6.
6) 9% of people who try marijuana will develop a cannabis use disorder (however this is still less addictive than nicotine [68%], alcohol [23%], and cocaine [21%])

Question 5

What are some cognitive deficits experienced by marijuana users?

Answer 5

1) Non-intoxicated regular cannabis users perform worse on global neuropsychological tests by a third of a standard deviation or less (may recover w/in days to months after cessation of use), and severity is worse with early age of onset, high frequency and long duration
2) Marijuana-induced cognitive dysfunction may account for its association with motor vehicle accidents