Cannabis for Treating Psychiatric Problems? A Clear Yes, Maybe.

Will Hall
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Marijuana is now legal in two states, and legal for medical use in 23 states and the District of Columbia. Polls show the majority of Americans support cannabis legalization, and more and more of the country is joining the legalization trend. As a counselor working with people diagnosed with psychosis and mental illness I am often asked about my opinion and clinical experience — as well as my personal experience — with medical cannabis.

The issue is not clear-cut either way, but I think it is time for everyone, especially if you are concerned with the risks of pharmaceutical drugs, to set aside what we think we may know and take a serious look at cannabis as an option for people with serious mental health challenges. Medical use of marijuana has clear potential for reducing psychiatric drug use, drugs that are notorious for their devastating adverse effects. The decision to use cannabis is not simple, and along with the War on Drugs anti-pot propaganda there is also a lot of pro-marijuana fanaticism to wade through, but this is the reality: many people can forgo pharmaceutical drugs and use cannabis instead.

I don’t need to reiterate the extensive research on medical use of cannabis available on the internet, and I have already written about cannabis and substance use in counseling practice in a previous post on Mad In America (“The Substance of Substance Use”). But here are some more thoughts about cannabis specifically.

There is now widespread evidence people are already successfully using cannabis to treat psychiatric conditions. Cannabis has long been used as medicine and spiritual tool throughout human history, for for far longer than the brief period of prohibition when it’s been criminalized. Criminalization didn’t come from medical assessment of cannabis’ usefulness, but was instead a political decision motivated by racism and suppression of the insurgent youth culture. Extensive studies showing medical benefits — for cancer, Alzheimers, multiple sclerosis, hepatitis C, irritable bowel, Parkinsons, pain management, and other conditions — have driven ballot initiative success around the country. This has begun to convince even longtime opponents, with US President Obama formally acknowledging cannabis as no more dangerous than alcohol, and CNN’s chief medical correspondent Dr. Sanjay Gupta, one of the world’s most influential opinion leaders on medicine, recently reversing his opposition to medical marijuana. Dr. Gupta even apologized for his previous anti-legalization stance and “not looking hard enough” at the issue.

But what about mental health conditions?

Around the country, medical marijuana cards are routinely given to people suffering anxiety, depression, insomnia, ADHD, trauma, and mental health issues. The internet is replete with a growing number of testimonies of successful symptom alleviation through cannabis, including people diagnosed with psychotic disorders such as bipolar and schizophrenia, These are not just a few anecdotes, these are thousands of people giving firsthand accounts of benefitting from cannabis for mental health conditions. And with the growing number of dispensaries, review websites, and legal cannabis consumers, these testimonies are growing in number.

And at the same time, it is not uncommon for me to receive emails like this:

“Our son was doing so well in school, and then he started smoking marijuana and went psychotic and went into the hospital, where he was diagnosed with schizophrenia.”

“Before her delusions began I learned she was experimenting with marijuana…”

So what is going on?

Our culture has been saturated for years with a simplistic prohibition mentality around marijuana. Media reports demonize cannabis, with many scientific studies were twisted and manipulated to support a political agenda. Just one notorious example was the Heath/Tulane study in 1974. which claimed to show marijuana “kills brain cells.” These findings, reported by a mainstream research institution with impeccable scientific credentials, were considered gold standard evidence and quickly became part of the mainstream attitudes. “Marijuana kills brain cells” was paraded by President Reagan in his anti-drug propaganda and brought out by frightened parents everywhere when they discovered a joint in their teenager’s bedroom. The study even supported extremist media campaigns like the “This is your brain on drugs” television commercial, where a broken egg on a hot griddle became the last word on marijuana dangers.

The Heath/Tulane study was later exposed as pure scientific fraud: researchers were able to show brain cell death only by pumping so much marijuana smoke into the laboratory animals that the animals couldn’t breathe. It was asphyxiation from lack of oxygen, not ingesting marijuana, that caused the brain damage. The poltiicization of science continues, and Dr. Gupta writes that of current US marijuana studies, 94% are designed to investigate harm, not potential benefits.  Despite countless other studies showing marijuana’s benefits and extremely low risk profile compared to either tobacco or alcohol – two very legal and very deadly drugs — we have let prohibition politics, not solid science, shape and continue to determine US drug policy and leadership worldwide.

This corruption is even more true in mental health, where substance use has become synonymous with substance abuse, and the mental health system oversees abstinence-based treatments that are often the criminal punishment for users arrested for possession alone. No leading mental health organization has publicly expressed opposition to the War on Drugs or presented an honest discussion of the potential value of legalization. Mainstream mental health websites such as National Alliance for the Mentally Ill and the Schizophrenia Society of Canada continue to echo this demonization. Any potentially valuable caution about the role of cannabis use in psychosis – of which I will discuss more in a moment – gets lost and discredited in the general “just say no” message. There is no balanced discussion, not of how cannabis might help some people forgo the risks of psychiatric drugs relative to the possible risks to adolescent brain development. Mainstream opinion makers, driven in part by pharmaceutical and American Medical Association opposition to legalization, have instead elected to emphasize the psychosis-marijuana link research and ignore everything else.

NAMI medical director Dr. Ken Duckworth sums it up on the NAMI website “The overwhelming consensus from mental health professionals is that marijuana is not helpful—and potentially dangerous—for people with mental illness.” He doesn’t point out that this consensus is a result of politics, not medical science. The rest of the policy document has War on Drugs propaganda on full display. Dr. Duckworth writes, “Approximately one-third of people in America with schizophrenia regularly abuse marijuana.” Really? Can we see a study citation for that statement? The answer is no, there is no citation because NAMI made this claim up, there is no research behind it.

Dr. Duckworth also rings the alarm bell of addiction, counting the mental health industry’s conflation of use and abuse. He states that “a significant percentage of individuals who use marijuana will become physically dependent on the drug. This means that stopping their marijuana abuse will cause these people to experience a withdrawal syndrome.” Dr. Gupta, however, disagrees. Dr. Gupta writes on CNN that “In 1944, New York Mayor Fiorello LaGuardia commissioned research to be performed by the New York Academy of Science. Among their conclusions: they found marijuana did not lead to significant addiction in the medical sense of the word…” He adds, “The physical symptoms of marijuana addiction are nothing like those of the other drugs I’ve mentioned.”

My bet is with Dr. Gupta on this one. As Dr. Gupta’s reversal indicates, there is a clear case for legalization of cannabis because there is an undeniable scientific research base — and common sense base – for cannabis’ benefits relative to its risks. As a recreational drug there is just no comparing cannabis risks to other drugs such as alcohol and tobacco. But in the context of the War on Drugs’ demonization, proponents of marijuana have reacted with a defensive romanticization, adding to the confusion. Left in a vacuum by mental health and medical organizations that should have been providing sound and honest discussion on the issue, the many mainstream research studies on medical benefits of cannabis are often touted and available on aggressively pro-marijuana sites. You feel that you are pulled to one side of the other in this political – and economic – tug of war. (The pro-marijuana sites are after all, now burgeoning with advertising revenue from the surfacing marijuana industry. The message today is “cannabis is good for you,” and of course the next message will be “buy some today” and then “from us.”)

As a society we are thankfully stepping away from both demonization and romanticization. And this means looking at two important facts about cannabis: dosage and strain. 

The cannabis of today isn’t the cannabis of yesterday. But the commonplace claim that “marijuana today is stronger than it was in the past” is far from the whole picture. Yes there is a lot more strong marijuana out there, but that also has positive implications for medical use. There is a an increased complexity and sophistication of how cannabis is being used, in many different ways by many different people, that has to be understood.

As far as dosage goes, the importance of understanding this complexity is well illustrated by the experience of New York Times Pulitzer Prize winning columnist Maureen Dowd. In a high-visibility, and influential, act that formed part of Times reporting on growing legalization efforts in Colorado and elsewhere, Dowd got high on pot in Denver. And promptly had a psychotic episode. She presumably didn’t go on to be diagnosed bipolar, and did not need to be hospitalized, but her bad trip, replete with delusions of being dead and paranoid fears of the police, for some might be considered proof positive that cannabis is a bad idea for anyone “at risk for psychosis.”

Dowd, however, was in effect writing a denunciation of wine by binge drinking on tequila. “Alcohol makes you sick and pass out” says more about how, how much, and what we drink, than it does that we drink alcohol. Simple enough common sense, but that is exactly what has been lost with prohibition propaganda. Without adequate understanding, Dowd apparently downed an entire cannabis infused edible candy. Edibles are notorious for their potency. Then she did what anyone following sensible marijuana use knows not to do – she gobbled up even more of the edible when she didn’t feel any effects after a few minutes. She doubled the eventual impact of the drug, and delivered a massive dose to her marijuana-naive self after the slow-onset that is standard for eating marijuana (smoking effects are much faster; eating means the cannabis has to be digested before experiencing amplified effects.). It could be humorous – Dowd was lambasted in the internet for her irresponsibility – if it wasn’t so emblematic of the impact of prohibition. Rational discussion by a presumably thoughtful professional journalist turns into nonsense, fuel for more simplistic demonization.

Dosage, including the delivery method (and now there are tinctures, vaporizers and other methods beyond smoking or eating), is an important reality to cannabis consumption. If a drug leads to psychosis at a higher dose, but doesn’t at a lower dose, is the problem the drug or its use? If a drug at one dose is useful and at a higher dose is harmful, does that mean the drug is “useful” or “harmful?” So we begin to see one explanation for how a drug that many people find useful for psychosis can be the very drug that causes psychosis for many others. It becomes more understandable that my email inbox has emails from people blaming marijuana for mental illness alongside emails from people who’ve been helped.

Dowd also didn’t chose her strain with any care, and strains can make a huge difference in cannabis use. There are hundreds of strains of crossbred hybrid cannabis, with colorful names like Blue Dream, Girl Scout Cookies, AC/DC, and Lemon Alien Dawg. This diversity isn’t just fanciful or aesthetic: strains differ by aroma and flavor, Much more importantly, different strains have drastically different psychoactive effects. Alcohol intoxication might feel a bit different between beer, wine, and spirits, but not by much The different effects between different cannabis strains are like taking completely different substances.

There are 483 currently known compounds in marijuana, and at least 84 different psychoactive cannabinoids. THC is just one. This may explain why some people are using marijuana to alleviate psychosis while others find it makes psychosis worse. Medical marijuana users routinely share information about the qualities of different strains – some good for sleep, some for anxiety, some for depression, etc – to help each user find out what works for them. Of the many alkaloids, cannabidiol (CBD) is associated with anti-anxiety response, while THC causes more mind-altering, and is potentially paranoia and anxiety inducing. Similarly, marijuana users have long known that the sativa varieties are different than the indica; sativa is associated with a more energetic high, prone to produce anxiety and paranoid in some people. while indica is more sedating. There is strong evidence that high CBD cannabis can alleviate psychosis for the simple reason that it is anti-anxiety, in the same way that anti-psychotics are for many people helpful because they are tranquilizing. CBD, however, clearly lacks the devastating side effects of antipsychotic drugs.

(The cannabis industry is still only now emerging from the underground, and with lack of the regulation and quality control of other industries users still have to rely on trial and error. It’s not a guarantee that what the dispensary labeled as Blue Dream isn’t actually Kali Mist, or there isn’t sativa in that tincture marked indica. Medical users will be better served by legalization, which will allow greater testing and reliability of supply, as in the wine industry. The best role of regulation in the legalization process is fiercely debated by growers concerned about issues such as ecological sustainability, labor conditions, and the specter of Big Tobacco-style profiteering. In Sonoma County where I live, there is a huge marijuana industry and vast sums of money moving into the state in anticipation of California following the trend towards full legalization. The legal wine industry in the area is very shady, and has a deserved reputation for greedy disregard for the environmental and local community in its rapid expansion. That might be a cautionary tale: the gentle peace-ecology-love aura of marijuana may, some fear, quickly give way to the cutthroat realities of just another boom industry and agribusiness product.)

Word about CBD is getting out. Along with the emails from people tracing psychosis back to marijuana use, I now routinely encounter people in my work, lucky to be in a legal state or country or able to risk acquiring pot through the underground, who are using cannabis to help with distressing experiences associated with psychosis and mental illness diagnosis. Some have switched strains to high CBD and found different effects, some are using cannabis to help come off psych drugs, some are using cannabis instead of psych drugs, and some – very interestingly – have gotten benefits from cannabis and never gotten on psychiatric medications to begin with. Scientific studies on CBD support what I am seeing: a University of Cologne study from Germany, in a four week trial, found CBD as effective as an anti-psychotic in calming psychotic symptoms. A co-author of the study wrote “Not only was [CBD] as effective as standard antipsychotics, but it was also essentially free of the typical side effects seen with antipsychotic drugs.”

A glance through research results on CBD from studies around the world shows evidence to support what we know already: CBD marijuana can help mental health conditions. These users are often careful in dosage, some even using just a few drops or “homeopathic” doses to get the desired effects.

(Other research is also intriguing. Numerous studies show anxiety alleviation, and, consistent with studies on Alzheimers and Parkinsons, one University of Montreal study published in Psychiatry Research even showed cannabis users diagnosed with schizophrenia to have better memory and prefrontal lobe functioning than those not using cannabis. Could cannabis be not only a substitute for psychiatric medications, but a treatment for the harm they caused? And other studies that are more troubling, such as those showing memory impairment and youth development harm, are essential to come to terms with in any benefit/risk assessment, but what do dosage and strain have to do with the results these studies found?)

So the kind of cannabis used, as well as the dosage, may explain part of the puzzle of different reports around cannabis and psychosis. This is in addition to a general principle with all psychoactive substances, a principle that applies to cannabis as well:

Response to cannabis use is widely diverse and individual. The medical marijuana dispensary community is thoroughly familiar with the fact that as a “medicine” cannabis does not provide uniform “treatment.” Instead, just as each individual experiences “illness” differently, each individual has their own response, and what is right for one person might not be right for another – including the need to forgo cannabis altogether. Some people find the “high” contributes positively their medical condition and life circumstnaces, others seek out strains that have helpful effects without the high. Dispensary staff I’ve met are skilled at helping individuals navigate different strains and dosages for individual needs.

Substance abuse is a serious and devastating problem. Some people find that abstinence is the best strategy, such as following an AA 12 step program. Taking any drug – alcohol, tobacco, or cannabis — involves risks. Cannabis needs to be subjected to the same caution, but overall cannabis is undoubtedly much safer on the body than alcohol or tobacco (zero marijuana caused deaths compared to many millions of alcohol and tobacco deaths) and much safer than any psychiatric medication. The growing legalization and medicalization of cannabis will no doubt be used by some to rationalize their addiction or avoid facing the fact that the drug is not helping them – but this is true of any substance, including alcohol and psychiatric meds. Once we step outside the demonization/romanticization polarity of the War On Drugs mentality we can engage this complicated reality more clearly. Saying cannabis might be helpful for some people is not to deny it might make others worse.

What about me personally? I found years ago that marijuana only worsens my own anxiety and further disconnects me from reality. I was smoking around the time I was first hospitalized, and though I quit marijuana I still had another psychotic break many years later when I wasn’t using and hadn’t used marijuana for 8 years. I do believe that pot was a contributing – but in no way a causal – factor in my first crisis, however, and that smoking played a role in the several years onf decline that led to that crisis. But tellingly this was all wildly overstated by the hospital doctors who interviewed me. When I moved to Conard House, an outpatient facility in San Francisco, I was sent to a mandatory anti-drug meeting along with every marijuana user at the house, regardless of the frequency of use or whether or not it was abused or a problem. When I challenge the meeting leader by saying that marijuana was much safer than alcohol, I was kicked out of the program. (I was sent to a homeless shelter at 14th and Mission, right next to a thriving street crack market where I passed dealers every day on my way to and from my room. A good friend of mine from a previous program, who had been abstaining from cocaine for several years, was sent to the same shelter, I watched as he gradually lost control of his addiction with the temptation of those dealers; he left the shelter and I never heard from him again.)

I think that CBD strains are promising, and I personally would not hesitate to try a small dose of CBD marijuana in a time of emotional distress where I felt I had run out of other options. I would watch carefully my response, and proceed only if I felt confident I wasn’t going to get paraoind or become anxious. Friends, clients, and colleagues who use cannabis have educated me about its potential if I did ever find myself in need, and have introduced me to the California dispensary system. I’m grateful I live in a state where I can learn about these issues and can first try a CBD brownie (gluten free of course) instead of a dose of Seroquel if I ever get out of hand with sleep deprivation or go off the deep end in a psychosis. And when I’ve seen friends go down to the psychotic vortex and head for the hospital, I wish there was some CBD weed around to try first to help them break the crisis cycle, rather than relying on a psych med as a last resort.

With clients I work with I now feel it is unethical as a therapist to not include cannabis in the list of possible wellness tools for those in legal states. I am pro-choice regarding psych drugs, and if I acknowledge that anti-psychotics, even with the risks, might be a wise choice for some people, I would be completely, well, crazy not to acknowledge that cannabis might be a wise choice for some people as well. I’ve always welcomed herbal medicine and traditional chinese and other treatments into the range of possible wellness choices, because they have such a demonstrated history of helping so many people. Cannabis also has such a history, and I believe everyone working in the field as a therapist or psychiatrist needs to consider taking the same stance I have.

From a mental health advocacy standpoint, marijuana legalization also has many other implications that we as mental health professionals should look at. The AMA, APA, NAMI and other groups have failed to meet this issue responsibly. An American Journal of Public Health study by a team of economists, for example, examined states that had legalized marijuana for medical use. The study found there was a 10.8 percent reduction in the suicide rate of men in their 20s and a 9.4 percent reduction in men in their 30s. That is extraordinary – we know that psychiatric drug use can exacerbate suicidality (the drug warning is right there on the label), and alcohol of course can contribute to suicidality. It’s not clear exactly why greater availability of medical cannabis might lower suicide rates, but this is a very, very significant finding to study further for anyone who takes suicide prevention seriously. (I recently lost a dear friend to suicide, and I am convinced benzodiazepines and alcohol played a role in killing her. I wish her therapist and doctors had explored cannabis as an alternative – she needed any alternative – and her death is one of the things motivating me to write this blog post and “come out” with my clinical practice decisions around cannabis.)

Studies also show reduction in alcohol use results from legalization, which, again, has enormous implications. Alcohol is an extremely dangerous and socially destructive drug with notorious mental health harms. The National Council on Alcoholism and Drug Dependence reports that alcohol use is a factor in 40 percent of all violent crimes in the United States, including 37 percent of rapes and 27 percent of aggravated assaults. In 1995 alone, college students reported more than 460,000 alcohol-related incidents of violence in the US. A 2011 prospective study found that dating abuse was associated with drinking among college students. A 2014 study found marijuana had clearly lower rates of associated domestic and partner violence. As pro-legalization comedian Bill Hicks remarked, imagine you are at a sporting event and some guy in front of you is screaming and picking a fight: is he high on marijuana or is he drunk on alcohol?

Reducing alcohol use in society will likely reduce violence; reducing violence means reducing trauma in society as a whole. When did we lose sight of ending violence as a way of preventing the cause of so many mental health problems? And legalization has already reduced traffic fatalities associated with drunk driving in states where it is legal – each traffic death sends out shockwaves of trauma and grief, and turns many people to alcohol or psychiatric drugs. (Hicks also said the biggest traffic danger from driving high is hitting the garage door because you forgot to open it.) Marijuana legalization is an upstream solution with huge implications. From a public health standpoint there is really no argument: if we can bring alcohol use down in society, then marijuana legalization is clearly worth it. According to the Centers for Disease Control, abuse of prescription opioids such as Oxy-Contin and Vicodin is a national epidemic that kill 16,000 people annually and devastate lives and families. Cannabis legalization could also reduce the market and illegal demand for opiods, easing this epidemic.

Legalization of cannabis also has important implications for young people and families – once we understand the complexity of substance use. The War on Drugs has devastated the US black community, and it is shameful that white-dominated mental health organizations have not spoken up against prohibition. Prison and the police are a traumatizing factor that directly interfere with mental health recovery. While legalization, according to the Journal of Adolescent Health, has not led to an increase in teen marijuana use, it does give families and youth more flexibility. For young people using cannabis, it might be more realistic to switch the kind of cannabis they are using as a harm reduction approach, rather than giving cannabis up completely. Many young people are committed to cannabis as a lifestyle, a form of religious expression, and a pathway to independence. Under prohibition it is impossible to talk openly about their cannabis experiences, and difficult to differentiate cannabis strains they are consuming. It may be easier for a teen to hear “use CBD strains, not the THC strains” than for them to hear “you have to stop smoking entirely;” “You can smoke pot, but in moderation” might work better than “you can’t get high at all.”

A harm reduction perspective is best served by legalization. Collaborative relationships require honesty: young people today know that different strains do different things, and they know the hypocrisy of a War On Drugs that sends people to jail for smoking a joint and then sells their lawyer whiskey at the bar next to the courthouse. Overgeneralized associations between marijuana and mental health problems, including psychosis, ignore a complex reality.

Adolescents using marijuana who get into emotional and psychological difficulties are like any adolescents who get into emotional and psychological difficulties, for whatever reason. They need help and support. The family needs help and support. The problem is never “marijuana plus genetics equals psychotic disorder.” The marijuana may, or may not, be part of the problem. When families — and doctors —are blaming the marijuana it is usually a sign of a deeper problem being avoided. Prohibition is based on fear, the same fear behind the search for a simplistic answer, something to grab ahold of as the solution in a situation that feels out of control.

Cannabis use then often becomes a power struggle in families. As a therapist I have seen time and time again families where a son or daughter has been psychotic after using marijuana, and the family’s response is to ban their son or daughter from using. So what does the young person do? They keep smoking, of course, except now they have a new problem: hiding from the parents, a power struggle with their parents, and the beginning of a cycle of isolation if the power struggle continues. I have to work hard to stay in a trusting relationship with both sides, and that job gets harder the more prohibition fear entrenches intolerance. The solution is to create conversations about the substance; even if the parents are strongly against any marijuana use, it’s important to respect all sides, but on an equal playing fiend where the young person can be validated for a choice that has some science on its side. Dismissing one side doesn’t help. Doesn’t it make more sense to say Let’s talk? than to Just Say No?

I have no doubt that marijuana use has played a role in many people’s problems with psychosis. I routinely work with people to encourage them to stop smoking when they know it can lead to crisis. I’ve seen people off marijuana start using again and end up hospitalized. And marijuana can certainly lead to habituation for some people and play a role in substance problems. Educating society about these risks makes the same sense that educating society about alcohol risks makes sense – as long as the risks are not exaggerated. Personally I would like to see cannabis avoid the commercialization of alcohol and be a more accepted – but not promoted or advertised – personal option. We really don’t need any more consumerism than we already have. Instead, we need an honesty and smart use that we really don’t even have with alcohol, with all the alcohol advertising and the culture of happy hour and spring break.

And of the risks, what about the correlation between first break psychosis with a higher rate of marijuana use? There is in my view validity to that concern — and it also be at least in part misleading. What if the causality is sometimes in the other direction? What if people who end up psychotic are drawn to altered states of consciousness in general, what if they first seek out in marijuana what they eventually end up later seeking in their break to a psychotic reality? Working with young people over many years, I see the need to get “high” comes first, not after, the substance. Few families have honest discussions about the need to get high and get away – how it is a human need that everyone has. And getting high repeatedly may be an escape hatch out of untenable life circumstances and confusing options. Maybe a young person is drawn to cannabis by the same inner need that will eventually draw them to psychosis, correlating the two – but not indicating causality.

As we come to terms with the devastating impact that psychiatric drugs have on society, we face a compelling question: What if there was a substitute? Someone considering a benzo, or an anti-psychotic, or an anti-depressant, is about to embark on a risky treatment option that might work out fine, or might end up destroying their life. That is the reality of the risks of psychiatric drugs. The Soteria House alternative and the Open Dialogue approach, it should be remembered, do rely on psychiatric drugs as a last resort. What if everyone had, on a wide scale, the option of choosing something with a lower side effect profile, and perhaps thereby could be diverted from a risky pathway? That may be what the US is on the brink of with legalization. And what exactly do we know of Pharma’s influence in opposing marijuana legalization? The American Medical Association and APA have long opposed legalization; does medical cannabis represent a threat to Pharma markets?

These social implications have not gone unnoticed by the web of financial interests benefitting from cannabis prohibition. The same public policy corruption driving psychiatric drug use is also evident in efforts to block legalization. Dr. Herbert Kleber of Columbia University, an impeccably credentialed academic, is widely quoted in the press warning against marijuana – and also serves as a paid consultant to leading prescription drug companies. Oxy-Contin manufacturer Purdue Pharma and Vicodin manufacturer Abbott Laboratories are among the leading funders of the Community Anti-Drug Coalition of America and Partnership for Drug Free Kids – both  fierce prohibition advocates. (Other funders include Janssen and Pfizer.) When Patrick Kennedy’s so-called Project SAM (Smart Approaches to Marijuana) worked against Alaska’s legalization initiative, activists counterattacked by pointing out the organizations extensive  financial ties to the liquor and beer lobby. Dr. Stuart Gitlow, President of the American Society Of Addiction Medicine, another legalization opponent, went on the media circuit disputing President Obama’s statement that marijuana is no more dangerous than alcohol: Gitlow serves as medical director for pharma company Orexo, an opioid manufacturer. Former Drug Enforcement Administration head Peter Bensinger and former White House drug czar Robert DuPont (yes that was his title) now run a commercial firm that specializes in the market for workplace drug testing.

While some police have come out against the War on Drugs, many police are lobbying in favor of it. Is it because they receive millions in funds to use under drug money seizure and assets forfeiture laws? One Florida sheriff who led opposition to legalization went so far as to state openly that drug asset forfeitures were important for county law enforcement resources. California legalization was opposed by another police lobbyist who made a career of funneling federal War on Drugs grants to state law enforcement. This is corruption in the crudest form : a mandate for serving public good diverted to individual gain.

As Los Angeles Police Department Deputy Chief Stephen Downing told The Nation, “The only difference now compared to the times of alcohol prohibition is that, in the times of alcohol prohibition, law enforcement—the police and judges—got their money in brown paper bags. Today, they get their money through legitimate, systematic programs run by the federal government. That’s why they’re using their lobbying organizations to fight every reform.” Legalization means challenging economies of influence and politics of corruption that have made drug policy and criminalization big business. Importantly, ending alcohol Prohibition in 1933 involved a vast clearing out of this corruption from the federal to the local level; hopefully the grassroots drive for cannabis policy reform will likewise have wide anti-corruption implications.

Even when we support cautious consideration and avoid making any blanket endorsement, cannabis is a powerful psychoactive plant that involves risks. Small controlled doses – a few drops of tincture, a small puff from a cigarette, a single edible candy – are still unpredictable, and might launch someone onto an unpleasant altered state, make working or relating in public difficult, trigger insomnia, interfere with driving, set someone down a path to addiction, or worse. Harms to memory and cognition development among adolescents might reveal themselves after long term heavy use. There are risks: it’s not a one size fits all solution. It will take some time to sort out studies and research honestly and get a realistic sense of the social impact in the wake of a politicized and corrupted research legacy.

And this underscores one of the central problems with the cannabis policy discussion. Legalization activists wisely chose to emphasize medical uses on a pathway towards greater marijuana acceptance. But in practice, as a plant medicine, cannabis has never been and probably never will be a targeted medical treatment. It is a plant, not a pill. Cannabis is a choice to introduce a substance into one’s body that will have unique and unpredictable effects on consciousness. It’s a life decision. It changes you, in subtle ways or dramatic ways, to ingest a substance.

Like regularly taking alcohol, drinking coffee daily, smoking cigarettes, and the use of food and herbal medicines in traditional cultures, marijuana is really best understood as a relationship. The human body and mind have receptors uniquely designed to interact with cannabis, which helps explain the broad range of consciousness and physical health effects now bing studied and experienced. Specific uses and strains might target symptoms associated with a diagnosis, but cannabis is not like penicillin. Only the individual knows how perception and consciousness are altered, and whether that is experienced as a plus or a minus in life. Some people will choose to be high if it goes along with reduction of some other discomfort; others will prefer to avoid getting high in any form. From food to movies to wine to sexuality, “self-medicating” is after all a widespread social practice and should be acknowledged: we all, to some degree, medicate ourselves just as we all, to some degree, get high. And this is what we have overlooked in our understanding of psychiatric drugs – they too are very powerful mind altering substances that get us “high.” It’s not what we think of as a high, we are still altered when we take our Zyprexa or our Prozac, and some psychiatric drugs, such as the benzodiazepines and the stimulants, are widely used recreationally. The psychiatric drugs have clear toxicities to the body; cannabis has extremely few, and a wide profile of benefits. That’s why it’s been used around the world as medicine since prehistoric times. It is also mind altering, despite the emphasis on “medical” use, and we need to recognize that altering our minds is part of what we do as humans.

We need the freedom, especially when we are facing extreme distress and crisis, to choose what risks we want to take and what substances we want to introduce, or not introduce, into our bodies and minds. We are bombarded by physical and psychological stresses in virtually every aspect of our lives today. Some of us choose alcohol, Some of us choose yoga, running, and organic food. Some us will choose cannabis. We need to take a principled and ethical look at that choice, and we need to ensure that people exploring this option aren’t put in jail for it.

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74 COMMENTS

  1. As one develops a better understanding of medical cannabis, the use toward relieving symptoms is quite specific, effective and much less harmful than your average run of the mill pharmacueutical. Mr. Duckworth’s position is based on prescribers of traditional medications that the literature has clearly outlined as ineffective, potentially harmful, often times untested and superstitious. Many of my patients have switched to strain specific use of MMJ and have ceased all traditional Rx use. “The only thing to fear is fear iteslf” FDR CBD does not alter your consciousness and introducing a “plant”, sounds less than scientific while in actuality it is a highly studied and scientific approach. Examine leafly.com

    • The main reason it got banned, was because the du Pont family, wanted to sell their new fangled thing called nylon….. having hemp banned, meant no more hemp roses, hemp bags, hemp anything……. again just the greed of chemical company, the paybacks, the bribes, the involvement of bribed politicians…………. history of USA never changes.

    • Also I presume marijuana has some form of tardive profilg, causing breakdowns in memory, attitude, behavior, and increased risk for bipolar disorder. Its definitely permanently mind altering, its just a matter of having the ability to demonstrate and keep track of those changes.

      Even full blown tardive dyskinisia and memory lapses are actually hard to track (side effects of psych drugs), as people are self unaware and cannot sense how badly they’ve been hurt, continuing to think they’re just fine.

      • I do not find evidence of this in any of the people that I know who use cannabis for relief of anxiety, depression, psychosis, etc. They are very aware and I’ve not seen any evidence that their minds have been permanently altered in any way.

        I’ve not seen “skunk” produce psychosis in anyone yet. I’m not an expert on cannabis by any means but I’ve seen a lot of people who’re labeled as “mentally ill” who are reaping great benefits from the use of cannabis. And, it’s a hell of a lot cheaper than the damned toxic neuroleptics that the psychs want to poke down everyone!

      • Your presumption is wrong.

        Daily Marijuana Use Is Not Associated with Brain Morphometric Measures in Adolescents or Adults
        http://www.jneurosci.org/content/35/4/1505.short

        Nearly all of the claims that cannabis lowers IQ in heavy users who start young are based on just one study, Meier et al. 2012. This study found an IQ drop in 19 cannabis users who started in adolescence, continued usage into adulthood, and had 3 or more “dependency” diagnoses. There are a number of concerns regarding this study. The results have been brought into question in the same journal:

        -Rogeberg O. Correlations between cannabis use and IQ change in the Dunedin cohort are consistent with confounding from socioeconomic status. Proc Natl Acad Sci U S A. 2013.
        -Daly M. Personality may explain the association between cannabis use and neuropsychological impairment. Proc Natl Acad Sci U S A. 2013.
        -Rogeberg O. Reply to Moffitt et al.: Causal inference from observational data remains difficult. Proc Natl Acad Sci U S A. 2013.

        In addition:

        • The authors admitted that, “our data cannot definitively attest to whether this association is causal”.
        • Users only abstained for 1 week. It can take longer for effects to completely wear off in the heaviest of users [Fried. 2005; Pope et al. 2001; Hooper et al. 2014].
        • Abstention from using was not verified by testing (subjects could have still been under the influence).
        • The amount and frequency of cannabis use is largely unknown, therefore “dose dependency” cannot be established.
        • Mental illnesses such as major depression, anxiety, PTSD or traumatic brain injuries were not factored in. Often people self-medicate with cannabis.
        • Out of 1,037 subjects there were only 19 in the group labeled most dependent since adolescence that saw the 8 point drop (not a large sample).
        • There was not a statistically significant change in IQ for cannabis users who used less than 4 days per week.
        • A statistically significant drop in testing scores was not correlated with adult onset usage, even in the most “dependent” group.

        Regardless of the effect of heavy, adolescence onset, long-term cannabis use on IQ, we are not legalizing for teens. Studies have shown that legalized medical cannabis has not caused increased teen use [Choo et al. 2014; Lynne-Landsman et al. 2013; Harper et al. 2012; Anderson et al 2012], nor has decriminalization in Portugal [Hughes & Stevens. 2010].

        Also keep in mind that there is ample evidence that cannabinoids are neuroprotective, even the U.S. government has a patent on them for protecting the brain, Patent #6630507 – Cannabinoids as antioxidants and neuroprotectants.

    • Prove? Not even close. Correlation does not imply causation.

      People with mental disorders seek out substances to help with symptoms and are more likely to use cannabis. That does not mean that cannabis caused the problem.

      “Skunk causes psychosis, period, the most commonly used variety.”

      Skunk is a made up name. It is commonly used in the UK and causes a lot of confusion for some reason. It is just cannabis sativa, like all cannabis. There has always been stro0ng cannabis. Some of the strongest cannabis known was found growing wild in Africa.

      Skunk does not cause psychosis, that is a lie.

      Whereas hash has no risk. Because it has thc counteracting ingredients.

      Hash has less CBD than cannabis, one of the things that counteracts the effects of THC. You could not be more wrong.

      • No, actually, “oldhead” has proven that the belief that psychosis is a delusion, is itself a delusion. It’s psychotic to think otherwise, don’t you think?….
        I think that I have proven that “oldhead” DOES have a sense of humor, unless
        oldhead proves me wrong, in which case I will simply claim that it’s all a delusion, anyway…. I didn’t really write the comment you think you’re reading now. You’re hallucinating. When you’ve finished reading this comment, you will be healed of all psychosis and delusion. No, actually, I’m out of weed today. But thanks for asking!
        (I think maybe I spent too much time at that “Obamasweapon” website linked to above. Either that, or else it’s an MKUltra flashback….
        Man, MKUltra had some GOOD STUFF!….) Hey, just sayin’….>grin<

  2. In recovery, I live with/in/around occasional paranoia and inpulses to abuse food and overeat. When I’ve used marijuana recreationally, it exacerbated the symptoms. I was peeking out windows and eating myself sick. Like any drug, results may vary I guess. That said I’ve known individuals who have had fantastic results with some other major health concerns and several anecdotes from friends who reported that without any other form of therapy or treatment, the voices they heard just “stopped.” (how’s that for effective! saves hours on the leather couch!!)

  3. Along with cannabis the psychedelics seem to be of great help for people who’ve suffered significant trauma resulting in their being labeled with PTSD. Aya hausca (sp) and acid and even Ecstasy have been used to shut down that part of the brain which keeps trauma survivors constantly hypervigilant and in the Fight/Flee/Freeze mode permanently, so that they can observe and deal objectively with their trauma in ways that are not possible for them normally. Of course, the psychedelics are even more demonized than cannabis in the wonderful War on Drugs(which was never about drugs but about destroying the African American community in America since people like Nixon and his ilk were so afraid of what might happen if this community gained equality in our society). In Britain many in the clinical community are calling for the lifting of the ban on doing studies with psychedelics because they offer such promise and hope to people who’ve survived trauma.

  4. Well researched, written, and convincing blog, Will, from the perspective of one who knows very little about pot these days. My neighbor, who worked in the “mental health” field for the past 20 years, did confess to me that most of the so called “bipolar” and “schizophrenia” he witnessed was due to psychiatric misdiagnoses associated with pot or heroin. But, I agree, all psychoactive substances have risks and potential benefits to some, and pot does appear to have fewer adverse effects than today’s psychiatric “wonder drugs,” which are the real egg fryers and brain damaging treatments.

  5. Drug use needs to be decriminalized. More lives have been destroyed through this criminalization than you can imagine. The War on Drugs never was a War on Drugs, it was always a war on the human beings who engage in the very human practice of using such substances for whatever reason, or lack thereof. Decriminalization means much ‘harm reduction’ when it comes to such users, and in that sense, it is a very good thing.

    I have a problem with the expression “a last resort”. I find that usually no “last resorts” are actually used as “last resorts”, and so it becomes a rather problematic business to become engaged in. In the case of “lunatic asylums”, currently called “mental hospitals”, what we’re really talking about are psychiatric prisons. Psychiatric prisons can only give the word ‘resort’ a bad name. Psychiatric prisons are 1. not a luxury we can afford to have, and 2. certainly no necessity. Let me look at my list. Food, clothing, shelter, no, not a word about imprisonment. As, when we refer to psychiatric drugs, we are, in a sense, speaking about “psychiatric restraints”, or imprisoning tools, I think it would be helpful to dispense with the “last resort” rhetoric. What did I write? Oh yeah, neither a need nor a luxury item, not for the person who has to endure such imprisonment anyway.

    You say you are “pro-choice” when it comes to psychiatric drugs. All fine and dandy, but only if “pro-choice” includes the choice of no psychiatric drug whatsoever. I consider myself anti-force when it comes to psychiatric drugs. I wouldn’t want marijuana, or, say, LSD, or Ketamine, for instance, imposed on me any more than I would want thorazine, or haldol, or clozapine, or what have you, prozac, imposed upon me. Nature has its own response to extreme situations, and some people call that response ‘extreme states’. It is important to realize that ‘extreme states’ are no more permanent than the extreme situations that give rise to them, and given that one thing leads to another, your extreme situation is likely to give way to original and creative problem solving should such a grappling for a solution be permitted.

  6. Medical marijuana is important, but it is a small side issue compared to the monstrous, government-sponsored war on marijuana consumers. – Science and widespread experience have shown marijuana has no significant harms. The DEA’s own administrative law judge, Francis Young, concluded after an exhaustive review of the evidence: – “Marijuana, in its natural form, is one of the safest therapeutically active substances known to man.”

    What is extremely harmful is the war on marijuana consumers. More than 700,000 innocent Americans are arrested for simple marijuana possession each year and made second-class citizens – for life! They will forever face large obstacles to decent employment, education, travel, housing, government benefits, and will always go into court with one strike against them. They can even have their children taken away!

    20 million Americans are now locked away in this very un-American sub-class. That has a horrible effect on the whole country, being an incredible waste of human potential.

    The fraudulent prohibition has never accomplished one positive thing. It has only caused vast amounts of crime, corruption, violence, death and the severe diminishing of everyone’s freedom.

    There is no more important domestic issue than ending what is essentially the American Inquisition.

  7. Great article, well-researched, balanced and informative. My only objection (and I understand your reasons) is in the title. It would seem more correct to say “interest in marijuana for making people feel or function better.” It is no more a “treatment” than Zyprexa in my mind – it’s just a drug that can improve some people’s mood and functioning and could potentially damage that of others, as you describe so well. To call it a “treatment” buys into the idea that mental distress is a “disease,” which does not appear to me to have ever been shown to be the case.

    That being said, I’ve often thought it would be interesting to do a head-to-head competition between marijuana and psych drugs for anxiety or depression. I bet it would match or beat any psych drug for helping with those experiences, and would certainly have vastly fewer side effects. The issue, as noted, is dosage control.

    Thanks for the additional info about the different types of marijuana as well. It seems that a well-informed clinician should be able to help advise a person on some viable options that are much less dangerous than the ubiquitous psych drugs that are so readily handed out without a tenth of the concern people give to this relatively innocuous plant.

    Thanks for a very educational blog!

    —- Steve

    • Steve, I agree, in the middle of this article Will Hall sounded as if he were a psychiatrist from the disease model, although he is much better than that.

      It would definitely be better to say that marijuana consumption might reduce subjective distress, or promote relaxation, or lead to improved work or social functioning. Marijuana doesn’t “treat” anything, if the anything is defined as imaginary discrete illnesses like ADHD, bipolar, major depression, etc. People’s problems have unique individual etiologies.

      Also, sending people to prison for 5, 10, or 20+ years for using or selling small amounts of marijuana is one of the most stupid things American government has ever done. The results show up in increased mental distress for the now-imprisoned “user”, damage to the user’s family, increased zombification (neurolepticization) the user, increased criminality of other forms after release, increased debt to the state, loss of taxable income for the state.

      This travesty involving marijuana is one of the reasons why America has about 5% of the world’s population, but almost 25% of the world’s prisoners (see link below). For how long will that be affordable given our current debt? (link also below)

      http://www.washingtonpost.com/blogs/fact-checker/wp/2015/04/30/does-the-united-states-really-have-five-percent-of-worlds-population-and-one-quarter-of-the-worlds-prisoners/

      http://www.usdebtclock.org/

      • I understand how Will chooses to tread a careful line between saying what needs to be said and maintaining his credibility with the mainstream. He’s actually done a great job of this and gets invited to places where “antipsychiatrist” – labeled people never get to come. So I respect his ability to tread that line, but felt it needed to be said.

        Can’t agree with you more about the incarceration of marijuana users. It is increasingly ironic that these psych drugs are touted as the “treatment” for everything from inability/unwillingness to pay attention to boring things to the natural grief from the loss of a loved one, and yet others who devise their own “treatment” that absolutely parallels the “reasoning” behind psych drugs are put in jail!

        There really is no distinction in my mind between getting high/drunk and using psych drugs, except for who profits. Dosage control is more of an issue with the self-applied approaches, as is purity of product, but in terms of what is trying to be accomplished, you’re giving a person a drugs in the hope s/he will feel/think/act “better” by some person’s definition. To call it a medical intervention is as silly as calling a shot of Jim Beam to relax after work a prescription.

        — Steve

    • I’ve often thought it would be interesting to do a head-to-head competition between marijuana and psych drugs for anxiety or depression. I bet it would match or beat any psych drug for helping with those experiences, and would certainly have vastly fewer side effects.

      Actually such comparative studies have been taking place among the masses on a subjective level for some time, and marijuana wins by a landslide.

    • Sorry it took me so long to write:

      You’re basically correct in that many / most effects from cannabis are “dose-related”.
      Most people have traditionally smoked it in a joint, or pipe. Both methods have their own dose-limiting effects. It’s easy to smoke “enough”, maybe even TOO easy…..
      The potencies of current strains are such that overall, the *quantities* SMOKED ARE LESS….
      For example, in High school a few decades ago, we kids smoked “gorilla killers” – meaning *LARGE* joints. Large “party bowls” were also common. I could not, and would not, smoke so much today. The weed’s much better….

      Also, you talk about cannabis like it’s a manufactured, industrial product, with strict quality control, and equivalent “doses”.
      Wrong again. There are 2 main sub-types of cannabis, INDICA, and SATIVA.
      Generally, one is calming / relaxing / sedating, while the other is more energizing, exciting, uplifting.
      (Honest, I can never remember which is which!)
      Also, today’s cannabis has been hybridized through MANY generations, and most is some mixture of sativa and indica. And then there’s CBD….
      The actual science is moving forward at near lightspeed….
      I’d suggest going to the local newstand, and getting a few copies of the various cannabis-themed magazines. Among the hype, there’s some excellent science….
      thanks.
      (I like your comments. Keep up the good work.)

  8. Let me “correct” this one quote for some perspective;

    “If a drug leads to tardive dyskinesia at a higher dose, but doesn’t at a lower dose, is the problem the drug or its use? If a drug at one dose is useful and at a higher dose is harmful, does that mean the drug is “useful” or “harmful?”
    [neuroleptics are frequently used to treat tardive dyskinesia as well as tourettes in children and other movement disorders, even though they damage the same part of the brain that causes them in the first place]
    “So we begin to see one explanation for how a drug that many people find useful for tardive dyskinesia can be the very drug that causes it for many others.”

    • When I first read this I was hostile, as I felt it was coercing me to try a new drug. I have since tried that “drug” and I totally agree with you. It can be helpful, but I only smoke a very tiny amount or else it gives me panic attacks. I think that’s because of the higher THC content in street stuff today. I don’t know what to do. But there is at least some truth in your words, Will Hall.

      • Let me take your questions and concerns seriously, “JeffreyC”, and see if I can be of some educational assistance, so to speak….
        First, make full use of the “placebo effect” that cannabis has.
        (I won’t get into a full discussion of that difficult word “placebo”….)
        When you get your “stuff”, take a few minutes to sit down, relax, and focus on what you’re doing. This is basic Vipassana / mindfulness meditation techniques…. Then, LOOK AT, smell, hold, think about those little dried flowers. That’s what they are – dried flowers.
        Think about a very real possibility – LESS is MORE.
        What I’m saying is that, yes, you can easily consume more than is good for you. So, try taking smaller “puffs”. Take one or 2 puffs, then let things sit for a bit. Do you *need* more? Do you *want* more? Or is that tiny amount enough? Also, yes, THC % is important, but the difference is still in the dose. And, different strains have different CBD profiles. “CBD” is cannabidinol, and other similar chemicals in cannabis, that do not get you “high”, but which DO have great therapeutic benefits. The research here is fairly new, but also advancing very quickly.
        And, of course, if you don’t like it, don’t do it. If you think it hurts more than helps, then stop doing it. But the suggestions I’ve written here should help you. It’s not at all the same as “popping a pill”. Yet!….
        Good luck…

  9. Good coverage of the issues Will.

    It got me thinking about how mental health ‘interventions’ might change. From night raids in Fallujah to the Freak Bros asking you to come to the hospital for a pipe and a chat. I can see benefits 🙂

    Regards
    Boans

  10. Great article.

    I’m 100% for legalization and treating it like any other legal drug (alcohol, tobacco). The only problem I have is with labelling it as “treatment”. People have used psychoactive drugs to deal with the mental condition called “life” from times immemorial and that’s pretty much it. I’d not stop it and war on drugs is ridiculous but it’s also irresponsible to say that using any kind of drug to tackle life problems is a form of treatment. Having a drink after a stressful day can relax you but drinking every time you have to deal with stressful events is a clear road to addiction. Maybe marijuana is safer than alcohol and has more benefits (it’s seems so at this point but the mythology surrounding it is so thick it’s hard to be sure) but I have reservations when it comes to recommending it to people in distress.

  11. The only reason this drug got so popular is because it gave teens something rebellious to do.

    I hate smoking pot. It is a crappy feeling not even worthy of the phrase “getting high”.

    Adderall, Ritalin and cocaine get you high, marijuana doesn’t.

    • Adderall and Ritalin are the legal, commercial, patented forms of “speed”, or meth / methamphetamine. Like in “Breaking Bad”.
      So-called “marijuana” is a racist, made-up word for the dried female flowers of the cannabis plant. It’s herbal medicine.
      If you don’t like it, then don’t do it. How hard is that?
      (That old fraud Freud wrote a book extolling the virtues of cocaine….
      While I do appreciate your comments, it seems you either didn’t read the article, or forgot. And, what made it “rebellious” for teens was it’s illegality, right?….

  12. I’m concerned with the discussion of medical marijuana here. The overall tone seems to leave open the potential for using it now for the treatment of psychiatric problems. But there is a significant amount of research that needs to be done first. Towards that end, marijuana should be reclassified as a Schedule 2 controlled substance, and there should be a significant increase in research funding for medical marijuana. The existing FDA structure, as poor as it is, isn’t applied to regulate marijuana, which makes it even more of a crapshoot with the cannabis products that are on the market now than with psychotherapeutic drugs.

    I agree that there is a clear future for the medicinal use of marijuana, but not within the existing piecemeal regulatory structure. The June 23/30 2015 issue of JAMA, The Journal of the American Medical Association, contained several articles related to medical marijuana. Vandry et al. reported on edible cannabis products that they purchased from three randomly selected dispensaries in three cities: Los Angeles, San Francisco, and Seattle. Of the 75 different products purchased from 47 different brands, only 17% were accurately labeled with respect to their THC content. Twenty-three percent were underlabeled (contained more THC than claimed on the label); and 60% were overlabeled (contained less THC than claimed on the label). Some of the overlabled products contained negligible amounts of THC.

    The non-THC content of tested products was generally low. Forty-four products (59%) contained detectable levels of CBD. But only 13 had their CBD content labeled. Four products were overlabeled and nine were underlabeled.

    Another study, in that issue, Whiting et al. did a systematic review and meta-analysis of randomized clinical trials of cannabinoids for various medical conditions. The study concluded there was moderate-quality evidence for the use of cannabinoids (smoked THC and nabiximols) to treat chronic pain and spasticity. There was low-quality evidence to support using cannabinoids for nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders and Tourette syndrome. There was very low quality evidence for improvement in anxiety as assessed by a public speaking test. There was some evidence that cannabinoids (mainly nabiximols) were associated with an improvement in sleep. There was no evidence showing that cannabinoids helped in the treatment of depression or glaucoma. Most of the indications that qualify by state law for medical marijuana is supported by poor quality scientific evidence.

    Andy LaFrate presented data to the American Chemical Society on the results from his lab on its analysis of marijuana. The average potency of THC is around 20%. An unexpected consequence of breeding for higher THC strains has been that CBD levels have been lowered. Much of the time the CBD concentration in marijuana is low, meaning that the variety of strains are actually very similar, chemically. This is changing, but there has been evidence of serious mislabeling of edible products, as noted above.
    LaFrate also tested for biological and chemical contaminants and found that it had a surprisingly high amount of microbial growth. . “You’ll see a marijuana bud that looks beautiful. And then we run it through a biological assay, and we see that it’s covered in fungi.” Contaminant testing is not mandatory yet, but should be soon in Colorado. LaFrate noted that many samples had fungi or bacteria. Some marijuana products tested have butane, used to strip and concentrate THC from the plant. Other samples had heavy metals.

    THC in particular seems to be the psychoactive chemical in marijuana that triggers symptoms of psychosis. There was an experiment done at the Institute of Psychiatry at Kings College, London. That looked at the effects of THC and CBD, the two main ingredients in cannabis. You can see a video of a reporter participating in the experiment here. Her mixture of THC and CBD left her with the giggles: “No matter how hard I tried to take the experiment seriously, it all seems hilarious.” But with pure THC, it was a different story. “It’s horrible. It’s like being at a funeral . . . Worse . . . It’s just so depressing. You want to top [kill] yourself.”

    On THC and CBD mixture, she said she seemed flippant; on pure THC, she just didn’t care. With pure THC, she was suspicious, introverted; “weird.” Every question seemed to have a double meaning. She felt morbid. “It’s like a panic attack.” The researchers used the Positive and Negative Syndrome Scale (PNASS), a standard test to measure changes in psychotic symptoms. On the PNASS sub scale used, changes above four was clinically significant; what would be associated with schizophrenic psychosis. She scored fourteen. The effects were temporary.

    I’ve been a therapist working with individuals with substance use disorders for over thirty years and think that the current medical marijuana movement is more like the time patent medicines in the 1800s and early 1900s. There is a clear place for the medicinal use of marijuana, but not as it is now practiced. The lack of regulatory control over its use and the poor quality of scientific research into the benefits from specific chemicals in cannabis (that do have treatment potential) is leading to a future I fear could be worse than what currently exists with pharmaceutical medications.

    I’ve taken the information above from articles I’ve written in my own blog on marijuana and medical marijuana. Some of those article titles are: “Let’s not Get Ahead of Ourselves;” “Is the Cart Before the Horse?;” “Clearing Away the Medical Marijuana Smoke.” If are interested in more information, go to http://faith-seeking-understanding.org/.

    • Cannabis should not be a scheduled drug. Putting it at schedule two would mean it is in the same class as meth and cocaine. That does not make sense.

      Obama could remove cannabis from scheduled status with an executive order. It would take 5 minutes.

      • IF the goal is to promote greater research of the MEDICAL use of marijuana, then it will likely have to remain classified as a controlled substance. Cannabis is addictive and should fall somewhere in the Schedules. If it was just reclassified as a Schedule II controlled substance, the current restrictions on research would be lifted as it would no longer be a Schedule I substance. Getting a Schedule II classification is more likely to happen than a sitting president removing it as a controlled substance.

        • A great many people would disagree with your description of cannabis as addictive. I imagine that the commercial interest in cannabis, for medical and recreational purposes, will in the end result in decriminalization. In California where the medical use of marijuana has been legalized, there is a push to legalize recreational use as well. I imagine this will be the case in more and more states, especially as the financial benefits, in states where recreational use has been decriminalized, hits home. Any Schedule II classification is not likely to survive sustained pressure from what has become, in a few places at least, a thriving enterprise.

        • Cannabis “addictive,” yeah, right…statements like this make it unnecessary to read anything else you say to see that you know not of what you speak.

          Salted peanuts, hugs and kittens are also addictive, as are many things for many people, if the standard for addiction is not wanting to live without something. But I doubt that many people break out into cold sweats and writhe on the floor groaning and vomiting when they run out of peanuts, jellybeans or pot.

    • ChuckSigler

      >>>”marijuana should be reclassified as a Schedule 2 controlled substance”

      If marijuana were just a medicine, that might be true. Medical marijuana is important, but it is a small side issue compared to the 50 million people being persecuted by their government for choosing a near harmless plant FAR less harmful than alcohol.

      It’s insane that alcohol and tobacco are not on the schedule and near benign marijuana is not. The only just action is to remove marijuana totally from the scheduled drugs.

      • I think it would be fine to schedule alcohol and nicotine products as controlled substances; it is insane that they are not scheduled as controlled substances. But that isn’t going to happen. Using the fact that they aren’t scheduled to rationalize removing marijuana completely as a controlled substance seems to me as repeating the same mistake with marijuana that has been made with alcohol and nicotine.

        And marijuana is far from being near benign. Even pro medical marijuana supporters admit that. Here is a link to a short video by SC Labs and WeedMaps on overmedicating with cannabis. https://www.youtube.com/watch?v=USELNiFEP1c.

        In the video, Michael Backes, the Founder/Director of Cornerstone Research Collective, said: “Just because something has a drug safety profile that’s favorable, like cannabis does, doesn’t mean there aren’t potentially some issues.”

    • Have you tried smoking various strains of pot at different times to feel for yourself the variation that is and what it is to get buzzed ? Almost all the jobs accept those connected with behavior control have been sent to China . More and more people given labels that restrict , and guess what some of us don’t want to control the every day behavior called life in other people, except to stop in their tracks the controllers . Let’s call for cash therapy for people that have been marginalized by the controllers and let them spend their money as they please without being coerced by the controllers and wana be controllers. And yeah ,the right strain of hash can really help you relax and I don’t need a scientific study to verify that. “Get high with a little help from your friends “and leave the controllers in the dust.

    • as if the FDA has been protecting us all along from psychiatric drugs…

      drugs (and very potent herbs) are always problematic and will always be both appropriately used as well as misused and abused…

      discussing the pros and cons and the risks and benefits is important…that is what is happening here.

  13. Just jump in the deep end of the pool and find out how deep it is and what happens when you don’t either know how to swim or at least have a life jacket on.

    It is beyond ridiculous and amusing simultaneously when patients come in almost demanding I cater to their attitude how wonderful pot is for their mental health problems, and yet, they are coming in for problems. Um, is it really just me, or with marijuana laws so lax now that people can get away with using pot without much legal consequences, that the hypocrisy of this attitude is not worth my time?

    I say legalize it without caution, and watch the fallout for both users and careless, inattentive enablers and co dependents. The writer above notes the obvious consequences from alcohol this culture has dealt with for decades, why not just compound the problem addicts and abusers of drugs use as denial, projection,and deflection to demand their next drug of abuse and dependency be accepted without dissent.

    We have become a pervasive lot of rigidity, inflexibility, entitlement, oh,and of course dependency in so many facets of life, what’s one more element that benefits the few and harms the many?!

    Amazing how agendas continue to trump principles, eh?

    Hey, if I am wrong, we will be happy…

    Joel Hassman MD

    • Yeah, looks like you missed something somewhere along the line, as the argument you just used with the alcohol comparison is so jaded any adolescent could easily rebut it.

      I assume of course that you never prescribe psychiatric chemicals, and your principles say that no drug should ever be used by your “patients.” But again, marijuana is not a drug, it’s a healing herb. You need to do more research.

    • Just curious, Dr. Hassman. Why is it that you cannot believe a person consulting you, a psychiatrist, when he/she reports positive effects from Marijuana?

      Your statement here :

      “It is beyond ridiculous and amusing simultaneously when patients come in almost demanding I cater to their attitude how wonderful pot is for their mental health problems, and yet, they are coming in for problems. Um, is it really just me, or with marijuana laws so lax now that people can get away with using pot without much legal consequences, that the hypocrisy of this attitude is not worth my time?”

      –reads like typical discounting the credibility of *psychiatric patients*/ *consumers of mental health services*. The same exact attitude exhibited by your colleagues with regard to the- too numerous to mention- adverse effects of prescription only, FDA approved, psych drugs!

      I will continue my comment with a more general response that is not addressed to Dr. Hassman.

      The take home message for thoughtful readers would be that you are least likely to get rock solid beneficial information on *drugs* from a psychiatrist–

      In my 20+ years working with psychiatrists, I found most to be prudent in their off the cuff dismissals of a patients’ credibility, only making remarks about their ridiculous claims in private circles. To Dr. Hassman’s credit, he is lifting the veil of secrecy–

      I would also like to add that I have heard and believed the young adults who have shared with me their preference for Marijuana over psych drugs. And I have a great deal of confidence in an open dialogue approach to working out all issues around safe, effective medical uses for Marijuana. Much more likely than– say, depending on psychiatry for information re: safe/effective uses of prescription only psych drugs.

      Once again, Will’s writing demonstrates what is possible.Open discussion, a conversation that is not intended to be a debate. I don’t think anyone expects that anyone else is the end -all -expert– or can predict effects of any substance for each individual. I don’t think anyone curious or interested in this topic expects the definitive answer, but I do believe that we are ready to assume responsibility, sharing information honestly and respecting each other’s good intentions. I would imagine this notion of educated, supportive communities poses something of a threat to psychiatrists.

      ~Katie

    • I abhor the effects, smell, and sticky residue left behind by pot… Having said that, marijuana was labeled a schedule 1 controlled substance in 1972 along with cocaine and heroine with the assumption that additional studies would quickly prove it to be just as dangerous and addictive as the other two. No such study has ever been produced. In fact, marijuana is generally less dangerous and intrusive to the public than alcohol. But let’s just get crazy here and say it does pave the way to legalization of other drugs… Strength, additives, and price would then be controlled by the government and taxed instead of allowing it to be a criminal enterprise. If you are rejecting all mind altering substances from coffee to meth, I can attempt to see this from your perspective, but as far as marijuana vs benzos, pot is certainly better for you.

  14. This is an important discussion and as therapist and herbalist who often works with people in extreme states marijuana has had a mixed record. I have seen pot increase susceptibility to severe distress and for a smaller group pot has been an effective tool for decreasing anxiety, reducing manic symptoms and extreme states.

    Though dosage and the specific strains play a key role, one of the main factors in the decision to use pot has been personal neuro chemistry. Most of my clients are extremely sensitive due to their constitution and due to iatrogenic damage from psych drugs. Pot only increases their sensitivity, anxiety and potential to dissociate and experience confusion. I would say this is for about 80 percent of the people I work with. For a smaller percentage pot is a life saver and extremely useful.

    • Jon, as Will gets into above, the strain matters. CBD, unlike THC doesn’t cause anxiety even for folks who’ve been injured by psych meds most likely — although we can get radically sensitive to just about anything as you know. It may, though, cause sleeplessness which is just as bad and perhaps worse for that population since in the long run that would loop back into nervous system chaos…lack of sleep never a good thing. While it’s in the body, though, it’s got a very wakeful calm for many. I did some research once this piece was published. It is calming, but not sedating and for some causes insomnia even as it calms (also brings wakeful clarity, according to some accounts)…which still makes it inappropriate for the folks you’re caring for…but not for the reason indicated.

      I was shocked to learn that there are strains of marijuana where the CBD out ranks the THC 20:1 which means the THC is essentially non-existant. It’s THC that causes both the drowsiness that makes it a sleeper for some and the paranoia and psychosis like symptoms it brings out in others or the famous “high” effects that the general user gets. Rather fascinating stuff.

      https://www.leafly.com/news/cannabis-101/whats-the-deal-with-these-high-cbd-strains

      https://www.leafly.com/hybrid/acdc

      This is an interesting report from a user found on this page: https://www.leafly.com/hybrid/acdc

      Most HELPFUL
      Sarananona
      a year ago
      “Some reviewers report that medicine with high CBD and low THC don’t get you “high” but that isn’t the whole story. This makes it sound like the medicine doesn’t alter the user’s internal and/or external experience, which isn’t true. Many people report that these high CBD/low THC medicinals bring on immediate relaxation, a sense of well-being and a very gentle tingling sensation. This has certainly been my experience….”

      and

      From Project CBD:
      https://www.projectcbd.org/sleep-disorders

      Sleep Disorders
      In the United States, approximately 70 million people suffer from insomnia, insufficient sleep or another sleep disorder. CBD has been mistakenly described as sedating. In modest doses, CBD is mildly alerting. Cannabidiol activates the same adenosine receptors as caffeine, a stimulant. But several patients with sleep issues report that ingesting a CBD-rich tincture or extract a few hours before bedtime has a balancing effect that facilitates a good night’s sleep.

      • Hey yes Monica…the strains that I have seen be very effective for certain people have been high CBD varietals…either smoked or used a edibles. However even high CHD strains have affected many of my clients poorly. Even though high cannabidiol varietals seems to be much more effective for calming pain, for insomnia, severe restlessness and extreme states, I am continuing to see many folks with already taxed nervous systems react poorly to these strains.

        As an herbalist I think of marijuana as one very strong tool amongst many tools. Some people do well with it but others do better with milder anxiolytic herbs as well as a variety of tonic and adaptogenic herbs. And as you know so well, I have found diet to be paramount in assisting people to recover.

        I think when exploring helping people through extreme states we should be looking at a whole panoply of plant medicines…and that should very much include marijuana as one option. Several people I work with use pot as their primary tool for reducing the potential for mania. That should be legal and easily accessible for anyone.

  15. Will- I believe we have entered a time in society when there are no right or wrong answers. Clearly, IMO, my beautiful 25 year old son died 1-13-12 from the consequences of his use of today’s turbo-charged MJ strains so ubiquitous in the U.S. (whatever we should decide to call the hydroponic cultivated strains of MJ since growers have cross-bred to increase the THC and almost bred out the CBD properties ). I shared my son’s tragic loss with the MIA crowd after I met Bob Whitaker at a conference in TX, 2012, and was so comforted by his words of support about the link b/t psychosis-pot which are in his book – Anatomy of An Illness. I saw firsthand the atrocities of my son’s entry into the MH “industry” the nite this amazing kid with 23 years of proven accomplishments and successes went into the most horrifying episode of hallucinations and delusions after admitting he’d been smoking MJ and it was the ONLY substance he tested (+) to THC. I believe from the depths of my soul, today’s pot carries a high risk of drug-induced psychosis (for a subset of users) which leads to a quick diagnosis, and entry into the tainted and pathetic MH system. My son in Oct ’09 despite 23 years of NO mental instability (and NO history of any severe MI in either family lines just the opposite actually) was trapped into a vortex that will haunt me to my last breath. I WISH Shane had never entered a system that overlooked his use of MJ- denied any link to psychosis ( apparently completely ignorant or just stupid because one can’t read ALL the sci data on PubMed and not realize there is indeed a subset of users who develop MH changes particularly from the higher potency of THC strains.)
    We can all differ in our perspectives but I caution you and the MIA viewers to please realize there are people, especially while the brain in going thru “pruning” at least to age 25, who develop psychotic symptoms from psychoactive substances like THC. I didn’t know until it was too late for my son this generation is surrounded by a “culture of pot” and kids don’t consider pot “a drug”. Since my son’s shocking and profoundly sad death, my nephew (than age 17) experienced a very disturbing change in him from using pot with his varsity sports friends though all the so-called medical professionals denied pot was related. Fortunately, my nephew and his family knew the horrific events of my son’s demise and it took several months for my nephew to rid himself of these bizarre physical symptoms even though he stopped using pot. My brother recently admitted years ago he could not use pot (when it was the “weak” pot back in the 80s) as it triggered paranoia thoughts. Thankfully, my nephew is completely back to his functional thriving self and now in college doing great but he has tried to share his family’s negative adverse effects from today’s turbo-pot with his peers. Sadly, my nephew’s friends don’t believe him! Society refuses to accept there is a subset of users who indeed can not metabolize THC especially over a period of time. I find it unfortunate Dr Ken Duckworth’s words of caution about the psychosis-pot link can’t be respected. While I never went near NAMI while my son was hospitalized because I don’t believe in “mental illness” (I do believe people can develop mental instability but there are always IMO root causes), Dr Duckworth is absolutely correct.

  16. I have to wonder how many people responding above have actually read what Will wrote. He answers, quite beautifully, most of the questions and issues people have in the above comments.

    It’s a long, well thought out piece. If you didn’t actually read it I highly recommend doing so.

  17. Enlighten us, all you cannabis defenders, of all those people out there on the planet these past 50 years who are or were outward and entrenched users of cannabis who have truly, honestly, and wholeheartedly across general public opinion have genuinely improved our lives without dissent. My money is even if someone will offer an example, it will not be universally accepted by those who are unbiased and objective as an honest example.

    What a disingenuous, dishonest, and frankly, despicable effort here at this thread to claim that cannabis use benefits the public at large. You as cannabis defenders use alcohol as a convenient and disposable analogy when it suits a defense, then dispose it when it suddenly loses it’s benefit, and then gloss over the realities that psychotropic agents aren’t just about the sole highs, but have painful lows as well.

    Like, the pharmacological ones the FDA legitimizes, hmm?

    Oh, and by the way, there are those who are using the efforts to legalize cannabis to then pave the way for cocaine and heroin next. Yeah, tell us all how that is going to work out.

    Anyone who honestly reads here who tries to be objective and impartial, remember the defenses of the addict or hopelessly dependent chemical user, it starts with denial, moves on to projection, then shifts to minimization and deflection, and ends with frank pathological rationalization.

    All immature, ineffective, and painfully wasted efforts. What the addict wants you to miss, for every possible real benefit, the next 9-10 will be harmful and disruptive.

    Hey, just one person’s opinion, but, does it serve the narrative here?

    Joel Hassman, MD

    • Wow, that seems unnecessarily reactive. I’m not sure what an “entrenched user” is in your mind…but as a medicine I would most certainly suggest minimal usage of any cannabis product with long term maintenance use being problematic (for anyone who gave it a shot). Medicine, if used to actually HEAL shouldn’t be needed forever and in my mind if cannabis is being used in that way, then it too shouldn’t be needed beyond a time-limited healing process. I see people healing all around me…it’s a lovely thing. Options are good.

      And to be clear…I don’t consume alcohol or any form of cannabis or any other intoxicating substance (including caffeine). — at one time or another I’ve tried all of them but it’s been many years since I used any of them

      cheers man…you need some

    • I abhor the effects, smell, and sticky residue left behind by pot… Having said that, marijuana was labeled a schedule 1 controlled substance in 1972 along with cocaine and heroine with the assumption that additional studies would quickly prove it to be just as dangerous and addictive as the other two. No such study has ever been produced. In fact, marijuana is generally less dangerous and intrusive to the public than alcohol. But let’s just get crazy here and say it does pave the way to legalization of other drugs… Strength, additives, and price would then be controlled by the government and taxed instead of allowing it to be a criminal enterprise. If you are rejecting all mind altering substances from coffee to meth, I can attempt to see this from your perspective, but as far as marijuana vs benzos, pot is certainly better for you.

    • How does the legalization of cannabis benefit the public at large? Without hesitation, it limits the illegal trafficking of pot by drug cartels, further limits the sale by gangs and other second and third party dealers which also limits turf and gang violence marginally, it saves the taxpayer in legal fees to defend and prosecute small time “offenders”, and it saves an average of 30k a year per prisoner who would have been incarcerated for possession, and without the limitations of a drug charge, those people can find lucrative work options instead of being confined to the swinging door created by the prison system in this country. There is nothing disingenuous, dishonest, or despicable about those claims or the benefit they would provide to the American public at large.

  18. Monica (and Will),
    I did read the entire piece and I agree that it reflects Will’s usual thoughtful attitude. I was bothered a bit by what I saw as his criticism that more physicians and medical organizations do not suggest marijuana as a possible treatment.
    While I agree that there is a Catch 22- we do not know enough because research has been severely restricted, I do not see how one can recommend something when one is never sure not only what that something actually is or what its effects will be for any given person.
    I much prefer legalization over the expansion of indications of medical marijuana. I do not want to be the arbiter for who does and does not get access. I would much prefer to be in the position of just talking to people about how use may or may not be helpful.

    • Hi Sandra,
      I agree that recommendations shouldn’t be made…about any drug, medication or herb…

      discussing how things may or may not be helpful is the way to go in general! that’s what informed consent is all about.

      having lived with severe hypersensitivities (which are finally clearing up now, five plus years out from the withdrawal) I’ve learned that recommendations are dangerous…across the board. Everyone should always be able to make decisions based on the (always) limited knowledge we have and trust their own bodies and sense, too). We never know what is best for someone else…our bodies are all too individual.

    • Interesting, if applied widely this idea – that one can never be sure what a drug will do for any given person – would support the position that neuroleptics and antidepressant medication should never be prescribed for anyone. Because wwho knows who will have severely adverse side effects to the drugs? Similar to what Peter Goetzche already says, that psychoactive rugs are too dangerous and most psychiatrists unable to use them judiciously, leading to much more harm than benefit. On the other hand, risk is ever-present and without ever taking a risk nothing good would happen.

      • bpdtransformation,
        While I think I tend to be conservative across the board, there is the added problem with cannabis is that there are many active ingrediaents which vary from plant to plant.
        I have suggested that following the ideas of Joanna Moncrieff and taking a drug centered (vs. disease centered) approach to thinking about the use of all psychoactive substances is warranted and would likely lead to a generally conservative stance on thier use.
        I think this is the essence of first do no harm.

        • Interesting thoughts. With marijuana there has been increasing research as to its efficacy for a lot of complaints…mainly done abroad in places like Israel. And Sandra you’re right that there are many active ingredients and potencies that make it more complex to offer as medicine.

          But really up until the 1950s and the psychiatric revolution we were primarily using plants as medicine. Part of the magic of plant medicine is that there are a variety of constituents that often work synergistically and in ways that are hard to reduce to single constituent effects.

          In many ways we wildly changed course when we decided to use single chemicals as ways of chronically managing complex emotional states. It is like eating only one food for years when we are hungry.

          Herbs are not so easily reduced to randomized control studies as their constituents are variable and the method of administration and dosage affect the outcome. But certainly some have already been shown to be effective…such as St. Johns Wort for mild to moderate depression. Offering an herb such as this instead of embarking on a risky course of antidepressants is already a common practice in places like Germany.

          Outside of acute situations, my hope is that we begin to review traditional and indigenous ways of approaching “mental illness” that seemed to have served us far better than the modern drug model, and often involved the use of plants with their complex and varied constituents.

  19. An interesting phenomenon occurs whenever Will posts an educational blog on non-prescription psychoactive substances. I think Steve said it best near the top of this thread:

    “Thanks for the additional info about the different types of marijuana as well. It seems that a well-informed clinician should be able to help advise a person on some viable options that are much less dangerous than the ubiquitous psych drugs that are so readily handed out without a tenth of the concern people give to this relatively innocuous plant.”

    Then a dialogue happens in the comment thread and an entirely new approach to thinking about psychoactive substances is born.

    The interesting phenomena is a person centered approach to best use of psychoactive substances to improve functioning.. This is what is missing in the methodology employed to determine the best use for prescription only psych drugs. Or rather, the person as the best source of vital information is either a subject in a study or a patient whose experience and feedback must be re-coded to fit the narrative of the *expert*. The person is just a means to an end–

    Prescription only psychoactive drugs were developed, tested and are prescribed in a vacuum, while natural herbs like, Marijuana and other so-called , street drugs, have a legacy that is rich with a person centered research. Groups of people have built communities around the best use of psychoactive substances, even psych drugs, that is far superior to the content of any lecture or journal article produced by even the most knowledgeable psychopharmacology expert in the field of psychiatry. Community generated education is person centered, and any person in the community/group can acquire as much knowledge as he desires. The value of the shared experiences and knowledge is determined by each individual who enlists in a clinical trial, so to speak. (time honored, gold standard human tested)

    I have some reservations about Joanna Moncrieff’s drug centered approach, though I commend her for finding a very graceful and thoughtful way out of the pit of a fraudulently manufactured disease centered approach. My reservations really center on the shaky knowledge base of the psych drugs themselves. There’s a vacuum there, too. It is no longer a secret that the whole process of developing or designing psych drugs and the clinical trials to test them is wrought with a combination of contrived and deceptive maneuvers. Those people who may have had the best information about a drug in a RCT, for example, may well have been coded out of the study– because he didn’t fit the expert’s narrative– and so it goes. I wonder what psychiatrists think they really know about these drugs, given that so little is actually known about them.

    David Healy has been addressing it for over a decade, and he is gaining ground with Risk.org– an internet forum that has many of the same features as one of Will’s blogs about medical/psychiatric uses for pot. Yet, Dr. Healy’s posture and demeanor when attending a small panel discussion on withdrawal from psych drugs is clarified when he introduces himself– saying “I’m here to learn from you-” . You, being the audience of people withdrawing or helping a significant other withdraw from psych drugs. He is admitting there is so much he still does not know. (video is on you tube)

    I do not mean to discredit or defame Dr. Steingard, or Dr. Moncrieff. I am not suggesting that they aren’t concerned about best use for psych drugs or their patients well being. I think that thinking outside of the box and recognizing that there is already a very useful and successful model for developing sound and conservative practices around administering psychoactive substances, is difficult for professionals who view themselves in a role that denotes authority or expert. I understand this constraint from the perspective of a nurse. It is closely linked to intensive training on establishing and maintaining professional boundaries, I think. It becomes engrained on an instinctual level, and doesn’t yield easily to thoughtful reflection on its potential adverse effects. I have no idea how to change this mind set either.

    My own mind was changed by experience with children, adolescents and young adults– in various settings where I was supposed to be in charge of an activity with a group of kids. My first approach was task centered- both time consuming and labor intensive, I took control of every phase of the process, with less than optimal results. So, I redoubled my efforts and continued to strive for success, until one day, while I was frantically engaged in last minute problem solving, I had to leave the group to work out the solution. I returned in less than 10 minutes. That was all the time the group needed to work out a better solution.

    This same phenomenon happens regularly with my grand children. I am hardly surprised. There is an evidence base for collaborative learning, but there is no formula for changing the minds of those who believe they must function as authorities, experts.

    I believe that the problem with the many active ingredients which vary amongst different Marijuana plants, for instance–will be resolved by the individuals with vested interest, like Will, who studies and collaborates with other personally motivated individuals ; this group will have worked out their own individual problems with the problem — before the experts can turn out a reliable study.

  20. Molecule discovered that protects the brain from cannabis intoxication: It is called pregnenolone. It is a steroid hormone produced by the body. In 2014, it was discovered that pregnenolone, a molecule produced by the brain, acts as a natural defence mechanism against the harmful effects of cannabis in animals. Pregnenolone prevents THC, the main active principle in cannabis, from fully activating its brain receptor, the CB1 receptor, that when overstimulated by THC causes the intoxicating effects of cannabis. Essentially, when high doses of THC (well above those inhaled by regular users) activate the CB1 cannabinoid receptor they also trigger the synthesis of pregnenolone. Pregnenole then binds to a specific site on the same CB1 receptors (see figure) and reducing the effects of THC.

    The administration of pregnenolone at doses that increase the brain’s level of this hormone even more, antagonize the behavioral effects of cannabis. At the neurobiological level, pregnenolone greatly reduces the release of dopamine triggered by THC. This is an important effect, since the addictive effects of drugs involve an excessive release of dopamine.

    In a conversation it was hypothesized that the cases of schizophrenic psychosis from cannabis reported by researchers may be from consumers with low pregnenolone levels. It has been found in some studies “schizophrenics” are low in the hormone pregnenolone and report anxiety. Maybe it’s not cannabis that makes people psychotic?

  21. As a life-long but light-duty cannabis user and father of a 22 year-old with bipolar disorder, I came across this article while searching for information on the use of cbd to help my son. At 53, after many years of no or infrequent cannabis use, I was diagnosed with multiple sclerosis. Since I live in Washington DC, I was fortunate enough to get a medical marijuana card and began buying cbd oil and cbd-rich cannabis to help with the pain in my arms. Since I enjoyed cannabis already, this was a nice silver lining to an otherwise ugly diagnosis. In the year that I have been using regularly (2-3 tokes nearly every evening), I have experienced an increase in my health and overall mood. Seeing my son go through innumerable side effects from his 5-6 medications, I continue to wonder if small amounts of the right cannabis strain might aid his anxiety and occaisonal depression without tipping the scales. His BP was diagnosed only after a lengthy period of teenage self-medication that gave way to full psychosis and hospitalization. That was a terrible time and I never want him to face it again. In retrospect, we were poorly served by several therapists who focused on the drug use and completely missed the ultimate diagnosis.

    Patients seek and continue to “abuse” cannabis while on other prescribed medications because those drugs aren’t completely working, and have bad side effects. It seems to me common-sense that this is because there is something helpful in the plant. As noted by the author, we need to focus intelligently on strain, dosage, and individual response and tolerance.

    Will Hall’s excellent synopsis of the myriad considerations regarding the medical, recreational, and habitual uses of marijuana vis-a-vis psychiatric disorders mirrors my own personal experience as a concerned father. When my own (good and trusted) neurologist refused to recommend medical cannabis, and revealed that he knew less than I did about the endocannabinoid system, I realized how poorly the medical establishment is prepared to address the role and use of cannabis in our society. Thank you, Mr. Hall for covering all the bases in your wide-ranging discussion. Let’s hope that productive medical research on cannabinoids continues to flower and provide greater understanding of potential and applicable benefits. Don’t forget – the role of serotonin as a neurotransmitter was deduced as a result of LSD research in the 1960s. Fortunately, the incredible potential of psychedelics as an adjunct to therapy and self-exploration has resurfaced in our society. There is much we don’t know, so let’s be reasonable and open-minded and not close doors on subjects we don’t yet fully understand.

  22. Dear Will,
    You wrote this article awhile ago. Today the connection between marijuana and psychosis is so clear and so widespread that any doctor who is experimenting on people with mental health challenges by giving them cannabis is very compromised. Plus normal marijuana is all high THC today. It has sent people into psychosis by using it only one time: http://www.psychiatrist.com/PCC/article/Pages/2017/v19n01/16l01993.aspx Even though you lived in San Francisco where drug use was mainstream, and where some survived it intact while others did not, you need to warn people that a way of staying out of psychiatric treatment is to stay off of drugs, especially marijuana. No matter what other factors affect a person’s life, including trauma, it’s best if you warn people to stay away from drugs if they want to stay out of psych treatment. I do think California is worse than other states in roping people into the mental health system, for whatever reason. Probably at least 1/3 of mental health issues in this country are influenced by drug use. While alcohol can result in death by binge drinking we can also teach and warn against this, while we’re warning against drug use. Please consider that it is really not moral to be experimenting and pushing a substance that clearly harms a large number of people.