Wednesday, November 20, 2019

Comments by Elizabeth Stuyt, MD

Showing 8 of 8 comments.

  • Sandra, Thank you for your excellent review of this article and I have long been a fan of attempting to treat all mental illness symptoms with approaches that don’t involve medications if at all possible. However, I also agree with the two previous comments that the use of marijuana absolutely needs to be taken into consideration when dealing with any psychotic symptoms. We in Colorado are experiencing a significant rise in psychosis and violence with psychosis in emergency rooms and mental health programs/substance abuse treatment programs directly correlating with the increase in THC potency in the marijuana available. In the state hospital where I work a large majority of the folks I have been asked to do substance abuse assessments on were using marijuana either alone or in addition to other drugs at the time of their incident offense and they were so actively psychotic and violent they ended up on a lot of medications in order to keep them from harming themselves or others. I try to convince their medical providers to attempt to get them off meds once they are stable but this is a hard sell because they were so violent before. When we have had similar patients go through our 90 day inpatient dual diagnosis program in the same hospital, I have been successful in getting some off meds and in others significantly reducing their medications with good outcomes which to me indicates marijuana was playing a big role in their psychotic symptoms. Also we frequently discover the person doesn’t really have schizophrenia or schizoaffective disorder but more likely severe PTSD they have been attempting to “treat” with marijuana. In my experience PTSD psychosis does not respond to antipsychotic medication at all and therefore find EMDR and similar treatments most effective once the person is no longer using marijuana. I believe the study that jewelsfs was taking about is: Patel R et al. Association of cannabis use with
    hospital admission and antipsychotic treatment failure in first episode
    psychosis: an observational study. BMJ Open 2016;6:e009888.
    doi:10.1136/bmjopen-2015-009888
    A large observational study of over 2000 participants showing that cannabis was associated with substantially worse clinical outcomes resulting in the use of multiple antipsychotics. I hope this is helpful.

  • Vortex – I apologize, I didn’t reply before because I wasn’t exactly sure what you meant by “alchogol” however, if you mean alcohol – of course it is potentially addictive and a problem for many people and of course it can be a gateway drug if started in adolescence – this is why most states have laws that limit alcohol purchase to those 21 and over. However it is water soluble and if consumed in moderation (one glass for women, up to 2 for men a few times a week)- especially with food, it is metabolized by the body fairly quickly to water and CO2 and the negative effects can be minimal. There are many reports of health benefits of low dose of alcohol. The problem comes when people drink excessively or alcoholically, especially the high potency alcohol with higher proof. So this situation could be similar with marijuana – or at least marijuana with less than 5% THC and balanced CBD. However, it is fat soluble so it takes longer to be metabolized and stays in the body longer, especially the brain which is full of fat. The point I was trying to make with my blog is the biggest problem with our current marijuana is the increased potency of THC, which has no known health benefits – similar to how I don’t think Everclear has any known health benefits – and it is potent purely to get people addicted so they continue to use the product and provide money to the dealers. For marijuana users who do not think they are addicted to it they need to quit smoking for a while to see if they are. For people who use occasionally they probably are not just like people who drink alcohol occasionally are not addicted to it. However, if they smoke marijuana every day – they most likely are addicted to it. I definitely see this with tobacco smokers who never thought they were addicted to nicotine until they had to quit.

  • Substrate – you are exactly right and it is the high dose THC that has caused the most problems (15% or higher). There is no evidence anywhere that these concentrations of THC are helpful medicinally. Most of the research that has been done with smoked cannabis have the highest THC at 8%. Are you saying all these researchers were clueless as to the actual potency of the THC? The “astronomical” increases I was referring to are in the cannabis concentrates such as oil, shatter, dab etc. that folks are smoking with blow torches – this is no longer marijuana but is “crack cannabis” in which THC can be 80-90%. And with the increases in THC potency we are seeing increases in violence and aggression. It is no longer the “calming weed” it used to be. This is a fascinating article including case reports on highly popularized story lines in which marijuana led to unnecessary violence, health risk and in most cases, both. It analyzes the role marijuana may have played in the tragic outcomes. It includes the planned parenthood shooter, the Boston marathon bombers, and even Osama Bin Laden. Miller NS and Oberbarnscheidt T. Marijuana violence and law. J Addiction Research and Therapy. 2017 doi:10.4172/2155-6105.1000S11-014.

  • I really like how you have “re-framed” this Chuck. Yes – it is the population of people who are at risk for addiction, for what ever reason, in which I believe marijuana is a gateway drug. I have had several patients who were addicted to heroin in our program who told me that they knew they needed to stay away from marijuana or they would be right back to using heroin if they started using marijuana again. One even bemoaned the fact that he felt like he would have to leave his beloved state of Colorado in order to stay away from heroin because there are marijuana dispensaries on every corner – his words.

  • Thanks Chuck, You are absolutely correct, the black market is flourishing here in Colorado. Especially in Pueblo where the cost of living is cheaper than most of the state and it is easy for people to buy houses and turn them into grow sites. We have also had numerous grows in the National Forests surrounding Pueblo and recently there was a report that the police have confiscated over 27,000 plants so far.

  • Ron,
    You have to actually read the studies on this. Yes it is true that there was a reduction in hospitalizations for opioid overdoses (13%) in states that legalized medical marijuana but the people in the studies were middle aged folks who were using opiates for chronic pain and they found by switching to marijuana, they experienced some benefit and reduced their opiate use. And this was all before the legalization of retail marijuana anywhere. So for this group of people – there was this benefit. However, especially since 2013 with the legalization of retail marijuana, marijuana use in adolescents and young adults has significantly increased and the use of opiates in this group has also significantly increased, with a significantly steady increase in opioid overdose deaths in this group. They are not using marijuana for chronic pain. They are using marijuana to get high and they are not using it instead of other drugs, they are using it in addition to other drugs.

  • Human Music,
    you clearly do not know me and you are making a lot of assumptions about me that are not true. I am afraid you probably don’t care to know the truth because it helps you to lump all psychiatrists together but I have spent most of my career trying to help people get off drugs and that includes psychiatric drugs. I have never been a big fan of medication. They are definitely never the solution. Sometimes they are necessary in the short term but I work very hard to help people get off psychotropics. Initially it is usually a hard sell because people have been led to believe that they “have to have them”. However, with commitment and perseverance my team has been successful in helping a lot of people find recovery and do it totally drug free (including tobacco and pharmaceutical drugs). I work in a state funded 90-day dual-diagnosis inpatient program where the state foots the bill so I am not “profiting” off of addiction or patients. It is amazing that we have this program available for those who have failed previous treatments. And is it very gratifying to see people find that they can live life without any mind altering chemicals – whether it is pharmaceutical or an addictive chemical including marijuana. This is why I work in this field.

  • Dear Madmom,
    I am sorry to hear about your daughter’s situation and your experiences. I agree with you about the harm that psychotropic medications can do. In fact I have spent most of my career getting people off psychotropic medications. I find that many people are “misdiagnosed” in my opinion and that they are often suffering from previous life trauma and medications are not the solution. I see them because they have often turned to addictive drugs as a way of “self-medicating” and then they get put on all other kinds of medications with no one ever stopping any – just adding more. It is often extremely difficult to get people off medications when they have been on them for a long time but we have been fairly successful in helping quite a few people do this – but it takes commitment and support. I have indeed seen the research you are referring to but this is about pure CBD and is in very preliminary stages – as they say – “might” help with psychosis. I do think there might be benefits from CBD for many things however I believe we still need more research. For example, there have been anecdotal reports of children with severe seizure disorder benefiting from CBD oil but there are also reports of severe side effects from the CBD and in some cases worsening of the seizures. I would not recommend someone with psychosis smoking “pot” to see if it helps if it has any THC in it. I would not recommend “smoking” anything as a matter of fact.