Medical Marijuana: The Good, The Bad, and The Ugly
Introduction:
Medical marijuana is a complex substance that presents both potential benefits and risks, and as a psychiatrist, I approach its use with an open mind. In my practice, I have observed a wide range of outcomes among patients who use medical marijuana. For some, it has been a transformative treatment, allowing them to reduce or even eliminate their reliance on traditional psychiatric medications. These patients have found responsible use of medical marijuana to be incredibly beneficial, effectively managing conditions like autism, anxiety, insomnia, and depression. However, it's important to acknowledge that medical marijuana can also have significant negative effects. Although rare, there have been instances where individuals develop severe side effects such as psychotic disorders, necessitating hospitalization. Most patients fall somewhere between these extremes, experiencing varying degrees of relief or, conversely, challenges such as decreased motivation—a well-documented effect in those who use marijuana daily. This handout aims to provide a balanced view, helping you understand the nuanced role medical marijuana can play in psychiatric treatment, tailored to individual needs and circumstances.
What Does the Research Say?
It is complicated and depends on who is financing the research, implicit bias is involved with the varying outcomes of a great deal of marijuana research. We can attempt to minimize the role bias plays in research by looking at meta analyses of large numbers of studies. But the outcomes are just as confusing with this approach: The relationship between cannabis use and anxiety in teens and young adults is notably complex, with research showing mixed results.
For instance, many studies indicate that cannabis can both trigger and relieve anxiety, depending on factors like the amount used, the individual's susceptibility, and the context of use. Additionally, it's challenging to determine whether cannabis directly causes anxiety or if it's used as a coping mechanism by those already experiencing anxiety. Factors such as genetic predisposition, environmental stressors, and the use of other substances complicate this relationship further. Therefore, understanding whether cannabis is a cause or a solution for anxiety requires more detailed study, as current evidence does not clearly point in one direction.
Is Medical Marijuana FDA Approved?
It is also important that “Medical Marijuana” is a term used in certain states, including Pennsylvania, but that does not mean it is an approved “medication”. As of the time of this writing (April, 2024), there was no FDA approved use for any strain of marijuana. However, the FDA has approved certain drugs that contain individual cannabinoids, such as dronabinol (Marinol and Syndros) and nabilone (Cesamet), which are used to treat conditions like nausea caused by chemotherapy and anorexia associated with weight loss in AIDS patients.
An Important Note on Cannabidiol (CBD):
Cannabidiol (CBD) is a non-psychoactive compound found in the Cannabis sativa plant. Unlike tetrahydrocannabinol (THC), CBD does not produce a "high" or intoxication. It interacts with the body's endocannabinoid system but has a low affinity for cannabinoid receptors such as CB1 and CB2. Instead, it acts through multiple other pathways, including serotonin receptors, which may explain its potential effects on mood disorders and anxiety.
The 2020 research article "Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders" reviews the therapeutic potential of cannabidiol (CBD) for neuropsychiatric disorders. CBD, a non-psychoactive component of Cannabis sativa, has shown anxiolytic, antidepressant, and antipsychotic effects in both animal and human studies. Preliminary clinical trials support CBD's efficacy and safety, suggesting a positive risk-benefit profile for treating psychiatric disorders.
Understanding Medical Marijuana in Pennsylvania: A Guide for Patients
The rest of this handout aims to provide you with essential information about the use of Medical Marijuana for multiple disorder in Pennsylvania, helping you make informed decisions regarding its use for therapeutic purposes.
Getting Started with Medical Marijuana:
For those new to medical marijuana, here are some guidelines to help you begin:
High CBD and Indica Strains: Start with strains that are high in CBD and are of the Indica variety. These strains are less likely to cause anxiety and are known for their relaxing effects.
Avoid Sativa Initially: Sativa strains are more activating and might cause discomfort or increased anxiety for new users.
Sedative Effects: If you are looking for more sedative effects, gradually increase the Indica ratio in your strains.
Morning Use: For morning usage, opt for strains with a high CBD concentration to prevent excessive sedation.
Hybrid Strains: Consider hybrid strains that combine the qualities of both Indica and Sativa. These can be tailored to provide relief for specific conditions, including Autism.
Expert Consultation: Always consult with healthcare providers or dispensary staff who are knowledgeable about the latest trends and benefits of various cannabis strains.
Understanding Cannabis Components:
Cannabinoids: Marijuana contains several bioactive compounds, including THC (Tetrahydrocannabinol) and CBD (Cannabidiol). THC is responsible for the psychoactive effects, while CBD is known for its potential therapeutic benefits without causing a "high."
Terpenes: These compounds give the cannabis plant its distinct smell and contribute to its therapeutic effects.
Flavonoids: These provide the plant color and have antioxidant and anti-inflammatory properties.
Potential Risks and Considerations:
Brain Health: While CBD is considered to be brain-protective, excessive and prolonged use of THC might be harmful. In genetically predisposed individuals, THC could potentially trigger psychotic disorders, worsen depression, and worsen anxiety.
Intellectual Risks: Studies do show a decrease in IQ in teens who use marijuana heavily; this is reversed when marijuana is stopped.
Motivation: High THC consumption can reduce motivation, which is usually reversible upon reducing or stopping use.
Digestive Health: Marijuana might exacerbate nausea or reflux by relaxing the lower esophageal sphincter, increasing the risk of acid reflux.
Cannabinoid Hyperemesis Syndrome (CHS): In rare cases, prolonged, heavy marijuana use might lead to CHS, characterized by severe nausea, vomiting, and abdominal pain.
Cancer Risks: The evidence linking marijuana use to cancer is mixed. Factors such as the method of consumption, frequency, duration of use, and age at initiation could influence this risk.
Legal and Safety Considerations:
Compliance with State Law: Ensure that you are fully aware of and comply with Pennsylvania's medical marijuana laws and regulations.
Federal Law: Marijuana is illegal federally in the United States. It is classified as a Schedule I drug under the Controlled Substances Act, which means it is determined to have a high potential for abuse and no accepted medical use, prohibiting its use for any purpose at the federal level.
Safe Purchasing: Always buy medical marijuana from licensed dispensaries that adhere to state regulations and safety standards.
Proper Usage: Follow the recommended dosages and administration methods as advised by your healthcare provider.
Additional Resources:
This guide is designed to assist you in navigating the use of medical marijuana with a better understanding of its benefits and risks. Always consult with your healthcare provider before starting any new treatment.
For further reading and more detailed information on the medical uses of marijuana, consider exploring comprehensive books and reputable online resources. Always ensure that the information is up-to-date and applicable to the state of Pennsylvania. Here are some other resources to look into:
This blog explores the various risks associated with marijuana use, specifically segmented by different age groups.
Here is a great website for families of patients with autism to learn more about medical MJ strains that may be helpful.
For further reading on the medical uses of MJ, you can check out this comprehensive book: Medical Cannabis: The Beginner's Handbook
Here is the Commonwealth of Pennsylvania’s website for medical marijuana.
