Ask the Doctor

Carmen McIntyreQuestion: “What do you think about Medical Marijuana for some or all psychiatric diagnoses, such as anxiety, panic attacks, rage outbursts, etc.?”
The Michigan Medical Marijuana Program allows for persons who have been issued a registry identification card to possess 2.5 ounces of usable marijuana.  There are specific qualifying conditions, and a physician with a “bonifide physician-patient relationship” completes a form validating the disabling condition.  Physicians do not “write” a prescription” for marijuana.  The only “psychiatric diagnoses that qualify for the program are Post-Traumatic Stress Disorder (PTSD) and Agitation due to Alzheimer’s Disease.  The data for this “medical” use of marijuana is fairly weak.  It is modestly effective for pain relief, particularly nerve pain; appetite stimulation for people with AIDS wasting syndrome; and control of chemotherapy-related nausea and vomiting.  However, it is not considered a “first-line” treatment nor has it been shown to be more effective than other treatments.
So what is marijuana?
Marijuana comes from the hemp plant species Cannabis Sativa. People typically smoke the plant’s dried leaves, flowers, stems and seeds.  It can also be mixed into food, or brewed as a tea.  It is often called pot, weed, herb, or hash.  Hashish is a concentrated form of the drug.
THC, or tetrahydrocannabinol, is the active ingredient in marijuana.  Shortly after using it, the physical signs and symptoms include rapid heart rate, increased blood pressure, increased breathing rate, red eyes, dry mouth, increased appetite, and slowed reaction times.  People typically use it because it generally causes euphoria and feelings of detachment and relaxation. Symptoms usually start to decrease after 3-4 hours.  Marijuana lingers in the system up to a month, especially when used regularly, so impairments due to the drug can last for days to weeks.
Marijuana is the most frequently used illegal drug in the U.S.   While the use has remained stable over the past decade, addiction has increased.  Using marijuana also makes it more likely the user will try other drugs.  Many people think marijuana is safe, or at least no worse than cigarettes.  However, there are many risks to using marijuana, particularly for those with pre-existing psychiatric disorders.
There are definitely “studies”, some that were conducted with good scientific methods, some that were poorly done, that showed relatively few adverse effects from marijuana.  However, most show some common effects, which, along with my experience with my consumers who used marijuana, makes me unable to recommend marijuana, especially for those with mental illness.
Common side effects of marijuana include:

  • Panic attacks or anxiety, found with women more than men.
  • Adjustment disorder with depressed mood found in 16% of men after use of cannabis, major depression in 14%, and dysthymia 10.5% (serious MI ruled out prior), which was dose-related.
  • Short-term use leads to depersonalization, de-realization, feeling of loss of control, fear of dying, irrational panic and paranoid ideas.
  • 15% identified psychotic symptoms such as hearing voices, unwarranted feelings of persecution or risk of harm from others.
  • Confusion, memory and attention impairment, and emotional liability are also common.
  • Among individuals making serious suicide attempts, 16.2% met criteria for cannabis misuse/dependence compared with 1.9% of controls.
  • Chronic or heavy use makes the adverse effects more likely or severe. In those smoking at least two “reefers” a day for 10 years, the most common effects were anxiety, paranoia or depression (21%), tiredness and low motivation (21%).

These effects of marijuana are the same as symptoms of many mental disorders, so it doesn’t make sense to treat mental disorders with marijuana.  In fact, people with pre-existing mental illnesses often find that use of marijuana increases their symptoms, caused their first episode of illness, and at times results in hospitalizations.
A myth is that there is no addiction with marijuana.  Studies have shown that people administered THC daily for 30 days progressively lose the “high” sensation and thought the marijuana was getting weaker.  One of the signs of dependence is having to use more of the drug to get the “high” feeling.  Another indicator of addiction or dependence is withdrawal.
Studies have found that in the first week of abstinence the subjects became irritable, uncooperative, resistant and at times hostile.  They also became hungry and experienced insomnia.  The effects waned over 3 weeks.  Cessation of smoked cannabis led to restlessness, anxiety, dysphoria, irritability, insomnia, anorexia, muscle tremors, increased reflexes and autonomic effects including changes in heart rate, blood pressure, sweating and diarrhea.  Some prolonged de-personalization persisted after cannabis cessation.
Finally, there are also medical consequences to marijuana use, including an association with increased rates of lung cancer and lung disease; affects to the reproductive hormones causing problems with menstruation in women, and gynecomastia (development of breasts) in men; a decrease to libido and fertility in men (lowers sperm count and quality); and it has been linked to dental and cardiovascular problems in the elderly.
So, does this mean that every person who uses marijuana will have these bad effects?  No.  Are there people, even those with other mental illnesses, who use marijuana occasionally without negative effects?  Yes.  Do I recommend the use of marijuana?  No, I cannot.  The risks to the brain and body are too high, and there are alternatives that are more effective.  If I were to treat persons with painful terminal illnesses, such as AIDS or certain cancers, there may be situations when I could justify it, but as a psychiatrist, I cannot.
Dr. Carmen McIntyre is the Chief Medical Officer at the Detroit Wayne Mental Health Authority. She is committed to ensuring that the Authority meets the mental health needs of those with substance use disorders, children with
serious emotional disturbance, mental illness, and persons with intellectual and/or developmental disorders in Wayne County.

 

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