The use of cannabis and its products has grown dramatically over the past two decades, and that these chemicals have became more potent. According to the authors, 10% to 30% of the general population and 75% of primary care patients who use cannabis say they do so to manage health-related symptoms. And how does that work out? Below is a summary of some of the points made in the article, broken down by medical condition.
PTSD
Although cannabis is frequently used by people with PTSD, the authors report that there is low-certainty evidence that cannabis fails to reduce PTSD symptom severity or to improve other mental health symptoms in patients with PTSD, such as hyper-arousal and sleep problems. They cite one study of 80 veterans that compared three different formulations of smoked cannabis and placebo that found no differences in the severity of PTSD symptoms between cannabis and placebo users over three weeks, but dry mouth, nausea, dizziness, and somnolence were more common in those taking THC, the active ingredient in cannabis.
Anxiety
Here’s an interesting point made in the article. Half of those reporting use of cannabis for symptom management do so to treat anxiety, yet chronic cannabis use has been associated with anxiety disorders. In studies with THC, one single dose of the drug (7.5 mg) reduced anxiety is some healthy volunteers, but a higher dose (12.5 mg) induced anxiety. That reminds me of an article by Maureen Dowd that I read over a dozen years ago. I just traced it down. She had gone to Colorado shortly after cannabis was legalized there, and she had eaten a marijuana-laced chocolate bar. Here’s a snippet of her article:
I felt a scary shudder go through my body and brain. I barely made it from the desk to the bed, where I lay curled up in a hallucinatory state for the next eight hours. I was thirsty but couldn’t move to get water. Or even turn off the lights. I was panting and paranoid, sure that when the room-service waiter knocked and I didn’t answer, he’d call the police and have me arrested for being unable to handle my candy.
Depression
As with anxiety, according to the authors, cannabis is viewed by many in the general public as being potentially beneficial for the relief of depression, but there is scant scientific data on the efficacy of cannabis as a treatment for depression. They cite one study that reported that cannabis use was not associated with higher rates of remission among those with major depressive disorder. A meta-analysis of trials that examined depression symptoms as a secondary outcome in those with other primary diagnoses (usually multiple sclerosis) found cannabis was not associated with improved depression symptoms. One prospective cohort study found that cannabis use was not associated with higher rates of remission among those with major depressive disorder.
The authors also mention further studies suggesting that heavy cannabis use may be associated with self-harm; one in which cannabis use has been associated with suicidality (yep, that’s the word they used) in young adults; another in which adolescents and young adults with cannabis use disorder (CUD) were associated with a higher risk of self-harm and death by unintentional opioid overdose; and a third study that found veterans with cannabis use disorder were at substantially higher risk of self-injurious behavior (both with and without suicidal intent).
Cannabis and Mental Health Conclusions
After discussing other afflictions such as bipolar disorder, psychosis, ADHD, cannabis use disorder, and how cannabis affects cognition, the authors conclude as follows:
Cannabis and its derivatives are commonly used by those with mental health symptoms and conditions. There are no therapeutic uses of cannabis for mental health conditions that are currently supported by the empiric literature. However, there are striking evidence gaps, and future research may help clarify the role of cannabis in managing mental health conditions. Moreover, clinicians must be aware that cannabis use—particularly regular use of higher THC doses—can pose substantial risks to mental health, especially in vulnerable groups, such as adolescents and young adults with developing brains; those with poorly controlled mental health symptoms, bipolar disorder, or psychotic disorders; those at high risk for psychotic disorders (with prior psychosis events or family history); pregnant individuals; and those at risk for substance use disorders. Clinicians have a vital role to play in educating and counseling patients about the use of cannabis to address or treat mental health symptoms and conditions and about the potential for serious adverse effects.
I wouldn’t call that a high endorsement of pot and its relatives, would you? I think I’ll stick with my occasional Manhattans, wines, and chilled beers.
