Is cannabis good for mental health?

Aswan, Egypt. (Dr. Noorali Bharwani)
Aswan, Egypt. (Dr. Noorali Bharwani)

Cannabis has been smoked for psychoactive effects at least for 2,500 years.

Each day more than 400 Canadians are hospitalized because of harm from alcohol or drugs.

Every day 10 Canadians die in hospitals from harm caused by substance use. Cannabis accounts for nearly 40 per cent of hospital stays among youth for harm from substance use.

Incidence is high among youth age 10 to 24. Statistics show the heaviest users of cannabis consume a high proportion of alcohol as well.

Nearly 70 per cent of the hospitalizations for harm caused by substance use involve mental health conditions.

What is cannabis?

Cannabis, also known as marijuana among other names, is a psychoactive drug. Psychoactive drug changes brain function and perception, mood, consciousness, cognition, or behavior.

Cannabis can be used by smoking, vaporizing, within food, or as an extract.

Onset of effects is felt within minutes when smoked, and about 30 to 60 minutes when cooked and eaten. The effects last for two to six hours. Short-term side effects may include a decrease in short-term memory, dry mouth, impaired motor skills, red eyes, and feelings of paranoia or anxiety.

Long-term side effects may include addiction, decreased mental ability in those who started regular use as teenagers, and behavioral problems in children whose mothers used cannabis during pregnancy.

There is a strong relation between cannabis use and the risk of psychosis.

Is cannabis good for mental health?

A review of 40 years’ worth of studies suggests cannabis may not be effective in treating mental health disorders, but experts say that might have more to do with the lack of high-quality research than the drug itself.

A review article published in Lancet Psychiatry (Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis. October 28, 2019), looked at 83 studies dating back to 1980 on cannabis as a treatment for depression, anxiety, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder and psychosis.

The study concluded there was “scarce evidence” to suggest cannabis improves the symptoms of any of these conditions based on 3,513 participants.

Not all experts agree with this study. Some felt the data from the studies examined in the review isn’t necessarily up-to-date. Some felt the data was of low quality. There was no discussion in terms of what people are actually consuming. Certainly, more research is needed on the medical benefits of cannabis in the treatment of mental health problems. For example, randomized controlled trials related to cannabis and psychiatric conditions would help to come to scientific conclusion.

Experts believe cannabis should not be the first line of treatment for psychiatric disorders as there are many unanswered questions. For example: How often should a person take it, dosage, and how long should they take it for? There is a risk that cannabis can make certain psychiatric conditions like schizophrenia worse.

It is not prudent for a physician to recommend cannabis for mental health disorders without first trying well tried therapies and other proven medications. Use of cannabis in mental health is an uncharted territory. For medical purposes, cannabis isn’t a proven treatment for mental health disorders.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Are most doctors biased against the use of medical and recreational marijuana?

Health care professionals are worried about the long-term use of medical and recreational marijuana. (Dr. Noorali Bharwani)
Health care professionals are worried about the long-term use of medical and recreational marijuana. (Dr. Noorali Bharwani)

Government of Canada’s plan to end the prohibition on recreational pot use is going through the parliament and will soon become a law.

Although cannabis plant has a history of medicinal use dating back thousands of years across many cultures, scientifically the use of medical cannabis is controversial.

Unfortunately, we do not live in a perfect world. Majority of the people are blessed with good health. Some of them maintain their good health by way of pursuing healthy lifestyle.

Others are not so fortunate. Some suffer from chronic incurable diseases, chronic pain, and significant disabilities. They need more than regular comfort and painkillers.

As doctors, our job is to relieve pain and suffering. So what is the role of marijuana in relieving pain and suffering? How can we prevent abuse? Can we find a right balance between proper use of marijuana, harm reduction and abuse? That is not going to be easy.

We are still struggling to get alcohol abuse under control. Alcohol abuse has already taken many innocent lives by way of motor vehicle collisions, brain damage and domestic violence.

Now the health care system and law enforcement agencies will have to deal with marijuana abuse and its unfortunate consequences. Although marijuana is legalized for medical use only, it is already available in the market for drug abuse. Soon recreational use of marijuana will become legal.

Legalising recreational marijuana is going to be a money making business. Ottawa has agreed to give the provinces and territories 75 per cent of tax revenues from the sale of marijuana. But the doctors are worried. Statistics show Canadians have one of the highest rates of non-medical marijuana usage in the world.

A report in the Globe and Mail (December 13, 2017) by Geordon Omand says, “There is little to no research to support the supposed benefits of medical cannabis, and what evidence exists suggests that using marijuana as medicine may do more harm than good.” Family doctors’ associations support this statement across Canada.

There is limited evidence to suggest cannabis can reduce nausea and vomiting during chemotherapy, improve appetite in people with HIV/AIDS, and reduce chronic pain and muscle spasms.

Like any other medication marijuana is not without adverse effects. Short-term use increases the risk of both minor and major adverse effects. Common side effects include dizziness, feeling tired, vomiting, and hallucinations.

Long-term effects of cannabis are not clear. Concerns include memory and cognition problems, risk of addiction, schizophrenia in young people, and the risk of children taking it by accident. American Academy of Paediatrics opposes the legalization of medical cannabis.

The College of Family Physicians of Canada has advised its members to use cannabis for chronic pain or anxiety only for those patients who have not responded to conventional treatment. It should not be used for anxiety or insomnia.

According to the Canadian Medical Association Journal (August 9, 2016) Canadian doctors are divided about how permissive new marijuana rules should be. A recent Canadian Medical Association survey shows just over half (51.7 per cent) oppose allowing cannabis use in public spaces. Many preferred setting the minimum age for purchase at 21 or 25 (45.7 per cent).

The guidelines and policies issued to date by most medical licensing bodies consistently state that more information is required on the medical risks and therapeutic benefits of marijuana.

Physicians have been advised to have necessary clinical knowledge to engage in a meaningful consent discussion with patients.

Health care professionals, law enforcement agencies and many families are going to face lots of challenges in the futures. Hope all goes well.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Important Things to Remember About Recreational and Medical Use of Marijuana

A bird in Maui. (Dr. Noorali Bharwani)
A bird in Maui. (Dr. Noorali Bharwani)

Dr. Sanjay Gupta, Neurosurgeon and Chief Medical Correspondent for CNN is reported to have said, “Every 19 minutes somebody dies of a prescription drug overdose. It doesn’t happen with marijuana.” In the past Gupta was against legalising medical marijuana in the U.S. but now he is in favour of it. He sees some benefit for certain types of illnesses.

The use of medical marijuana (medical cannabis) as a medicine has not been rigorously tested due to several restrictions. But there is some evidence to suggest cannabis can reduce nausea and vomiting during chemotherapy, improve appetite in people with HIV/AIDS, and reduce chronic pain and muscle spasm.

Medical marijuana can improve sleep, and improve tics in Tourette syndrome. When usual treatments are ineffective, cannabinoids have also been recommended for anorexia, arthritis, migraine, and glaucoma. It should not be used in pregnancy.

Use of marijuana is not without side effects such as: dizziness, feeling tired, vomiting, and hallucinations. There is some concern about the long-term use of marijuana. It may cause memory loss, addiction, and schizophrenia.

Recreational use of cannabis is illegal in most parts of the world, but the medical use of cannabis is legal in certain countries, including Canada and 29 states in the U.S.

A cannabis plant includes more than 400 different chemicals, of which about 70 are cannabinoids. In comparison, typical government-approved medications contain only one or two chemicals. The number of active chemicals in cannabis is one reason why treatment with cannabis is difficult to classify and study.

Articles in the Canadian Medical Association Journal (CMAJ September, 2017) make few important points on the use of medical marijuana:

  1. Despite widespread availability, medical marijuana is still experimental.
  2. Use of medical marijuana can increase the risk of motor vehicle collision.
  3. The drug should be titrated slowly with low initial dosing.
  4. Users of medical marijuana may be vulnerable to psychosis.
  5. Recreational and medical marijuana are not equivalent and therefore, should have different frameworks for access.
  6. User should remember there are substantial gaps in our knowledge on the use of medical marijuana.
  7. More vigorous research is required to make better use of this drug.

“I do want to mention a concern that I think about as a father. Young, developing brains are likely more susceptible to harm from marijuana than adult brains. Some recent studies suggest that regular use in teenage years leads to a permanent decrease in IQ. Other research hints at a possible heightened risk of developing psychosis,” says Gupta in one of his articles.

On August 11, 2016, Health Canada announced the new Access to Cannabis for Medical Purposes Regulations (ACMPR). The ACMPR allow for reasonable access to cannabis for medical purposes for Canadians who have been authorized to use cannabis for medical purposes by their health care practitioner.

These individuals will continue to have the option of purchasing safe, quality-controlled cannabis from one of the producers licensed by Health Canada. Canadians will also be able to produce a limited amount of cannabis for their own medical purposes, or designate someone to produce it for them.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Synthetic Hallucinating Designer Drugs are Not Synthetic Marijuana

A lake in Kananaskis to relax and unwind. Better than smoking weed.
A lake in Kananaskis to relax and unwind. Better than smoking weed.

Naturally growing cannabis (marijuana) is a popular psychoactive plant that is often used recreationally. Use of marijuana is in the news almost every day. Not to mention the recent death of a very accomplished actor. Cannabis is also unique in that it contains a psychoactive substance, THC. In some jurisdictions, it is legal to use medical cannabis to treat pain, insomnia, and stimulate appetite.

Then there is “synthetic” cannabis, a psychoactive designer drug created by spraying natural herbs with synthetic chemicals that, when consumed, produce psychoactive effects similar to the effects of cannabis. According to Wikipedia, synthetic cannabis are often known by the brand names K2 and Spice. “Synthetic” is considered a misnomer, because the ingredients contained in these products are mimics, not copies.

An article in the Canadian Medical Association Journal (Five things to know about synthetic cannabinoids, February 18, 2014) says, “Synthetic cannabinoids are not synthetic marijuana.” They are a large family of chemically unrelated compounds functionally similar to delta-9-tetrahydrocannabinol (THC), the active component of Cannabis sativa. It is important to remember, synthetic cannabinoids are NOT derived from cannabis.

The article says the use of synthetic cannabinoids is increasing, quoting statistics from the American Association of Poison Control Centers. The typical users are adolescent males and young men in their early to mid-20s, with the most commonly stated reasons for use being curiosity, relaxation and attaining the desired effects of THC while avoiding toxicological detection. Synthetic cannabinoids cannot be legally sold in Canada.

Use of synthetic cannabinoid can cause psychosis, agitation, seizures, acute kidney injury, low potassium level, high blood pressure, increased heart rate, heart attack and death. Clinical diagnosis of synthetic cannabinoids overdose is difficult to make in a patient presenting with acute psychosis unless there is a high index of suspicion.

There is no specific antidote.

So, it boils down to the same old adage, “Prevention is better than cure.” There are so many wonderful things to do in life that one wonders what drives people to drugs, smoking and drinking. I guess we are all not made of the same outlook in life. People in the same family, carrying similar genes, sometimes end up in different directions. There are so many genetic and environmental factors over which we have no control. That does not mean we should not try and be healthy and make the best of what we have been given and improve on it.

You can be what you want to be. Keep smiling. Talk to you again soon.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!