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Masterclass by Diana M. Martinez (MD) on marijuana’s effects upon psychiatric disorders. Dr. Martinez is a Columbia University professor of psychiatry, New York. She specializes in addiction research. Tilray provided medication (cannabis), and she disclosed that she received it for one study. She has no other financial relationships. Take-home points
For ages, cannabis use has been controversial. The fact that cannabis is a Schedule I controlled substance has made research more difficult and has led to a lack of understanding about its benefits and harms. Dr. Martinez provides a comprehensive overview of the effects of cannabis based on the National Academies of Sciences publication Health Effects of Marijuana. An Evidence Review and Research Agenda. The cannabis plant contains cannabinoids. Two of the most popular cannabinoids are tetrahydrocannabinol, which causes the “high”, and cannabidiol. CBD has many subjective effects and does not cause a high. There are many forms of cannabis, such as the smoked or flower form and prescription cannabinoids that contain THC, such as dronabinol, nabilone, Cesamet, and CBD. There are both risks and benefits to cannabis and cannabinoids, according to research. Talking to patients about cannabis use should be a rational process. It is important that patients who are not responding to psychiatric treatment have rational discussions with their clinicians about cannabis use. This includes chronic pain, anxiety and insomnia.
Benefits
Evidence supports the use of cannabinoids and cannabis for chronic pain relief. The smoked and vaporized forms of cannabis were evaluated in most studies. Research suggests a dose of 5-20 mg of oral THC is about as effective as 50-120 mg of codeine, although there are few head-to-head studies to reinforce this finding. The pain management arsenal will likely include cannabis. There are risks associated with cannabis use, including addiction and intoxication. Cannabinoids could help you avoid addiction to cannabis or other substances. Although cannabinoids, which are THC, have shown promise in treating disorders like PTSD and obsessive compulsive disorder (PTSD), larger controlled trials are necessary. Cannabinoids can also be combined with behavioral interventions like exposure therapy to produce a positive effect.
Risks
Evidence is strong that cannabis may be associated with an increased risk of developing psychotic disorders, especially in those who are genetically predisposed. There is some evidence that cannabis can cause mania and hypomania in bipolar disorder patients who use it frequently. Cannabis addiction can occur. About 9% of people who use it will develop a substance use disorder, and the risk of developing a substance use disorder increases to 17% in people who start using cannabis in their teenage years. Regular cannabis use can cause withdrawal symptoms such as insomnia, sleep problems, cravings and decreased appetite.
National Academies of Sciences, Engineering, and Medicine. A Review of the Evidence and a Research Agenda on Health Effects of Marijuana. Washington, DC: National Academies Press, 2017. Whiting PF et al.
JAMA. 2015;313(24): 2456-73. Fischer B et al. Am J Public Health. 2017 Jul 12. doi: 10.2105/AJPH.2017.303818. *
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Show notes by Jacqueline Posada MD, associate producer and psychiatry professor at George Washington University. She is also a staff physician at George Washington Medical Faculty Associates. Dr. Posada is free from conflicts of interest. *
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