Let me start by stating that I am not a researcher or cannabis expert. I am a mental health provider that has worked with many people who have a variety of experiences with cannabis use and cannabis dependence with outcomes ranging from feeling unmotivated, high & relaxed to having a full blown psychotic episode resulting in inpatient hospitalization. Cannabis is a substance in which I have a significant interest in learning more about and decided to do a deep dive into some research to be update to date. I feel a responsibility to understand the impacts this substance may have on the clients that I work with to support people in making the most informed decision for their lives with the information we have today. There is more for me to learn regarding cannabis for medical conditions, but for now I will focus on cannabis use that I experience in my clinical work in the outpatient setting.
Firstly, it is important for me to explain why I am choosing the word cannabis intentionally in this article. In the 1930s the word “marijuana” was used to demonize Latinos and people of color. Check out this npr article to learn more about the racists roots of “marijuana”. We know today that people of color are more likely to be arrested than their white counterparts for cannabis use. According to the ACLU, black individuals are 1.8x more likely to be arrested by their white counterparts. If you are doing anti-racist work, being mindful of language can be a place to start in changing stigma. We know substance use has significant roots in racism and I encourage you to learn more outside of this article.
Additionally, this is not a “do this” or “do that” article, simply an article to share research so that people (including you reading this) can make more informed decisions for their health and well being. There are various people in my life that I care for deeply that use cannabis regularly to manage stress, help with sleep, get high for fun, and the list goes on and on. I wonder about the myths of “it’s not harmful” and the ramifications of that, as the strains today are “not your dad’s weed” and research shows that in recent years there are a higher percentage of youth that believe cannabis is not harmful, i.e. they are unaware of the potential risks to their health. Of note, there are various indigenous communities that have used cannabis and other psychoactive substances for centuries as medicine and in various rituals and traditions, and it is important to be educated on various uses and benefits to these cultures and peoples.
Let’s start here together -> 12 min Youtube Video from Osmosis to learn about the brain and how cannabis is processed in the brain via different administration, such as smoking or ingesting. This video also discusses the differences between THC, CBD and CBN. Of note: Today’s cannabis is significantly more concentrated than cannabis of years ago.
What did we learn? Let’s debunk some myths.
Myth #1. Cannabis is not addictive
Cannabis (THC) hits the reward system of the brain and when the benefits and pleasure are experienced from use the brain wants more. Cannabis can be very effective in relieving emotional distress quickly. This is why when I explore potential harm reduction strategies with my clients by asking, “Have you explored CBD instead of smoking cannabis (THC)?”, the answer I often receive is, “I tried CBD and tinctures but smoking (THC) makes me feel relaxed quickly and less anxious and the CBD stick or tincture did not”.
Myth #2. Cannabis impacts the brain the same at all ages
People who use cannabis starting at younger ages will end up with different reward pathways than those who do not. There is some research that suggests that adolescents who are chronic cannabis users have higher rates of depression and anxiety in adulthood. When I am working with clients whose brains have not yet fully developed, the brain develops into the mid to late 20s, I provide education regarding the potential long-term impacts of their use on their developing brain. My spiel often goes like this, “It is always up to you what you choose to do regarding your substance use, there is evidence that cannabis use can affect the developing brain in increasing depression and anxiety, therefore if I were you I might consider waiting to use cannabis after your brain has fully developed if possible OR consider decreasing the amount of use in the near future”.
If you have identified cannabis use as problematic in your life (or maybe others have) and you are interested in making changes to your use, you can consider other harm reduction strategies such as learning more about the potency of the strains and use less potent cannabis, choose to use less throughout the day, or consider a larger CBD to THC ratio than you use today. If you are working with a therapist, psychiatrist or primary care doctor, it is important that you discuss changes to your substance use to explore ways to mitigate physical and psychological withdrawal or interaction effects with other medications or supplements.
Anecdotally, I have noticed that close people in my life who had shared that they used cannabis chronically throughout their adolescents do have both depression and anxiety that significantly have impacted their lives and well-being well into their adulthood. Hopefully there can be more research done to figure out what can be done, if anything, to support the brain to manage or reverse the negative consequences of chronic cannabis use in adolescents.
Myth #3 People who use cannabis will become psychotic
No, we know that a many people will not experience psychosis, while others may experience mild paranoia. Research shows that if you have a family history of certain mental health conditions such as bipolar and schizophrenia that those individuals have a higher risk of experiencing drug induced psychosis or having a “psychotic break” due to THC being a psychoactive substance. It is important to know about our family history of mental health issues to make more informed decisions about substance use.
Myth #4 You cannot withdrawal from cannabis
According to researchers J. Connor et. al. (2021), “Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ9-tetrahydrocannabinol (THC)”. Some withdrawal symptoms include: anxiety, irritability, anger, depression, sleep disturbance and less likely symptoms include chills, headache, stomach pain and sweating.
Myth #5 Cannabis use does not affect sexual functioning
This topic requires much more research, therefore the findings have often deemed to be inconclusive. Some of my clients have shared that they noticed that when they were using cannabis regularly, they noticed a decrease in motivation for sex. Some of this can be attributed to the changes in the reward system and impact to motivation. There is also a lack of evidence for cannabis use and impacts to the reproductive systems. It has been well researched the smoking tobacco or nicotine has a negative impact on the quality of sperm. If you have more information on this, such as if this is a result of smoking versus the substance I would love to learn more- please send me a message so we can chat. If smoke inhalation itself affects sperm health, we can hypothesize that smoke from cannabis may likely have a similar effect.
How is the medical and mental health field doing in California with treating individuals with medical marijuana?
According to a cannabis training that I recently completed through UCLA, we are behind in the United States in terms of medical providers prescribing cannabis. Other countries’ medical providers, such as in Canada, seem to have more of a grasp on what strains to prescribe at which doses to individuals presenting with medical and mental health issues. Some of this may have to do with that in the United States cannabis is still federally illegal, therefore it may pose an issue for providers who work in agencies that receive federal funding (or even work privately) to prescribe an “illegal” substance, despite medical cannabis being legal to prescribe state wide.
In conclusion
With all this said, there is so much more we have to learn about cannabis use therefore it is necessary that the federal government remove cannabis from being a schedule 1 drug on the DEA list for it to be further researched and understood. Further complications when studying attempting to study one variable include polysubstance use (use of other substances), co-morbid mental health issues and medical health conditions. This information is a “scratch of the surface” of potential cannabis use outcomes and I hope that we learn a lot more in the near future so that everyone has more information to make the most informed decision about their cannabis use.
Resources
J. Connor, D. Stjepanović, et al. (2021). Clinical management of cannabis withdrawal https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.15743
Sending love,
Joanna