By Will Hall
Cannabis (marijuana) is now legal in two states, legal for medical use in 23 more, and roolls show the majority of Americans support legalization. As a counselor working with people diagnosed with psychosis and mental illness I am often asked about my clinical — as well as my personal — experience with medical cannabis.
The issue is not clear-cut, but I think it is time for everyone, especially if you are concerned with the risks of pharmaceutical drugs, to set aside what we think we may know and take a serious look at cannabis as an option for mental health challenges. The decision to use any substance is complex, and along with War on Drugs anti-pot propaganda there is also a lot of pro-cannabis fanaticism to wade through. But this is the reality: despite some risks, cannabis has huge potential for promoting mental health while avoiding pharmaceutical drugs and their devastating adverse effects.
I don’t need to reiterate the research on medical cannabis easily found online, and I have already written about my counseling approach to substances in general in a previous post (‘The Substance of Substance Use”). But here are some more thoughts about cannabis specifically.
People are already using cannabis successfully to treat psychiatric conditions. Cannabis has long been a medicine and sacrament throughout human history, for far longer than the brief period of prohibition. Criminalization didn’t come in 1937 because of any medical assessment, but was instead a political decision. The first anti-pot laws were motivated by racism against blacks and Mexicans, and later Nixon sought to suppress an insurgent youth culture. Today there are extensive studies showing medical benefits for cancer, Alzheimer’s, multiple sclerosis, hepatitis C, irritable bowel, Parkinson’s, pain management, epilepsy, and many other conditions, and this evidence has driven successful cannabis legalization ballot initiatives around the country.
The legalization trend is now convincing even longtime opponents. US President Obama formally acknowledging cannabis as no more dangerous than alcohol, and CNN’s chief medical correspondent Dr. Sanjay Gupta recently reversed his opposition to medical cannabis. Dr. Gupta, who is one of the world’s most influential medical opinion leaders, even apologized for his previous anti-legalization stance and for “not looking hard enough” at the issue.
But what about mental health conditions? Should we embrace cannabis as a treatment?
Around the country, medical cannabis cards are given to people suffering anxiety, depression, insomnia, ADHD, trauma, and mental health issues. The internet is replete with a growing number of testimonies of successful symptom alleviation through cannabis, including people diagnosed with psychotic disorders such as bipolar and schizophrenia, as well as using cannabis to come off psych drugs. These are not just a few anecdotes, these are many thousands of people giving firsthand accounts.
“Since I’ve started smoking regularly I’ve started working out regularly, haven’t had a bipolar episode, no panic attacks, stopped cutting completely”
“When I was in a manic phase, marijuana relaxed me and helped me get to sleep. I often felt as though I had so much energy inside me that I would jump out of my skin, and the cannabis helped tremendously with that.”
As the number of dispensaries, review websites, and legal cannabis consumers increases, testimonies like these are growing. And at the same time, it is not uncommon for me to receive emails like these:
“Our son was doing so well in school, and then he started smoking cannabis and went psychotic and went into the hospital, where he was diagnosed with schizophrenia.”
“Before her delusions began I learned she was experimenting with cannabis…”
So what is going on?
A simplistic prohibition mentality has saturated our culture for years, with media reports and scientific studies thoroughly demonizing cannabis. Just one notorious example was the Heath/Tulane study in 1974, which claimed to show cannabis “kills brain cells” in laboratory animals. This finding, by a mainstream research institution with impeccable scientific credentials, was considered gold standard and was widely repeated in the media. “Marijuana kills brain cells” was paraded by President Reagan in his anti-drug propaganda, and is still today brought out by frightened parents when they discover a joint in their teenager’s bedroom. In the “This is your brain on drugs” television commercial, a broken egg on a hot griddle became the last word on what cannabis does to your brain.
The Heath/Tulane study was later exposed as scientific fraud: researchers were able to demonstrate brain cell death only by pumping so much cannabis smoke into restrained laboratory animals that the animals couldn’t breathe. Brain cells need oxygen to survive, and it was asphyxiation, not ingesting cannabis, that caused the brain damage. This corruption of science isn’t just from the Reagan era, though: it continues today. Dr. Gupta writes that of current US cannabis studies currently underway, 94% are designed to investigate harm, not potential benefits.
Medical professionals should have helped guide us through this confusion. Instead we find the same corruption of a public trust. No leading mental health organization has publicly expressed opposition to the War on Drugs or presented an honest discussion of the pros and cons of cannabis legalization. Even with the prohibition tide now turning, mainstream organizations such as National Alliance on Mental Illness and the Schizophrenia Society of Canada continue to echo cannabis demonization, trailing behind both consensus scientific views and common sense.
Regarding cannabis and psychosis, mainstream mental health opinion makers have stayed firmly in line with pharmaceutical industry and American Medical Association opposition to legalization. Without exception they have elected to emphasize the research linking psychosis to cannabis while ignoring everything else worth considering. Cannabis’ demonstrated usefulness for anxiety, PTSD, depression, reducing psychotic symptoms, helping people discontinue psychiatric medications and get off painkillers – none of this finds its way into the mainstream mental health discussion. Just as the mental health industry has lagged far behind in recognizing the value of holistic health options in general, it is lagging behind on the value of cannabis.
NAMI medical director Dr. Ken Duckworth sums it up on the NAMI website: “The overwhelming consensus from mental health professionals is that cannabis is not helpful—and potentially dangerous—for people with mental illness.” He’s correct – but overlooks that this consensus is a result of politics, not medical science. Dr. Duckworth deploys full War on Drugs propaganda in his NAMI policy writings: “Approximately one-third of people in America with schizophrenia regularly abuse cannabis,” writes Dr. Duckworth, and the implication is clear. But is there a citation for that incredible statement? No, because there is no evidence behind it.
He also rings the alarm bell of addiction, continuing the mental health industry’s conflation of use with abuse. “A significant percentage of individuals who use cannabis will become physically dependent on the drug.” writes Dr. Duckworth. “This means that stopping their cannabis abuse will cause these people to experience a withdrawal syndrome.”
CNN’s Dr. Gupta, however, disagrees. He writes that “In 1944, New York Mayor Fiorello LaGuardia commissioned research to be performed by the New York Academy of Science. Among their conclusions: they found cannabis did not lead to significant addiction in the medical sense of the word.” Dr. Gupta adds, “The physical symptoms of cannabis addiction are nothing like those of the other drugs I’ve mentioned.”
As Dr. Gupta’s reversal of position indicates, there is a clear and growing case for cannabis’ benefits relative to its risks – including for mental health. This reality is slowly coming to light, but in the context of the War on Drugs, legalization advocates have themselves made things confusing. Pro-legalization forces, understandably defensive given the brutal atmosphere of criminalization and imprisonment, have often become cannabis cheerleaders and dismissed any discussion of risks as more propaganda. Left in a vacuum by mental health and medical organizations that should have been providing leadership on the issue, mainstream research studies on medical benefits are often touted and available on aggressively pro-cannabis sites. You feel that you are pulled to one side of the other in this political, cultural, and economic tug of war. The pro-cannabis sites are after all, now burgeoning with advertising revenue from the surfacing cannabis industry. There is a lot of money at stake around legalization. The message today is “cannabis is good for you,” and the next message will be “buy some from us.”
As a society we are thankfully stepping away from both sides of this war. A new honesty around cannabis is taking place in medical cannabis states such as California (where I live) and on the internet. As fear diminishes and people become freer to speak openly, two important facts are emerging as central to this discussion: dosage and strain.
The cannabis of today isn’t the cannabis of yesterday. But the commonplace claim that “cannabis today is stronger than it was in the past,” and therefore riskier, is far from the whole picture. Yes there is a lot more strong cannabis out there, but that also has positive implications for medical use. Cannabis is being used today in many different ways by many different people, and this increasing sophistication needs to be understood to get the real story.
This is well illustrated by the cannabis experience of New York Times Pulitzer Prize winning columnist Maureen Dowd. In a high-visibility act that formed part of Times reporting on growing legalization efforts in Colorado and elsewhere, Dowd got high on pot in Denver — and promptly had a psychotic episode. She presumably didn’t go on to be diagnosed bipolar, and didn’t need to be hospitalized. But her reporting about her bad trip, replete with delusions of being dead and paranoid fears of the police, reinforced prohibition stereotypes and was considered proof positive by some that cannabis is a bad idea for anyone “at risk for psychosis.”
Dowd, however, was in effect writing a denunciation of wine by binge drinking on tequila. “Alcohol makes you sick and pass out” says more about how, how much, and what we drink, than it does about that we drink alcohol. Simple enough common sense, but that is exactly what has been lost in the discussion around cannabis. Without adequate understanding, Dowd apparently swallowed an entire cannabis infused edible candy. Edibles are notorious for their potency. Then she did what anyone following sensible cannabis use knows not to do – when after a few minutes she didn’t feel any effects, she gobbled up even more of the edible. This doubled the eventual impact of the drug, and after the slow-onset that is standard for eating cannabis (unlike smoking, eating means the cannabis is digested before experiencing amplified effects), she delivered a massive dose to her cannabis-naive body. Hence the overwhelming trip. It could be humorous – Dowd was lambasted in the internet for her irresponsibility – if it wasn’t so emblematic of the impact of prohibition. Rational discussion by a presumably thoughtful professional journalist turns into nonsense, more fuel for simplistic demonization.
Dosage, including the delivery method (and today there are herbal tinctures, vaporizers, and other methods beyond smoking or eating), is an important reality to cannabis consumption. If a drug at one dose is useful and at a higher dose is harmful, does that mean the drug itself is “useful” or “harmful?” If a drug leads to psychosis at a higher dose, but doesn’t at a lower dose, is the problem the drug or how it’s used?
So we begin to see one explanation for how a drug that many people find useful for psychosis can also be a contributor to psychosis for many others. It becomes more understandable why my inbox has emails from people blaming cannabis for mental illness alongside emails from people who’ve been helped.
Dowd also didn’t understand the what of cannabis use. She didn’t chose her supply with any care, and that can make a huge difference: there are hundreds of strains of crossbred hybrid cannabis, with colorful names like Blue Dream, Girl Scout Cookies, AC/DC, and Lemon Alien Dawg. This diversity isn’t just fanciful or aesthetic: strains differ by aroma and flavor, but much more importantly, different strains have drastically different psychoactive effects. Alcohol intoxication might feel a bit different between beer, wine, and spirits, but not by much. The difference between different cannabis strains, however, is like taking completely different substances.
There are 483 currently known compounds in cannabis, and at least 84 different psychoactive cannabinoids. THC is just one. And different compounds lead to different mental experiences. This may explain why some people are using cannabis to alleviate psychosis while others find it makes psychosis worse. Today medical cannabis users routinely share information about the qualities of different strains – some good for sleep, some for anxiety, some for depression – to help each user find out what works for them.
Cannabis users have also long known that the sativa varieties are different than the indica; sativa is associated with a more energetic high, prone to produce anxiety and paranoid in some people. while indica is more sedating. Of the many alkaloids, cannabidiol (CBD) is associated with tranquilizing response without strong mind-altering effects, while THC causes more mind-altering, and is potentially paranoia- and anxiety-inducing. Testing can pinpoint THC to CBD ratios in cannabis, and today dispensaries provide detailed information about their product that was impossible under prohibition. There is strong evidence that high CBD cannabis can alleviate psychosis for the simple reason that CBD is tranquilizing, in the same way that anti-psychotics are for many people helpful because they are tranquilizing. CBD, however, not only lacks the stronger reality-distorting effects of THC that can become so disorienting and panic-induing on some people, but it clearly has none of the devastating side effects of anti-psychotic drugs. No one has ever suffered thyroid damage, tardive dyskinesia, or kidney failure from cannabis.
(The cannabis industry is still only now emerging from the underground, and without the regulation and quality control of other industries, users have to rely on trial and error. It’s not a guarantee that what the dispensary labeled as Blue Dream isn’t actually Kali Mist, or that indica tincture is actually sativa. As in the legal wine industry, users will be served by allowing greater testing and reliability of supply. The proper role of regulation, however, is fiercely debated by growers in the current Gold Rush atmosphere. There are concerns about ecological sustainability, fair trade labor conditions, and the specter of Big Tobacco-style profiteering. In Sonoma County where I live, there is a huge cannabis industry and vast sums of money moving into the state in anticipation of California legalization. The wine industry in the area, despite being legal and regulated, is very shady, and has earned a deserved reputation for greedy disregard for the environment and local community. That might be a cautionary tale: the gentle peace-ecology-love aura of cannabis may, some fear, quickly give way to the cutthroat realities of just another boom industry and agribusiness product. Or, the issue might be upstream: with large monied interests corrupting politics, it may take democratic reform to get all industries – wine and cannabis – more in line with public interests.)
Word about CBD is getting out. Along with the emails from people tracing psychosis back to cannabis use, I now routinely encounter people in my work, lucky to be in a legal state or country or able to risk acquiring pot through the underground, who are turning to cannabis for help with psychosis and mental illness diagnosis. Some have switched to high CBD strains and found different effects, some are using cannabis to help come off psych drugs, some are using cannabis instead of psych drugs, and some – very interestingly – have gotten benefits from cannabis and never gotten on psychiatric drugs to begin with.
Scientific studies on CBD support what I am seeing: a University of Cologne study from Germany, in a four week trial, found CBD as effective as an anti-psychotic in calming psychotic symptoms. A co-author of the study wrote “Not only was [CBD] as effective as standard antipsychotics, but it was also essentially free of the typical side effects seen with antipsychotic drugs.” Harvard researchers who published a different study in Schizophrenia Research wrote that “The amount of THC is particularly of concern, whereas CBD is the component that is thought to have medicinal value even in schizophrenia.” They concluded that “there is no evidence from this study that it [cannabis] can cause the psychosis.”
A glance through research results on CBD from studies around the world shows evidence to support what we know already: CBD cannabis can help mental health conditions. These users are often careful in dosage, some even using just a few drops or “homeopathic” doses to get the desired effects.
(Other research is also intriguing. Numerous studies show anxiety alleviation, and, consistent with research on Alzheimer’s and Parkinson’s, one University of Montreal study published in Psychiatry Research even showed cannabis users diagnosed with schizophrenia to have better memory and prefrontal lobe functioning than those not using cannabis. Those study participants were taking psych meds: could cannabis be not only a substitute for psychiatric medications, but a treatment for the harm they caused? There are other studies that are more troubling about risks, such as those showing memory impairment and youth developmental harm, but these need to address dosage and strain questions to be able to better understand what is going on.)
So the kind of cannabis used, as well as the dosage, may explain part of the puzzle of different reports around cannabis and psychosis. This is in addition to a general principle with all psychoactive substances, a principle that applies to cannabis as well: Response to cannabis use is widely diverse and individual. This is confirmed by a University of Manchester study published in Schizophrenia Bulletin that found that “impacts of cannabis on people with psychosis are quite complex and variable.” (The study even showed that “Cannabis use was associated with an improvement in general functioning” compared to non-users.)
The medical cannabis dispensary community is thoroughly familiar with the fact that as a “medicine” cannabis does not provide uniform “treatment.” Instead, just as each individual experiences an illness differently, each individual has their own response to a medicine like cannabis. What is right for one person might not be right for another – including the need to forgo cannabis altogether. Some people find the “high” contributes positively their medical condition and life circumstances, others seek out strains that have helpful effects without the high. Dispensary staff I’ve met are skilled at helping individuals navigate different strains and dosages for individual needs.
Substance abuse is a serious and devastating problem. Some people find that abstinence is the best strategy, such as following an AA 12 step program. Taking any drug – alcohol, tobacco, or cannabis — involves risks. Cannabis needs to be subjected to the same caution, but overall cannabis is undoubtedly infinitely safer on the body than alcohol or tobacco (zero cannabis caused deaths compared to many millions of alcohol and tobacco deaths). In any direct comparison, cannabis is much safer than any psychiatric medication. That includes the possible link to psychosis, because we know that psychiatric drugs themselves definitely cause psychosis in some people.
The growing legalization and medicalization of cannabis will no doubt be used by some to rationalize their addiction, or rationalize getting high when the drug is not helping them. But this is true of any substance, including alcohol and psychiatric meds. Once we step outside the War On Drugs mentality we can engage this complicated reality more clearly. Saying cannabis might be helpful for some people is not to deny it might make things worse for others.
What about me personally? I found years ago that cannabis only worsens my own anxiety and further disconnects me from reality. I was smoking around the time I was first hospitalized, and though I quit cannabis I still had another psychotic break many years later when I wasn’t using, and hadn’t used, cannabis for 8 years. I do believe that pot was a contributing – but in no way a causal – factor in my first crisis, and that smoking played a role in the several years of decline that led to that crisis. But this was all wildly overblown by the hospital doctors who interviewed me. When I moved to Conard House, an outpatient facility in San Francisco, I was sent to a mandatory anti-drug meeting along with every cannabis user at the house, regardless of the frequency of use or whether or not it was abused or a problem for us. When I challenged the meeting leader by saying that cannabis was much safer than alcohol, which I thought was a commonsense statement, I was summarily kicked out of the program. (I was sent to a homeless shelter at 14th and Mission, right next to a thriving street crack cocaine market where I passed dealers every day on my way to and from my room. A good friend of mine from a previous program, who had been abstaining from cocaine for several years, was sent to the same shelter. I watched as he gradually lost control of his addiction with the temptation of those dealers; he left the shelter and I never heard from him again.)
I think that CBD strains are promising, and I personally would not hesitate to try a small dose of CBD cannabis in a time of emotional crisis where I felt I had run out of other options. I would watch carefully my response, and proceed only if I felt confident I wasn’t going to get paranoid, become anxious, or have my rational faculties impaired. Over the years friends, clients, and colleagues who use cannabis have educated me about its potential if I did ever find myself in need, and now that I live in California a friend has introduced me to the California dispensary system. I’m grateful I live in a state where I can learn about cannabis more honestly. If I ever get out of hand with sleep deprivation or go off the deep end in a psychosis, I’m glad I can first try a CBD brownie (gluten free of course) instead of a dose of Seroquel. And when I’ve seen friends go down to the psychotic vortex and head for the hospital, I wish there was some CBD weed around to try and help them break the crisis cycle, rather than relying on a psych med as a last resort.
In my work with clients I now consider it unethical as a therapist to not include cannabis in the list of possible wellness tools. I am pro-choice regarding psych drugs, and if I acknowledge that antipsychotic meds, even with the risks, might be a wise choice for some people, I would be completely, well, crazy not to acknowledge that cannabis might be a wise choice for others. I’ve always welcomed herbal medicine and traditional Chinese and other treatments into the range of possible wellness choices, because they have such a demonstrated history of helping so many people with such few risks. Cannabis also has such a history, and I believe everyone working in the mental health field needs to consider taking the same stance I have. There are a lot of states where cannabis is still illegal, and it is wrong for people living in those states to continue to be denied a possible treatment option.
From a mental health advocacy standpoint, cannabis legalization also has many other implications that we as mental health professionals need to take initiative around, because the AMA, APA, NAMI and other groups have failed to take any honest leadership on the issue. An American Journal of Public Health study by a team of economists, for example, examined states that had legalized cannabis for medical use. The study found there was a 10.8 percent reduction in the suicide rate of men in their 20s and a 9.4 percent reduction in men in their 30s. That is extraordinary – we know that psychiatric drug use can exacerbate suicidality (the warning is right there on the drug label), and alcohol of course can contribute to suicidality. It’s not clear exactly why greater availability of medical cannabis might lower suicide rates, but this is a very, very significant finding for anyone who takes suicide prevention seriously. (I recently lost a dear friend to suicide, and I am convinced benzodiazepines and alcohol played a role in killing her. I wish her therapist and doctors had explored cannabis as an alternative – she needed any alternative – and her death is one of the things motivating me to write this blog post and “come out” with my clinical practice decisions around cannabis.)
Studies also show legalization leads to reduction in alcohol use. That in itself has huge mental health implications. Alcohol is an extremely dangerous and socially destructive drug with notorious mental health harms. The National Council on Alcoholism and Drug Dependence reports that alcohol use is a factor in 40 percent of all violent crimes in the United States, including 37 percent of rapes and 27 percent of aggravated assaults. In 1995 alone, college students reported more than 460,000 alcohol-related incidents of violence in the US. A 2011 study found dating abuse directly associated with drinking among college students, and a 2014 study showed cannabis was significantly lower than alcohol in association with domestic and partner violence. As pro-legalization comedian Bill Hicks remarked, imagine you are at a sporting event and some guy in front of you is screaming and picking a fight: is he high on cannabis or is he drunk on alcohol?
Reducing alcohol use in society will likely reduce violence; and reducing violence means reducing trauma. When did we lose sight of ending violence as a way of preventing the cause of so many mental health problems? The decline in alcohol use associated with legalization has already reduced traffic fatalities from drunk driving. Each traffic death sends out shockwaves of trauma and grief, and turns many people to alcohol or psychiatric drugs.
Marijuana legalization is an upstream mental health solution with enormous implications. From a public health standpoint there is really no argument: just considering the effect of bringing down alcohol consumption alone makes cannabis legalization clearly worth it.
And that is just one effect. Cannabis legalization also reduces the market and illegal demand for opiods: according to the Centers for Disease Control, abuse of prescription opioids such as Oxy-Contin and Vicodin is a national epidemic that kills 16,000 people annually and is destroying lives and families.
Legalization of cannabis also has important implications for young people – once we understand the complexity of substance use. The War on Drugs has devastated the US black community, and it is shameful that white-dominated mental health organizations have not spoken up against prohibition. Prison and the police are a traumatizing factor that directly interfere with mental health recovery. While legalization, according to the Journal of Adolescent Health, has not led to an increase in teen cannabis use, it does give families and youth more flexibility. For young people using cannabis, it might be more realistic to switch the kind of cannabis they are using as a harm reduction approach, rather than giving cannabis up completely or punishing them with prison. Many young people are committed to cannabis as a lifestyle, a form of religious expression, and a pathway to independence. Under prohibition it is impossible to talk openly about their cannabis experiences, and difficult to differentiate cannabis strains they are consuming. It may be easier for a teen to hear “use CBD, not THC” than for them to hear “you have to stop smoking entirely;” “You can smoke pot, but in moderation” might work better than “you can’t get high at all.”
Collaborative relationships require honesty: young people today know that different strains do different things, and they know the hypocrisy of a War On Drugs that sends people to jail for smoking a joint and then sells their lawyers whiskey at the bars next to the courthouse. A harm reduction perspective is best served by legalization. Overgeneralized associations between cannabis and mental health problems, including psychosis, ignore a complex reality.
Adolescents using cannabis who get into emotional and psychological difficulties are like any adolescents who get into emotional and psychological difficulties, for whatever reason. They need help and support. The family needs help and support. The problem is never “cannabis plus genetics equals psychotic disorder.” The cannabis may, or may not, be part of the problem. When families — and doctors —are blaming the cannabis it is usually a sign of a deeper problem being avoided. Prohibition is based on fear, the search for a simplistic answer, something to grab ahold of as the solution when things feel out of control.
Cannabis use often becomes a power struggle in families. As a therapist I have seen time and time again families where a son or daughter has been psychotic after using cannabis, and the family’s response, likely reading articles such as Dr. Duckworth’s on the NAMI website, is to ban their son or daughter from using. So what does the young person do? They keep smoking, of course, except now they have a new problem: hiding their use, a power struggle with their parents, and the beginning of a cycle of isolation. I have to work hard to stay in a trusting relationship with both sides, and that job gets harder the more prohibition fears entrench intolerance. The solution is to create conversations about the substance; even if the parents are strongly against any cannabis use, it’s important to respect all sides, but on an equal playing field where the young person can be validated for a choice that has some science on its side. Dismissing the other side when you have the power of the police to back you up won’t help or lead to compromise. Doesn’t it make more sense to say Let’s talk? than to say Just Say No?
I have no doubt that cannabis use has played a role in many people’s problems with psychosis. I routinely encourage people to stop smoking when they know it can lead to crisis. I’ve seen people off cannabis start using again and end up hospitalized. And cannabis can certainly lead to habituation for some people and play a role in substance abuse problems. Educating society about these risks makes the same sense that educating society about alcohol risks makes sense – as long as the risks are not exaggerated. (Personally I would like to see cannabis avoid the commercialization of alcohol, and instead become an accepted – but not promoted or advertised – personal option. We really don’t need any more consumerism than we already have.)
And what about the correlation between first break psychosis and a higher rate of cannabis use? There is in my view some validity to that concern — and it also may be misleading. What if the causality is in the other direction? What if people who end up psychotic are drawn to altered states of consciousness to begin with, what if they first seek out in cannabis what they eventually end up seeking out later in their break to a psychotic reality? Working with young people over many years, I see the need to get “high” comes first, not after, the substance. Few families have honest discussions about the need to get high and get away — a human need that everyone has. And getting high repeatedly may be an escape hatch out of untenable life circumstances and confusing options. Maybe a young person is drawn to cannabis by the same inner need that will eventually draw them to psychosis, correlating the two – but not indicating causality? And as continued research shows the complexity of these relationships, is the fear of a cannabis-psychosis link just another artefact of the War On Drugs, used to shut down open discussion and spread prohibition politics in the mental health field? It certainly seems to be working: mental health professionals I talk with tend to parrot the psychosis-cannabis link research as the final word in the discussion in much the same way people parroted the “killing brain cells” research.
As we come to terms with the devastating impact of psychiatric drugs, we face a compelling question: What if there was a substitute? I believe mental health problems arise from emotions and life circumstances, and wouldn’t advise anyone to just “numb” out meaningful emotional responses with any substance. Numbing things out can interfere with a natural healing process. At the same time, there is no reason to be either-or. One can still come to terms with emotional challenges while receiving some relief from a substance or holistic treatment. And emotional crisis sometimes becomes so overwhelming that grappling with it directly might feel out of reach or impractical.
Someone considering a benzo, or an anti-psychotic, or an anti-depressant, is about to embark on a risky treatment option that might work out fine, or might end up destroying their life. That is the reality of the risks of psychiatric drugs. The Soteria House alternative and the Open Dialogue approach, it should be remembered, do rely on psychiatric drugs as a last resort. What if everyone had, on a wide scale, the option of choosing something with a lower side effect profile, and thereby avoid a risky pathway? Legalization of cannabis may be making that option real for many people. And if that is a possibility, this raises the question: what exactly do we know of Pharma’s influence in opposing cannabis legalization? The American Medical Association and APA have long opposed legalization; does medical cannabis represent a threat to their markets?
There is a clear nest of financial interests benefitting from cannabis prohibition, and the same public policy corruption promoting psychiatric drug use is behind efforts to block legalization. Dr. Herbert Kleber of Columbia University, an impeccably credentialed academic, is widely quoted in the press warning against cannabis – and also serves as a paid consultant to huge prescription drug companies. Oxy-Contin manufacturer Purdue Pharma and Vicodin manufacturer Abbott Laboratories are among the leading funders of the Community Anti-Drug Coalition of America and Partnership for Drug Free Kids – both prominent prohibition advocates. (Other funders include Janssen and Pfizer.) When Patrick Kennedy’s so-called Project SAM (Smart Approaches to Marijuana) worked against Alaska’s legalization initiative, activists counterattacked by pointing out the organization’s extensive financial ties to the liquor and beer lobby. Legalization opponent Dr. Stuart Gitlow, President of the American Society Of Addiction Medicine, went on the media circuit disputing President Obama’s statement that cannabis is no more dangerous than alcohol: Gitlow serves as medical director for Pharma opioid manufacturer Orexo. Former Drug Enforcement Administration head Peter Bensinger and former White House drug czar Robert DuPont (yes that was his title) now run a commercial firm that specializes in the market for workplace drug testing. And while some police in the US have come out against the War on Drugs, many police are lobbying in favor. Is it because under drug money seizure and assets forfeiture laws they receive millions in funds for their departments to use? One sheriff who led opposition to legalization in Florida even stated openly that drug asset forfeitures were important for county law enforcement revenue. California legalization was opposed by another police lobbyist who made a career of funneling federal War on Drugs grants to state law enforcement. The economy of influence is clear.
Just as under alcohol prohibition, marijuana prohibition sinks deep roots of corruption into society as public good is diverted to individual gain. Speaking of federal grants and asset forfeiture, Los Angeles Police Department Deputy Chief Stephen Downing told The Nation, “The only difference now compared to the times of alcohol prohibition is that, in the times of alcohol prohibition, law enforcement—the police and judges—got their money in brown paper bags. Today, they get their money through legitimate, systematic programs run by the federal government. That’s why they’re using their lobbying organizations to fight every reform.” Legalization means challenging economies of influence and politics of corruption that have made drug policy and criminalization big business. Importantly, ending alcohol Prohibition in 1933 involved a vast clearing out of corruption from the federal to the local level; hopefully the grassroots drive for cannabis policy reform will likewise have wide anti-corruption implications.
Even when we support cautious consideration and avoid blanket endorsement, cannabis is a powerful psychoactive plant that involves risks. Small controlled doses – a few drops of tincture, a small puff from a cigarette, a bite from an edible candy – are still unpredictable, and might launch someone onto an unpleasant altered state, make working or relating in public difficult, trigger insomnia, interfere with driving, set someone down a path to addiction, or worse. Memory and cognition harms might reveal themselves after long-term heavy use. There are risks: it’s not a one size fits all solution. It will take some time to sort out research honestly and get a realistic sense of cannabis in the wake of a politicized and corrupted research legacy.
And this underscores one of the central limitations to the cannabis policy discussion: is cannabis a medicine, or is it something more?
Legalization activists wisely chose to emphasize medical uses as a pathway towards greater acceptance. Demonstrating specific medical benefits challenged the War On Drugs classification of cannabis as a schedule one substance with no medical use. But in practice, as a plant medicine, cannabis has never been and probably never will be a targeted medical treatment. It is a living botanical life form, not a pill. Pharma has fanciful ideas about keeping the plant illegal and marketing derivative products like synthetic THC, but cannabis is not like penicillin. There is a reason why it is associated with spiritual practice and shamanism throughout history. Since prehistoric times cultures using cannabis have considered mind-body and spirit as one, and seen medical and religious practices as the same. People get ill, after all, not just bodies. The goal of a plant medicine is to support the holistic health of the whole person in their life and community context, not treat specific diseases separate from that broader reality.
Cannabis is very complex chemically, and the human body actually has an endocannabinoid system that cannabis is uniquely suited to interact with. The endocannabinoid system affects a vast number of life processes, and is vital to maintaining health and preventing illness in a comprehensive way. This appears to be why cannabis has such extremely wide health uses and has been effective in treating so many different conditions. Western medicine, however, is mechanistic and doesn’t look holistically at the mind and body as a single unified organism. It prefers to break down illness into specific component parts with specific treatments. This is one reason mainstream medicine is skeptical of plant remedies valued by traditional cultures for their broad effects.
So it would be a mistake to consider cannabis simply as a new western medical treatment. When people find cannabis useful for psychiatric conditions or for coming off psychiatric medications, it may be more meaningful to think in terms of a relationship to a substance, just as traditional cultures have thought in terms of relating to a plant spirit. And that substance or spirit can be very powerful. Like any substance, it can be misused and is not for everyone, and like any substance it means understanding our own personal responses and needs holistically. Like alcohol and caffeine, cannabis, even in its low THC varieties, changes consciousness and can produce a “high” that some people will enjoy, some people will not enjoy, and can cause problems for some people.
From food to movies, wine to video games, sexuality to long distance running, altering consciousness and “self-medicating” are widespread social practices. We need to acknowledge that we all, to some degree, choose to get high. We all make choices that change our consciousness. And this is what we have overlooked in our understanding of psychiatric drugs – they too are very powerful mind altering substances that get us “high.” They are high-tech, experimental, and risky highs compared to the plant medicines people have used for millenia, but they are still highs. Psychiatric drugs are not what we think of as a recreational drug, but we are still altered when we take our Zyprexa or our Prozac: and some psychiatric drugs of course, such as the benzodiazepines and the stimulants, are widely sold on the street for their recreational uses.
Because psychiatric drugs have such a clear downside, interest in using cannabis instead of psych drugs is here to stay and will only grow as legalization spreads. It’s time for us to leave behind the politics of the War on Drugs and start to have a more honest discussion of the potential benefits, and risks, of all substances, whether they are psychiatric drugs, or cannabis. Cannabis might just be a spirit that our culture needs – and, after years of fear and repression, is ready for.
On topic from Beyond Meds:
*it is potentially dangerous to come off medications without careful planning. Please be sure to be well educated before undertaking any sort of discontinuation of medications. If your MD agrees to help you do so, do not assume they know how to do it well even if they claim to have experience. They are generally not trained in discontinuation and may not know how to recognize withdrawal issues. A lot of withdrawal issues are misdiagnosed to be psychiatric problems. This is why it’s good to educate oneself and find a doctor who is willing to learn with you as your partner in care. See: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up