Cannabis, Mental Helath and Context: A new NORML Report

[IndianaToker]

Cannabis, Mental Health and Context: The Case For Regulation
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by Paul Armentano
Senior Policy Analyst
NORML | NORML Foundation


<table border="0" cellpadding="2" cellspacing="0" width="100%"> <tbody><tr valign="top"> <td>•</td> <td>Cannabis In Context</td></tr> <tr valign="top"> <td>•</td> <td>Health Risks Call For Regulation, Not Prohibition</td></tr> <tr valign="top"> <td>•</td> <td>Endnotes</td></tr></tbody></table> Armed with sound-bites reminiscent of the 1936 propaganda film "Reefer Madness," the US government recently kicked off yet another smear campaign on the supposed dangers of marijuana. The Feds' latest charge: Pot causes mental illness.

"A growing body of evidence now demonstrates that smoking marijuana can increase the risk of serious mental health problems," US Drug Czar John Walters announced at a press conference1 hyping the White House's latest anti-pot campaign. "New research being conducted here and abroad illustrates that marijuana use, particularly during teen years, can lead to depression, thoughts of suicide, and schizophrenia."

Predictably, those looking for the science behind the White House's alarm would be hard pressed to find any. Absent from their campaign was any mention of a recent clinical study published in the April 2005 issue of the journal Psychiatry Research refuting a causal link between cannabis use and behavior suggestive of schizophrenia. "The current study ... suggest[s] a temporal precedence of schizotypal traits before cannabis use in most cases," its authors concluded. "These findings do not support a causal link between cannabis use and schizotypal traits."2

Survey data published in the journal Addictive Behavior also puts a damper on the White House's "pot leads to depression" claims. After analyzing survey results from 4,400 adults who had completed The Center for Epidemiologic Studies Depression scale (a numerical, self-report scale designed to assess symptoms of depression in the general population), researchers at the University of Southern California found: "Despite comparable ranges of scores on all depression subscales, those who used once per week or less had less depressed mood, more positive affect, and fewer somatic (physical) complaints than non-users. ... Daily users [also] reported less depressed mood and more positive affect than non-users." 3

Lastly, there are the results of a recent meta-analysis published in the journal Current Opinion in Pharmacology. The study's verdict? Those who use cannabis in moderation, even long-term "will not suffer any lasting physical or mental harm. ... Overall, by comparison with other drugs used mainly for 'recreational' purposes, cannabis could be rated to be a relatively safe drug."4

Cannabis In Context

The phrase "relatively safe" is appropriate in any discussion regarding cannabis and mental health. No substance is harmless and in many cases, the relative dangers of a drug may be increased or decreased depending on set and setting. Cannabis is no different.

To date, there is a limited body of data noting an association – albeit a minor one5 -- between early use of cannabis and increased symptoms of depression, psychotic symptoms, and/or schizophrenia based on a handful of longitudinal studies.6 However, interpretation of this data is troublesome and much of it is not well understood.7 Identified as well as unidentified confounding factors (such as poverty, family history, polydrug use, etc.) make it difficult, if not impossible, for researchers to adequately determine whether any cause-and-effect relationship exists between cannabis use and mental illness. Also, many experts point out that much of this association may be due to patients' self-medicating with cannabis, as survey data and anecdotal reports of individuals finding therapeutic relief from both clinical depression and schizotypal behavior are common within medical lore, and clinical testing on the use of cannabinoids to treat certain symptoms of mental illness has been recommended.8

Nevertheless, until this association is better understood, there may be some merit in the government's caution that adolescents (particularly pre and early teens) and/or adults with pre-existing symptoms of mental illness refrain from using marijuana (and/or other psychoactive substances), particularly in large quantities. This statement, however, is hardly an indictment of marijuana's relative safety when used in moderation by adults or an endorsement of the federal government's efforts to criminally prohibit its use for all Americans. If anything, just the opposite is true.

Health Risks Call For Regulation, Not Prohibition

Health risks connected with drug use -- when scientifically documented -- should not be seen as legitimate reasons for criminal prohibition, but instead, as reasons for legal regulation. Specific to cannabis, if, as the Drug Czar alleges, studies demonstrate that those "who first used marijuana before age 12 [are] twice as likely as adults who first used marijuana at age 18 or older to be classified as having serious mental illness,"9 then this is an argument in favor of legally regulating cannabis in a manner similar to alcohol, so that better safeguards may be enacted restricting adolescents from legal access to it.10 Walters' concerns, however, do not support criminally prohibiting the responsible use of the cannabis by adults any more than fears regarding the abuse of alcohol by a minority of teenagers support a blanket prohibition on the use of beer by adults.

In addition, if, as the Drug Czar questionably suggests, "as many as one in four people may have a genetic profile that makes marijuana five times more likely to trigger psychotic disorders,"11 this claim is yet another argument in favor of regulation. If there does exist a minority population of citizens who may be genetically prone to potential harms from cannabis (such as, possibly, those predisposed to schizophrenia), then a regulated system would best identify and educate this sub-population to pot's potential risks, so that they may refrain from its use, if they so choose.

To draw a real world comparison, millions of Americans safely use ibuprofen as an effective pain reliever. However, among a minority of the population who suffer from liver and kidney problems, ibuprofen presents a legitimate and substantial health risk. However, this fact no more calls for the criminalization of ibuprofen among adults than do the Drug Czar's half-baked claims, even if true, call for the current prohibition of cannabis.

Finally, there lies the fact that cannabis prohibition has forever undermined the federal government's ability to educate its citizens, particularly young people, to the potential risks of marijuana when and where they present themselves. Ending prohibition and enacting a legal, regulated cannabis market would likely restore this lost credibility, as evidenced by the fact that science-based, federal education campaigns regarding the health risks of tobacco and drunk driving have greatly reduced smoking and driving under the influence among teenagers, while similar, rhetorically-based campaigns regarding teen pot use have been largely met by their target audience with groans and snickers.

As concluded by the Netherlands Drug Policy Foundation some years ago, cannabis' "health risks are remarkably limited, but cannabis is not completely harmless." As a result, the Foundation determined: "There ought to be a special legal regulatory system for cannabis because its use definitely does entail health risks. If cannabis was completely harmless, the same rules could be applied as to tea. Cannabis should not be made freely available, but the rules on cannabis can be very general and lenient." Placed in this context, the administration's latest anti-pot campaign does little to advance the government's position in favor of tightening prohibition, and provides ample ammunition to wage for its repeal.



Endnotes
1 Office of National Drug Control Policy. "White House Drug Czar, Research and Mental Health Communities Warn Parents That Marijuana Use Can Lead to Depression, Suicidal Thoughts and Schizophrenia." May 3, 2005.

2 J Schiffman et al. 2005. Symptoms of schizotypy precede cannabis use. Psychiatric Research 134: 37-42.

3 Thomas Denson and Mitchell Earleywine. 2005. Decreased depression in marijuana users. Addictive Behaviors (Article in press; corrected proof version available online June 20, 2005).

4 Leslie Iverson. 2005. Long-term effects of exposure to cannabis. Current Opinion in Pharmacology 5: 69-72.

5 The British Advisory Council on the Misuse of Drugs noted, “On current evidence, smoking cannabis was likely to increase the chances of developing schizophrenia by just one percent.” London Telegraph. "Cannabis use will impair but not damage mental health". January 23, 2006.

6 D Fergusson et al. 2006. Cannabis and psychosis. British Medical Journal 332: 172-175; Wayne Hall. 2006. The mental health risks of adolescent cannabis use. PLOS Medicine 3; D Semple et al. 2005. Cannabis as a risk factor for psychosis: systemic review. Journal of Psychopharmacology 19: 187-194.

7 R Ferdinand et al. 2005. Cannabis use predicts future psychotic symptoms, and vice versa. Addiction 100: 612-618.

8 C Ashton et al. 2005. Cannabinoids in bipolar affective disorder: a review and discussion of their therapeutic potential. Journal of Psychopharmacology 19: 293-300.

9 http://www.mediacampaign.org/newsroo...05/050305.html

10 According to national data compiled by the University of Michigan, 86 percent of 12th graders say that marijuana is "fairly easy" or "very easy to get." Some surveys note that teens respond that marijuana is now easier to obtain than alcohol; See: Associated Press. "Teens Say Buying Dope Is Easy." August 19, 2002.

11 http://www.mediacampaign.org/newsroo...05/050305.html


Link to report: http://www.norml.org/index.cfm?Group_ID=6798