A recent study, published on the JAMA Open Network, assessed the risks and benefits of providing a medical marijuana card to patients with anxiety, depression, pain and insomnia, finding that patients with faster access are more likely to develop cannabis use disorder (CUD).
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) details the conditions for CUD, dividing them into cannabis abuse and cannabis dependence. It’s estimated that of the almost 200m cannabis users worldwide, 10% qualify for CUD with the caveat that a user can be negatively impacted by cannabis use without being addicted.
The DSM 5 recognises that people with anxiety or depression are more likely to develop CUD. Which begs the question: Why are researchers giving a drug to patients to treat a condition when it’s been shown that same drug has the potential to aggravate those conditions? And how can regular use be classed as dependency when patients need their medicine daily?
WHY THIS STUDY
With the move towards legalisation, it’s only natural that the medical community would want to formally assess the implications of prescribing cannabis to patients. The study authors point out that, “cannabis has been reported to improve pain, sleep, and anxiety and depressive symptoms and is commonly sought for these concerns.”
But the problem is that, “according to national data, 3 in 10 US adults who use cannabis develop CUD, with 23% developing severe CUD and often with a tolerance to delta-9-tetrahydrocannabinol (THC) and withdrawal symptoms.”
On top, “data are lacking on whether the rates of addiction in adults with a medical marijuana card are similar to the rates in those who use cannabis for recreational purposes.” Not to mention that, “cannabis use has been associated with psychotic and depressive disorders, mania, suicide, and cognitive impairment.”
To get answers, this study recruited 186 participants and divided them into two groups. One group was given a medical marijuana card immediately and the second group had to wait 12 weeks before getting their card. The study found that the group with immediate access was more likely to develop CUD.
HOW THE STUDY WORKED
The study was set up as follows: “All participants in the immediate card acquisition group reported obtaining a card before the baseline visit, and all participants in the delayed card acquisition group agreed to wait 12 weeks to procure a card. Quantity and frequency of cannabis use; sleep quality; and depression, anxiety, and pain symptoms were reported and assessed at every visit via interviews and daily via smartphone diaries. Participants could continue their ongoing medical or psychiatric care during the trial.”
The study found that, “the immediate card acquisition group reported significantly greater cannabis use throughout the intervention period than the delayed card acquisition group.” However, most cases of CUD were “mild,” with patients reporting “2 to 4 symptoms” such as “higher tolerance and continued use despite physical or psychological problems caused or exacerbated by cannabis.”
But they also observed a positive effect on overall “wellbeing and perceived stress” as a result of having easier access to cannabis. Plus, there were no cases that resulted in psychosis, mania, hypomania or suicidal ideation. This mixed bag of results demonstrates two things: 1. The researchers don’t understand cannabis. 2. The definition is CUD is meaningless.
As someone who has used cannabis for years, and has definitely abused it in the past, my observation is that cannabis will spotlight and intensify what I’m already feeling. If I’m anxious or depressed, it will magnify those feelings, causing me to over-use. If I’m calm, I’m likely to melt into oblivion. The bottom line: my use is directly related to how I’m already feeling and has little to do with cannabis.
This aspect of cannabis use is not news. This 2014 study confirmed that cannabis causes paranoia in some people, though it’s fair to say the majority of cannabis users have experienced it at some point. Joe Rogan often talks about this side of cannabis use on his podcast, saying he likes the “self-critical” aspect of marijuana because it reveals what needs fixing or changing in his life.
But we can go back further, all the way back to 1845, to the publication of the first study on the effects of cannabis on the mind, Hashish and Mental Alienation, written by Jacque-Joseph Moreau (1804 – 1884). He went to the Middle East to study the effects of cannabis and was surprised by the low incidence of mental illness there compared to Europe.
He made key observations that are often overlooked today, in particular, he noted how the specific situation of the subject, in particular personal background and problems, as well as the atmosphere at the time of using, deeply affected the effects of hashish, and as a result affected everyone differently.
On top, Moreau noted that individual physiology plays a role in the effects of cannabis, writing: “It does not have the same effect on everyone. The same dosage can produce extremely different results, at least in intensity, according to individual reports.” This means that not only is there a big difference between taking a few hits on a jay throughout the day and popping one 300mg edible after lunch, two different individuals will have different reactions to these doses.
CANNABIS USE DISORDER
Here’s one thing I know: Give a sad person a bag of weed and they’re going to rip through that shit. This is also not news. But there are some oversights in this study that add to the confusion of its results. There was no control group, no placebo, no tracking of dosage or strength or range of THC products used and no assessment of environmental circumstances.
The importance of environment cannot be over-stressed. It’s been shown that those at highest risk to CUD include out of work, young men. But I’m willing to bet that if these young men had decent jobs and support networks, it would affect their cannabis use either by reducing it or by making them more conscious of how they integrate it into their lives.
It’s my experience that the longer I use cannabis, the less I need, and this is an experience I’ve found to be common amongst regular users. Yes, it’s true that chronic use can dull the high but a short break, two to four days, fixes that. Oh dear, do I sound like I have a disorder? Whatevs. This is my medicine. I need it daily. Which brings me to the criteria for CUD.
They make no sense and border on the ridiculous. Can someone please tell me what it means to take cannabis in a high-risk situation? Like if your mom might catch you? I’m not saying there are no risks involved with cannabis use, but why does the psychology literature read like a bad crime novel? And what a surprise, this study found no cases of psychosis, mania, hypomania or suicidal ideation. Huh. Fancy that.
As cannabis legalisation spreads, there’s no question we need more studies to understand the plant and the implications of regular use. But as Ruth Fisher PhD points out in this article, historically it is people’s use of drugs that drives scientific discoveries for medical use, not the other way around. It’s simply not true that we know nothing about cannabis use. What is true is that the current protocols are flawed and are contributing to misinformation.