Overall, although businesses promote particular ratios of THC and CBD in marijuana for specific therapeutic indications, empirical support for these claimed effects on mental illness is lacking.Ĭomorbid medical conditions and prescription opioid use are common among people with serious mental illness, and some patients and clinicians have a strong interest in using marijuana rather than opiates for pain. Some strains of moderate-CBD, low-THC marijuana are available via state-registered dispensaries, but their impact on people with mental illness is not clear. In early 2018, a placebo-controlled trial reported that very high doses of oral CBD (without THC) reduced psychotic symptoms among people with schizophrenia ( 7). Whether CBD is helpful to people with serious mental illness is a question of intense interest. Although many people believe that marijuana is helpful for people with posttraumatic stress disorder (PTSD), not a single prospective, controlled trial of any type of marijuana for people with PTSD has been published, and retrospective studies have reported mixed findings ( 6). Similarly, heavy use of high-THC marijuana is associated with increased risk of developing mania and depression as well as exacerbation of mania and depression among people with an existing mood disorder. It is associated-when used heavily-with increased risk of schizophrenia among adolescents and worsens symptoms and course of illness among people with schizophrenia ( 5). Marijuana that is high in THC causes psychotic symptoms among people with and without psychosis. ![]() Generally, the average amount of THC in typical street marijuana has tripled in the past 20 years, from 4% to 12% ( 4), whereas the proportion of CBD has declined, resulting in products that are putatively more psychotogenic.Ĭonsequently, careful consideration of the type and amount of marijuana constituents is needed when discussing marijuana’s possible effects on people with serious mental illness. Legal outlets provide cannabis products with a range of THC:CBD ratios. The amount and ratio of these compounds in products available on the street and in legal dispensaries are highly variable. THC produces feelings of euphoria, can engender paranoia and anxiety, and has addiction liability, whereas CBD does not have these effects, may reduce psychosis, and is not thought to be addictive ( 3). The impact of marijuana depends upon the consumed potency and dose of its major psychoactive components, tetrahydrocannabinol (THC) and cannabidiol (CBD), which have very different psychiatric effects. ![]() ![]() What is the evidence that cannabinoids can be harmful or helpful to people with serious mental illness? How will commercialization of recreational and so-called medical cannabis affect those who are vulnerable to addiction, such as persons with serious mental illness ( 2)? These changes in the legal and commercial landscape introduce many questions for the mental health community. To advance sales, marijuana-related businesses have developed an array of new products, are advertising heavily, and are profiling consumers. As a result, the marijuana industry is booming-in Washington State alone, over 20,000 pounds of marijuana are produced each month. Thirty-three states and Washington, D.C., have substantially reduced legal barriers to using marijuana ( 1), either by legalizing medical or recreational marijuana or by reducing legal penalties for possession.
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