On Medical Marijuana & Mental Health: Understanding Costs & Benefits
As a holistic practitioner, I feel that it’s my responsibility to be open to various forms of treatment and acknowledge the many different ways in which we can cope with distress. For some of us, this may mean going to therapy, exercising regularly, or testing out “alternative” methods like acupuncture, Reiki, or massage. Here in Rhode Island, where the state approves the use of medical marijuana, that may also mean visiting Compassion Centers to utilize this substance.
But what exactly IS medical marijuana? How is it regulated? And is it actually a valid form of treatment for mental and physical disorders? Well, these are exactly the same questions I hoped to answer for myself when I attended a training recently held by the Substance Use and Mental Health Leadership Council of Rhode Island. Because, I’ll be honest, I have clients who sometimes express interest in medical marijuana; I admit that I don’t know much about it; And I only think it’s fair as practitioners that we educate ourselves about any treatment our clients may pursue, regardless of personal opinions.
Before getting into the nitty-gritty of medical marijuana, I would like to attest that I am neither FOR or AGAINST, medical marijuana at this time, and the purpose of this post is not to take a stance on this topic. Rather, my goal here is to share with others the information I recently obtained so that clients, counselors, and the general public can use this to make a more-informed decision about their personal beliefs on this topic.
SO without further adieu, what exactly is medical marijuana? Medical marijuana is marijuana that is prescribed to treat physical and mental health issues. Proponents of medical marijuana argue that is a medicine just like any other, that is not addictive, can be a source of tax revenue for local governments, and will reduce the amount of people in prison for marijuana-related offenses. Proponents also argue that marijuana does not contribute to cancer or mental illness. It can be taken in multiple forms: by smoking, by vaporizing, or by ingesting it in form of edibles.
Does the form in which you ingest medical marijuana matter? Yes. Different forms of medical marijuana are metabolized differently by the body. For example, smoking marijuana creates a fast-acting, short-term high (most people will feel the peak effects 5-10minutes after use), while edible marijuana takes longer to be processed by the body, but then also results in a longer duration of high. Due to a delayed onset of effects, it is not uncommon for uninformed users of this form to over-take medical marijuana in edible form. In fact, a 19-year old in Colorado, died after consuming a marijuana edible that contained 6-servings of THC (the active ingredient in marijuana) and jumping from a building.
What can medical marijuana be used for? And does it work? This is an issue on which medical providers and medical marijuana advocates are divided. Proponents of medical marijuana argue that it can treat a variety of concerns, while medical providers and researchers argue that more research studies are needed to determine claims made by marijuana advocates. One of the major criticisms against medical marijuana is that the quality of the research studies are not significant enough to broadly market the claims that medical marijuana can be used as effective treatment. Of the research studies conducted, there has been substantial evidence that medical marijuana may be an effective treatment for chronic pain, to fight chemo-induced nausea and vomiting, and for improving patient-reported multiple sclerosis symptoms. There is also limited evidence that it may be effective for increasing appetite in HIV patients, decreasing social anxiety, and decreasing PTSD symptoms (limited evidence means there are some indicators that these claims may be true, but that the research is not conclusive enough to make definitive claims on this subject).
So, even if there is limited evidence that medical marijuana may be effective, isn’t that enough to give it a try? Why are people pushing back against a potentially helpful form of treatment? This is an issue many people feel strongly about. Some are clearly pro medical marijuana, some are firmly against, and others stand more in the middle. For those who find themselves in the middle ground, they argue that prescribers and users of medical marijuana need to be better regulated, that more research needs to be done on the effectiveness, and that people need to be better educated on the risks & benefits of medical marijuana use so that they can make more-informed decisions. One example provided in my training was prescribing Oxycodone to an elderly woman for chronic pain. In this instance, the patient would be prescribed a clear dose, would be educated about the potential side-effects of the medication, would learn the warning-signs for addiction to the medication, and would be given clear instructions on when and how to take the medication and safety factors to consider (for example: how many medications have labels that read “do not take before driving,” or “do not take when operating heavy machinery.”) Medical marijuana is not currently regulated at this same level. Thus, it makes it harder, some people argue, to appropriately and safely prescribe it as a medication.
If there are risks, what are they? According to the training I attended, the short-term effects of marijuana include impaired short-term memory, impaired coordination and balance, and impaired attention and judgement. These effects are normally only present during the time of use, but could place people at increased risk for accidents, injury, or poor decision-making. It can also negatively impact learning skills, though people believe these will start to repair themselves over time if a person stops using the substance. In the long-term, regular marijuana use can lead to addiction, bronchitis, emphysema, and increased risk for head, neck, and lung cancer. It can also decrease immune function, which could be dangerous for people on immunosuppressant drugs, and decreases sperm count and concentration in men. For a more detailed discussion on the health effects of marijuana, you can visit the New England Journal of Medicine and read their blog post on the research article Adverse Health Effects of Marijuana Use.
One last question: is marijuana addictive? Proponents of medical marijuana will say “no,” but research conducted in the article mentioned above argue otherwise. According to the study, conducted by Nora Volkow, Ruben Baler, Wilson Compton and Susan Weiss, approximately 9% of people who use marijuana become addicted. This is not as high as for alcohol (about 30% of people who use alcohol will become addicted) or heroin (almost 25% of people), but still argues that a small percentage of people are vulnerable to addiction for this substance and thus should be educated on this risk. Also, about 80% of medical marijuana users were previous recreational users of the drug, indicating that there may be a group of people who pursue medical marijuana not for its potential medical benefits, but for the desired side-effects associated with the high.
What now? Hopefully, I’ve highlighted that medical marijuana is a complicated issue, with people who firmly support both sides of the argument. As mentioned previously, my goal is not to take a personal stance on this topic, but to provide useful information to providers, or people in the community, who are considering this as a potential treatment, so that they may make informed decisions. For more information on science-based marijuana education and awareness, consider visiting the website Smart Approaches to Marijuana (SAM).