WESTMINSTER — The correlation between cannabis - marijuana - and “negative mental health outcomes” has been “unequivocally established,” reports the Indian Journal of Psychiatry. More than 30 other studies from around the world, from countries that include Sweden, Australia, and the United Kingdom, have shown the same.
Yet the sentiment in the United States, espoused even by our president in a recent interview with The New York Times, is that smoking marijuana is merely a “bad habit” and “not very different from cigarettes” and that pot was actually less dangerous than alcohol “in terms of its impact on the individual consumer.”
As a person who has worked with teenagers and young adults for more than 25 years and who has also been active in NAMI (the National Alliance on Mental Illness) as both a teacher in family education classes and also a support-group facilitator, I strongly disagree with our president and popular opinion on this issue.
Marijuana use can increase serious mental health issues. This is a significant and often-ignored or unknown fact that much of the rest of the world seems to understand better than we do.
For most people, marijuana will not trigger or exacerbate symptoms of mental illness. However, doctors, mental-health workers, researchers, and concerned family members have found in the U.S. what has been studied and learned in the rest of the world is true here too: use of marijuana particularly by those in their mid to late teens whose brains are still growing can cause very adverse mental health results in 8 to 13 percent of those consuming the drug.
Use can trigger depression, psychosis, and mood disorders. Those who use cannabis habitually have a greater risk of living with chronic mental illnesses compared to those who have never used.
Researchers think that using cannabis while the brain is still developing boosts levels of the chemical dopamine in the brain, which can directly lead to schizophrenia and other forms of mental illness.
Why are so many Americans so ignorant of these damaging outcomes?
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Recently, I shared an article on my Facebook page which reported links between marijuana use and psychosis. My point in sharing the link was to inform my friends (many of whom work in education or social services) about this connection.
The response I got was quick and virulent: people responded about why pot should be legalized, how much it helps people with certain medical conditions, and a whole lot more.
My hope in sharing information about the links between marijuana use and mental illness is to educate, not to legislate, though I do think extreme caution is necessary when considering the legalization issue because of the perception that what is legal is safe.
I know many youth and adults living with mental illness. Some undoubtedly would have developed their conditions whether or not they used marijuana, but it appears that for others, their cases have been triggered (and/or their symptoms have been made more severe) because they used marijuana while their brains were still growing.
People can live well with mental illnesses, but all agree that it would be better to avoid developing one in the first place.
It is difficult to hear those who should know better dismissing marijuana use as insignificant, when for about 1 in 10 regular or habitual teen users, that use can worsen serious and, in some cases, debilitating life-long illnesses.
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In Brattleboro, prizewinning science writer/author Robert Whitaker recently described a 50-fold increase in bipolar disorder cases in the past 50 years. He described three major reasons for the increase, one of which was use of marijuana by teens and young adults.
Sometimes, Whitaker said, those who used marijuana years ago express disbelief that there is a link between marijuana and psychotic behavior (and, if continued, mental illness), as they did not see this consequence with heavy users in the past.
The levels of THC, the active psychoactive ingredient in marijuana, are much higher in the varieties of the drug available today than they were in what people smoked 20 years ago.
The average amount of THC is much more potent. According to the Vermont Department of Health, the average THC content in marijuana rose from under 4 percent in 1983 to 10 percent in 2008. And, according to Nora Volkow, director of the National Institute on Drug Abuse, the usual rate of THC is now 12 percent, three times higher than in past decades.
“This is not your parents' marijuana,” Whitaker reported.
And, he said, the results are devastating.
A major European study first interviewed 50,000 Swedish soldiers about their marijuana consumption at the time they entered the army, then followed up with them over the next 15 years. The heavy consumers of cannabis at age 18 (defined as using at least 50 times) were over 600 percent more likely to be diagnosed with schizophrenia over the next 15 years than those who did not use.
Similarly, researchers in New Zealand found that those who used cannabis by the age of 15 were more than three times more likely to develop mental illnesses, including schizophrenia.
Other research has backed this up.
Cannabis use increases the risk of psychosis by up to 700 percent for heavy users, and that the risk increases in proportion to the amount of cannabis used. Additionally, the younger a person begins using cannabis regularly, the higher the risk of schizophrenia.
For many users, marijuana might not have long-term harmful effects. But for a significant minority (between 8 to 13 percent of those who start using in their teens), early marijuana use can lead to mental illness, with symptoms ranging from depression to psychosis.
And for them, the impact is dire - and perhaps avoidable.
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According to Dr. Sean Ackerman, a third-year psychiatry resident at the University of Vermont, “Many people think of cannabis as harmless. For some it can be, but there is also a well-established link to psychosis previously.”
“For people with a history of psychosis, it can cause a relapse, but even in people without psychiatric histories it can induce a temporary psychosis which lasts days or rarely even weeks, especially with heavy use,” Ackerman said.
“Most troubling, some research suggests that prolonged and early exposure to cannabis may result in long-term psychotic illness that otherwise wouldn't have occurred,” the doctor added.
“I started smoking weed at 18,” a 35-year-old graduate of an Ivy League college told me.
“In the following years, I would often turn to pot when I was bored or down, and it was very effective at elevating my mood,” he continued.
“I started to rely on pot to make me feel good. I began relying on an artificial happiness all of the time, rather than finding meaning in ordinary life.
“I would work into these cycles where I would smoke more each day until I was so far gone from reality that I was living in psychosis.
“Time and again after being hospitalized, psychosis recurred, but I was able to convince myself that the problem wasn't pot,” he said. “After repeated psychoses, I couldn't deny anymore that marijuana was contributing to my madness. Only after I'd lost years of my life unproductively spent in induced fantasy was I able to see this.”
Would this intelligent young man have developed psychosis without heavy marijuana use in his late teens and early twenties? We can't definitively know, but scientific research would indicate his marijuana use likely could be a triggering factor in his mental-health struggles. He has been living with a bipolar diagnosis since his early twenties.
Whittaker reported that once triggered, the symptoms of bipolar disorder do not completely go away, but people who continue to use marijuana often continue to have severe mental-health problems.
Anecdotally, I have known other people living with bipolar disorder who showed significant improvement in mood regulation after quitting the use of marijuana, but there is little scientific data about whether the impacts of early use can be reversed.
As a person who has facilitated support groups for family members who have loved ones suffering with a mental illness, early and heavy usage of marijuana is a common theme in the huge majority of families.
Some say that those with mental illness are drawn to use pot to self-medicate their confused mental state. There are surely cases where this is true, but data in numerous studies done over many years show that if you compare those who have not used pot regularly to those who have, there is an increased rate of major mental illness (depression, anxiety, bipolar, schizophrenia) in the groups who have heavy cannabis use - especially in those who began using regularly in their mid-teens.
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More education needs to happen before any more changes are made in the direction of legalization. The connections between marijuana and mental illness should be further explored, examined, and understood in the United States, as they have been in many other places in the world.
Should legalization occur, the state Legislature would certainly need to include funding for major educational programs to inform youth and parents about the connections between marijuana and mental health.
We have impressive education and outreach about opiate addiction in our state, and we have had community campaigns addressing drunk driving and other risks associated with substance use and abuse. I applaud the Brattleboro Area Prevention Coalition for beginning to raise awareness of this important issue with an educational website, “The Blunt Truth”.
This site talks about marijuana's impact on the brain, particularly on those younger than 25 and the impact that prolonged marijuana usage can have on both depression and more severe forms of mental illness such as schizophrenia.
Greater Falls Connections in Bellows Falls provides important information about marijuana and the brain on the organization's website as well.
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Finally, I will share a thought from former U.S. Representative Patrick J. Kennedy, a recovering addict living with bipolar disorder; he left the U.S. House of Representatives three years ago to work on de-stigmatizing mental illness, and fighting policies he says could worsen the problem - policies like marijuana decriminalization.
According to Kennedy, “We cannot promote a comprehensive system of mental-health treatment and marijuana legalization, which increases permissiveness of a drug that directly contributes to mental illness.”
I believe marijuana use and its impact on users is a complicated issue, one that we Vermonters need to seek to understand thoroughly before we move forward with more policy changes that could adversely harm the mental health of our next generation.