Medical marijuana in psychiatric illness

Recently, 16 states and Washington DC have legalized medical cannabis.

An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my answer is easy.  Right now it is not legal in Illinois, although it is one of the states that is pending. Even if it does become legalized, I work at a federal hospital under federal law, which still prohibits marijuana. Generally state law supersedes federal law, but not in the VA.

That still does not address the issue of potential benefits of medicinal marijuana. What I know about the use of marijuana in the context of psychiatric illness, is that some people find it worsens their symptoms (increase in anxiety and paranoia) and others find it to improve their symptoms (as a relaxant, to ease pain, or improve insomnia). Longterm use of marijuana can also cause apathy and low motivation.

There is also a myth that there is no such thing as addiction to marijuana. Over recent years, however, with more and more people including children using marijuana, it is becoming evident that there is a small subset of people that do become physically addicted, with problems seen similar to those in other drug addictions.

Let’s say in theory I could prescribe cannabis as a treatment for patients. I suppose the one problem I have with it is that there is not enough research and evidence to say that it is clinically useful. What we do know about marijuana (with some evidence), is that it helps in nausea (in specific patients, like those receiving chemotherapy), muscle spasticity (like in patients with spinal cord injuries), and in some cases neuropathic pain. Marijuana is still classified as a Schedule I drug (in the same category as LSD, PCP, and meth), while cocaine, for example, is classified as a Schedule II drug. What this means is that it is in a category that says those drugs do not have any medical use. This limits the ability of researchers to explore potential medical uses for marijuana.

I am not committing to saying that medical marijuana is a good or bad thing–only that there remains a great deal to be discovered about specific medical uses, and that the laws are still somewhat murky. Hopefully physicians will tread lightly and consider these issues before they pull out their prescription pads.

Christina Girgis is a psychiatrist who blogs at getaheadwithdrg.

 

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  • http://psychcentral.com/blog/ Dr. John Grohol

    I’m not sure your point? You seem to argue both sides of the medical use of marijuana and make only a passing reference to its use in mental disorders, saying some people experience positive benefits, while others experience negative effects.

    Is marijuana an appropriate prescription for anyone with a mental disorder diagnosis? Which diagnoses? When and how can a prescribing physician make such a determination? How does federal law impact a physician’s prescribing if their state allows it? Can psychiatrists prescribe marijuana in such states? Are such prescriptions considered legal in states where the state’s law does not specify the specific diseases where marijuana can be prescribed?

    Lots of questions, but very few answers from this article.

  • ninguem

    Is there any medical literature supporting marijuana for mental illness?

    I have one ask me for a medical marijuana card once. I said no, she asked way, and I suggested her involuntary psych admission for schizophrenia after the police picked her up half-naked walking the streets in the middle of winter might make it a bad idea to add potential hallucinogen to the mix.

    Maybe I’m missing something.

  • Dave

    There is some evidence that marijuana can cause people predisposed to schizoprenia to exhibit symptoms at a younger age. Probably not good for schizoprenics.

    I do have a friend with ADD whom pot helps amazingly. Give him some and he becomes the most focused general contractor ever. Seriously his painting and drywalling skills improve 100% (he generally only works on his own properties but I hired him to fix up my old home before I sold it.) it’d probably work okay for anxiety as well as long as the user didn’t become paranoid.

    • ninguem

      Yeah, I know I want my surgeon to fire up a bong before fixing my hernia.

  • http://getaheadwithdrg.wordpress.com/ Christina Girgis

    Thanks for the comment–to Dr. Grohol, to answer your questions. First you are correct in that I am arguing both sides–my point was that there is not enough evidence (except perhaps anecdotal) to advocate using medical marijuana as it stands. We could certainly use more data in the form of randomized controlled studies first, but those are limited currently due to marijuana’s classification. For now, although it is becoming legal in some states to prescribe, because the laws are not clear, physicians have to prescribe at their own peril. Because state law legalizes, but federal does not, physicians and patients CAN get prosecuted, but so far the U.S. Attorney General is choosing not to challenge these laws.

    For the most part, although medical marijuana has been legalized in some states, there are no official medical indications (which would be approved by the FDA, a federal organization). Therefore any prescribing done by physicians is for off-label use only, based again, primarily on anecdotal evidence at best.

    Hope that clarifies things a bit!

  • http://www.marijuana-syndromes.com John Mini

    Hi Christina,

    If you’re in this field, it’s important to look up the work of Hiroshi Ujike and other researchers at Okayama University in Japan, who published a study in 2002 that showed similarities between the brainwave patterns of schizophrenics and people who are under the influence of marijuana.

    I’ve found clinically that these schizoid brainwave patterns can synergize with a variety of pathologies, so I counsel against it in my practice if there’s any history or family history of such disorders.

  • Dorothy Green

    Well, perhaps in a few years, this weed that has been around for thousands of years will be legal and docs don’t have to get involved at all.

    For kids, I have heard, it is not good for a forming brain so we treat it like alcohol needing ID and education. DWI for marijuana? – there will be a way eventually but I would say if it is thought to be THE problem it would have to be a lot and more likely a mixture with some harder stuff.

    It is wrongly classified to begin with and like so many outdated laws on the books, needs to be changed. The history of how this came about is pretty well known now – a zealous government agent who wanted to be a super hero and revered for his “anti-drug campaign – maybe if he hadn’t succeeded we would have would have a few more full blown pot heads and lot less alcoholics.

    Prohibition doesn’t work. We have huge amounts of money being thrown at so called “drug wars” which hasn’t dented the problem. Ahd there are thriving prescription “pill mills” in S. Florida causing 7 deaths a day – doctor owed and operated – big business here – cash only – no DEA and state government nixed tracking system. So what is a physician peer group doing about this?

    Why do we fuss so over marijuana. Legalize it – solve a lot of drug war issues, provide jobs, taxes for healthcare, money for addiction rehab. There are far more addicting and dangerous drugs to deal with.

  • ninguem

    Legal or not, when relevant, I tell people to get off marijuana the same way I tell liver disease patients to get off alcohol or asthmatics to stop smoking.

    I’d say psychiatric illness is a good reason to stay off marijuana.

    • Anonymous

      marijuana doesn’t cause psychosis duh try it so you’ll actually know what you’re talkin about

  • Anonymous

    marijuana is not a man made drug! How can it be categorized as a narcotic when it grows from the ground? The bible says we can consume everything of the earth! You can’t tell me a closed minded doctor knows better…