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Medical Marijuana and Psychiatry
Medicinal plants have a long-rooted history in healing and wellness. The use of plants as medicines, in fact, predates written human history.
Ethnobotany, the study of traditional human uses of plants, is recognized as an effective way to discover future medicines. Some of the pharmaceuticals currently available to physicians – aspirin, digoxin, quinine, and opium – are derived from plants that have a long history of use as herbal remedies.
The use of herbs to treat disease is almost universal among non-industrialized societies. An added benefit is that it is often more affordable than purchasing modern pharmaceuticals.
But “what do you think about medical marijuana?”
Patients have been asking me that question with increasing frequency. Rather than belabor the issue I’ll cut to the chase:
In my opinion, it’s not a good idea.
The Cannabis plant has a history of medicinal use dating back thousands of years across many cultures. Medical marijuana refers to the use of cannabis and its constituent cannabinoids, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), as medical therapy to treat disease or alleviate symptoms. In the 1970s, a synthetic version of THC was produced and approved for use in the United States as the drug Marinol. Voters in eight US states asserted their support for cannabis prescriptions by physicians between 1996 and 1999. Fast-forward to year 2014, and 23 states plus the District of Columbia have passed medical marijuana laws.
Despite all of this, medical marijuana remains controversial.
Official Positions on the Matter
The American Medical Association and other medical organizations have issued statements opposing its use for medicinal problems. In short, they do not recommend it until more research is done.
As a psychiatrist, I prescribe a number of treatments for my patients. When it comes to treating psychiatric disorders, I prefer a non-invasive approach including psychotherapy and education about enhanced self-care.– Helen Farrell The United States Food and Drug Administration (FDA), furthermore, has not approved smoked cannabis for any condition or disease as it deems evidence is lacking concerning safety and efficacy of cannabis for medical use. The FDA issued a 2006 advisory against smoked medical cannabis stating, “Marijuana has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision.”
But with increasing publicity of medical marijuana comes escalating public demand. As a psychiatrist, I prescribe a number of treatments for my patients. When it comes to treating psychiatric disorders, I prefer a non-invasive approach including psychotherapy and education about enhanced self-care. In some instances, I do find that those things combined with the thoughtful use of medication to be most effective. In extreme cases, more invasive options such as electroconvulsive therapy can make a world of positive difference. Whatever the treatment recommendation, it is offered after serious thought and consideration of an individual’s problems, preferences and balancing risks versus benefits.
What Are the Risks?
With this in mind, there just simply isn’t enough known about medical marijuana to use it as a psychiatric treatment option. In fact, we do know about its considerable risks – especially for the person seeking psychiatric help.
Medical marijuana is not as benign as many people naively assume. The main active component of marijuana, or cannabis, is THC (tetrahydrocannabinol). And it has the potential for a host of side effects. Some of these can be euphoria or its counterpart, dysphoria. Fast heart-beat, impaired coordination, dry mouth, conjunctival injection and increased appetite are other problems that can arise from its use. This constellation of problems mimics common target symptoms found in both the depressed and anxious individual.
Along the same lines, we know from research that marijuana has an association with paranoia and in some cases has precipitated a psychotic episode for teenagers and young adults.
Regardless of one’s personal perspective on marijuana, every physician is obliged to uphold certain ethical guidelines and standards of care in their field. The American Psychiatric Association’s (APA) position statement on marijuana as medicine is defined as follows:
“There is no current scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder.” Taking it one step further, they go on to state, “in contrast, current evidence supports, at minimum, a strong association of cannabis use with the onset of psychiatric disorders.”
It has always been the position of the APA that medical treatment relies on these two very important factors:
- Evidence-based medicine
- Professional standards of care
It should furthermore be noted that the FDA (Federal Drug Administration) has not approved marijuana as a treatment for any medical problem whatsoever.
With increasing curiosity and interest, medical marijuana certainly warrants further investigation, research and attention. At this time, however, a responsible psychiatrist is not likely to dole out certifications for the substance. There is substantial inherent risk to physicians who do so as they are going against their Association’s guidelines.
With increasing curiosity and interest, medical marijuana certainly warrants further investigation, research and attention. At this time, however, a responsible psychiatrist is not likely to dole out certifications for the substance. – Helen Farrell Patients are right to ask their doctors for their professional opinions on the matter and should be wary of any doctor who offers uninformed medical advice that is not rooted in research and common practice. Patients should be aware that a blatant refusal from their doctor to advocate for medical marijuana likely has their very best interests in mind.
There is a strange dichotomy in medical and psychiatric practice. That is the tension between giving patients what they want versus giving them what they need. It can often be uncomfortable and challenging to refuse a patient requests for a specific intervention. But at the same time, patient safety is at the forefront of any good physician’s mind.
In psychiatric care, some of the best treatment interventions and therapeutic alliances arise out of challenging scenarios. Whatever the matter at hand, the most important thing for patients to engage in with their doctors is an open dialogue about their needs and goals.
For anyone disappointed in a psychiatrist’s refusal to support the use of medical marijuana in his or her treatment plan – remember this:
The most important thing to consider is the underlying symptoms you’re hoping to alleviate. Everyone has the same goals in mind – getting better and working towards optimal health.
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