In November of 2016, recreational cannabis was legalized in the State of California.
In January 2017, the results of this ballot proposition were visible. Recreational cannabis cafes opened in Berkeley, San Francisco, and across California … and anyone who was 21 years of age or older could have cannabis products delivered to their door. Although medical cannabis has been legal for over 20 years, the change from medical legalization to full legalization of recreational use has potential implications for mental health.
The Mental Health Implications of Legal Marijuana
Dr. kj Cottrell, a psychiatrist at Well Clinic, noted,
“I have definitely seen that more people are willing to consider and partake (in cannabis) for mental health symptoms.”
Dr. Cottrell opined that research on the benefits and risks of long term cannabis use is still needed. Dr. Harry McIlroy, an integrative physician at Well Clinic, agreed and stated, “This research will now be more likely to occur.” Dr. McIlroy added that there was “great risk for people under the age of 15 using cannabis with high concentrates of THC,” the psychoactive agent in cannabis products.
When Dr. Cottrell worked in psychiatric facilities, she was able to observe this firsthand.
“Early and consistent heavy use is more dangerous that people would like to talk about,” she explained.
Dr. Cottrell recommended extra caution for individuals who have family risk factors for bipolar disorder or schizophrenia, and for individuals who experience paranoia when using cannabis. “The symptoms that it triggers,” she warned, “can sometimes not be reversed.”
Both clinicians were in agreement that there were notable and positive uses of cannabis products in the medical realm, in treating chronic pain, seizure disorders, and appetite issues related to chemotherapy. However, Dr. Cottrell preferred to wait for further research on potential risks, before she would use it to treat mental health symptoms.
Thoughts on Prescribing Medicinal + Legal Marijuana
Dr. McIlroy agreed on the need for greater education about dosing, but is willing to prescribe cannabis to his patients, under close guidance and for certain mental health symptoms. The most frequent symptom that Dr. McIlroy treats is insomnia. He explained that sleep aids such as Ambien posed greater potential risks and more concerning side effects than did cannabis. However, he noted his caution in prescribing cannabis, particularly as it relates to levels of THC.
He endorsed a philosophy of “start low and go slow,” personalizing the dose for each patient based on a variety of factors and tolerance for the psychoactive agent.
Dr. McIlroy noted that a very low dose of THC can be combined with a high dose of CBD, the non-psychoactive agent, for symptoms of anxiety and even autism spectrum disorder. He felt that this was “sometimes safer” than other medications commonly prescribed for general and social anxiety, such as Xanax.
Drs. McIlroy and Cottrell were in agreement that cannabis was not particularly useful for treating depression. Instead, Dr. Cottrell has observed marked relief of depressive symptoms when heavy users decide to quit. “I have had a number of clients who have come in sick of being depressed and anxious,“ she explained, “and after about 3-6 months of not smoking, their depressive symptoms lift.” She did advocate caution upon withdrawal for heavy users, as they often experience physical withdrawal, which can include insomnia, irritability, angry outbursts as well as physical discomfort.
Time and continued research will continue to reveal the risks and benefits of cannabis use for mental health symptoms. In the meantime, both doctors recommended that further education for those considering cannabis, and caution with dosing. “If it is being used as a medicine” Dr. McIlroy warned, “it should be treated as a medicine.”
About the Author
Addie Liechty is a Licensed Clinical Social Worker at Well Clinic. In her words, “I seek to create working relationships that include safety, attunement and trust. I do this through collaboration and remaining non-judgmental and transparent with my reflections and questions.”