This article highlights physician difficulties prescribing cannabis, barriers to research for medical uses of cannabis and potential risks of longterm use of cannabis. It is a very hazy subject medically and legally.
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By Helen Lavretsky, MD, MS
Twenty states and Washington DC have now legalized the use of medical cannabis.
With all the attention legalized medical marijuana has been receiving, it is curious that very little attention was given to this topic during the recent APA meeting in San Francisco.
With all the attention legalized medical marijuana has been receiving, it is curious that very little attention was given to this topic during the recent APA meeting in San Francisco.
It was particularly ironic because on May 18 and 19, San Francisco hosted the International Cannabis and Hemp Expo, which promoted the culture of cannabis use. All you needed to gain entry was $15 and a medical complaint. . . such as insomnia or back pain.
Given the omission of meaningful discussion during the APA meeting—and the apparent confusion on the part of many psychiatrists about prescribing the substance and the ethical issues that it poses for many, Psychiatric Times is following up with a survey on the topic.
Given the omission of meaningful discussion during the APA meeting—and the apparent confusion on the part of many psychiatrists about prescribing the substance and the ethical issues that it poses for many, Psychiatric Times is following up with a survey on the topic.
Psychiatrists are invited to complete the survey and give their candid feedback on the subject.
Many of our patients have started asking if they are candidates for a prescription. I am a geriatric psychiatrist, and I have seen a surge in the use of marijuana (whether medicinal or not) by aging adults who may have used it in their youth. It is frequently provided to the elderly by their middle-aged children for pain, insomnia, anxiety, weight loss and—more recently—for the agitation associated with dementia. Many report improvement in these symptoms, and ask me to approve the use of medical marijuana throughout the day to help “mellow out” their parent. (The use of medical cannabis is legal in California where I practice.) This request puts me in the awkward situation of having to know about — and unwillingly consent to — marijuana use but not being able to prevent it. As a psychiatrist, I don’t feel that I can ethically approve any drug abuse in older adults.
Cannabis is commonly regarded as an innocuous drug. The prevalence of lifetime and regular use has increased continuously in most developed countries.
Many of our patients have started asking if they are candidates for a prescription. I am a geriatric psychiatrist, and I have seen a surge in the use of marijuana (whether medicinal or not) by aging adults who may have used it in their youth. It is frequently provided to the elderly by their middle-aged children for pain, insomnia, anxiety, weight loss and—more recently—for the agitation associated with dementia. Many report improvement in these symptoms, and ask me to approve the use of medical marijuana throughout the day to help “mellow out” their parent. (The use of medical cannabis is legal in California where I practice.) This request puts me in the awkward situation of having to know about — and unwillingly consent to — marijuana use but not being able to prevent it. As a psychiatrist, I don’t feel that I can ethically approve any drug abuse in older adults.
Cannabis is commonly regarded as an innocuous drug. The prevalence of lifetime and regular use has increased continuously in most developed countries.
However, accumulating evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.
We all know that the use of marijuana in the context of psychiatric illness can worsen symptoms (eg, it can increase anxiety and paranoia). Others report that marijuana diminishes their symptoms of anxiety, sleep, or pain.
Long-term use of marijuana can also cause apathy and low motivation. An appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states, following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms.
Cannabis is a risk-factor for mental illness. It can cause or create:o Psychological responses such as panic, anxiety, depression or psychosis. These effects may be described as “toxic” in that they generally relate to excess consumption of the drug.
o Effects on pre-existing mental illness.
o Dependency or withdrawal effects.
At the same time, there is still no evidence for the use of medicinal marijuana for most disorders.
Cannabis is a risk-factor for mental illness. It can cause or create:o Psychological responses such as panic, anxiety, depression or psychosis. These effects may be described as “toxic” in that they generally relate to excess consumption of the drug.
o Effects on pre-existing mental illness.
o Dependency or withdrawal effects.
At the same time, there is still no evidence for the use of medicinal marijuana for most disorders.
Some evidence suggests that it helps in nausea (eg, in patients receiving chemotherapy), muscle spasticity in 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 methamphetamines), while cocaine, for example, is classified as a Schedule II drug. This limits the ability of researchers to explore potential medical uses for marijuana.
Given the paucity of evidence for the uses of medicinal cannabis, and still very unclear and conflicting local and federal laws, physicians will be careful in prescribing medicinal marijuana.
Source:
http://www.psychiatrictimes.com/substance-use-disorder/haze-surrounding-medical-cannabis
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