Cannabis Use and Mental Health: A Critical Review of Risks and Benefits

By North Carolina Psychiatric Association

Several recent public opinion polls support the observation that attitudes toward the legalization of botanical cannabis products have changed dramatically over the past decade. Five jurisdictions in the United States have passed legislation decriminalizing use of small amounts of marijuana. Today, twenty-three states support use of some form of medical marijuana. As the first state to legalize marijuana, Colorado has witnessed the sale of over 1 billion dollars of marijuana products in the most recent year. The State of Colorado collected $135 million in tax revenue from these sales. Since public attitudes toward liberalization are more pervasive among younger voters, it seems inevitable that the momentum for further relaxation of restrictions on marijuana will continue. Concurrently, prevalence of use of marijuana has doubled over the decade from 20022013.

Public policy decisions relating to this phenomenon are complex and include implications for all institutions of society from law enforcement to public health and health care delivery. Constructive public debate about the pros and cons of liberalization must be informed by an understanding of what science has learned about the risks and benefits to health in different population groups. On September 21, 2015, the American Society of Addiction Medicine (ASAM) issued a new policy statement on marijuana, cannabinoids, and legalization that favors a more balanced response to legalization efforts.

This monograph, conceived and written by psychiatrist members of the North Carolina Psychiatric Association and supported by the Psychiatric Foundation of North Carolina, is intended to meet the need for a summary statement of what is known from scientific research efforts about the effects of use of cannabis products on the mental health of those who are using at varying ages and levels of vulnerability.

• Language: English
• Publisher: Xlibris US
• Release date: Feb 1, 2017
• ISBN: 9781524569693

North Carolina Psychiatric Association

Ureh Nena Lekwauwa, MD, DFAPA, is the current medical director of North Carolina’s Department of Health and Human Services, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. Chelsea L. Neumann, MD, is currently a PGY-5, first-year fellow at the Warren Alpert Medical School at Brown University Child and Adolescent Psychiatry Training Program. During her last two years of psychiatry residency at Duke University, she worked in Durham, North Carolina, at Triangle Residential Options for Substance Abusers providing psychiatric treatment to individuals with substance use disorders, during which time she collaborated with Dr. Ashwin Patkar to complete a review of the current literature outlining the effects of cannabis on physical and mental health. She has continued research interests in the effects of cannabis use on medical and psychiatric conditions and is currently researching the correlation between the quantity of cannabis use and depressed mood in adolescents. Heather N. Oxentine, MD, is currently a PGY-4 psychiatry resident at East Carolina University’s Brody School of Medicine. Her clinical experience includes research related to cannabis use either as a primary or as a secondary diagnosis. Further, Dr. Oxentine is interested in continuing research related to political and medical implications regarding the legalization of cannabis. Ashwin A. Patkar, MD, DFAPA, MRCPsych, DFASAM, is professor of psychiatry and community and family medicine at Duke University Medical Center in Durham, North Carolina. Dr. Patkar is the medical director of Duke Addictions Program and Duke Center of Addictive Behavior. He has over twenty years of clinical and research experience in addictions. Thomas Penders, MD, MS, DLFAPA, is associate professor of psychiatry at the Brody School of Medicine at East Carolina University. He is the president-elect of the North Carolina Psychiatric Association and the Addictions Committee chair. Diana O. Perkins, MD, MPH, DFAPA, is professor of psychiatry at the University of North Carolina at Chapel Hill. She is one of the founders and is the medical director of Outreach and Support Intervention Services (OASIS), one of the first Coordinated Specialty Care programs serving persons in the early stages of a psychotic disorder or at high risk for a psychotic disorder. The mission of OASIS is to foster sustained recovery and prevent disability from psychosis. Her research interests focus on discovering factors that contribute to psychosis vulnerability and finding better treatments for psychotic disorders. P. G. Shelton, MD, is an assistant professor of child and adolescent psychiatry at East Carolina University’s Brody School of Medicine.

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Copyright © 2017 by North Carolina Psychiatric Association.

Library of Congress Control Number:   2016920805

ISBN:      Hardcover            978-1-5245-6971-6

                Softcover            978-1-5245-6970-9

                eBook                 978-1-5245-6969-3

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Rev. date: 03/09/2017

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Contents

Marijuana Use Trends and Psychiatric Disorders

Marijuana and Psychosis

Cannabis: Pharmacology, Psychoactive Agents, and Drug Interactions

The Endocannabinoid System in Health and Disease

Medical Marijuana—Evidence, Accepted Indications, and Current Use

The Social Costs of Marijuana, the Most Frequently Used Illegal Drug in the World

Neurocognitive Effects of Adolescent Cannabis Use

Introduction

Several recent public opinion polls support the observation that attitudes toward the legalization of botanical cannabis products have changed dramatically over the past decade.¹ At the start of 2017 the citizens of 28 states, the District of Columbia and Guam may use some form of marijuana legally. Eight states have passed legislation regulating recreational sale and use of Cannabis. As the first state to legalize marijuana, Colorado has witnessed the sale of over $1 billion of marijuana products in the most recent year. The state of Colorado collected $135 million in tax revenue from these sales. Since public attitudes toward liberalization are more pervasive among younger voters, it seems inevitable that the momentum for further relaxation of restrictions on marijuana will continue. Concurrently, prevalence of use of marijuana has doubled over the decade from 2002 to 2013.²

Public policy decisions relating to this phenomenon are complex and include implications for all institutions of society from law enforcement to public health and health care delivery. Constructive public debate about the pros and cons of liberalization must be informed by an understanding of what science has learned about the risks and benefits to health in different population groups. On September 21, 2015, the American Society of Addiction Medicine (ASAM) issued a new policy statement on marijuana, cannabinoids, and legalization that favors a more balanced response to legalization efforts.

This monograph, conceived and written by psychiatrist members of the North Carolina Psychiatric Association and supported by the Psychiatric Foundation of North Carolina, is intended to meet the need for a summary statement of what is known from scientific research efforts about the effects of use of cannabis products on the mental health of those who are using at varying ages and levels of vulnerability.

Notes

1. Pew Research Center. In debate over legalizing marijuana, disagreement over drug’s dangers. http://www.people-press.org/2015/04/14/in-debate-over-legalizing-marijuana-disagreement-over-drugs-dangers/.

2. Hasin, D., Saha, T. D., Kerridge, B. T., et al. Prevalence of marijuana use disorders in the United States between 2001–2012 and 2012–2013, JAMA Psychiatry. 2015;72(12):1235–42.

About the North Carolina Psychiatric Association

The North Carolina Psychiatric Association (NCPA) is a professional medical organization that represents more than 900 psychiatrists statewide; it is the district branch of the American Psychiatric Association. NCPA’s mission is to promote the highest-quality care for North Carolina residents with mental illness, including substance use disorders; advance and represent the profession of psychiatry and medicine in North Carolina; and serve the professional needs of its membership.

About the Psychiatric Foundation of North Carolina

The Psychiatric Foundation of North Carolina is a 501(c)3 organization, and its primary goals focus on providing training, education, and research that assists psychiatrists in offering the best possible care for patients. It also works to educate the public about psychiatry; psychiatric