What Is the Relationship Between Cannabis and Other Mental Illness?

[A Zoom screen with the three panelists, Leah Berkenwald, and BTW Peer Educator Denezia Fahie.]

Leah Berkenwald: So we have some questions in the Q&A that I think would make a good follow-up here. So we, we asked about and talked about depression a little bit about anxiety. We have some questions from our participants about the relationship between cannabis and other mental illness, such as schizophrenia, dissonance and others. And there's also a question about how there there's actually warnings about this in Canada and why we don't have those warnings in the U S so let's see. What do you think?

[Leah Berkenwald and Denezia Fahie leave the Zoom screen.]

Dr. Staci Gruber: Canada, Canada has a, a legalized system at the federal level start with this. This is the reason that there are warnings and is quite a list of warnings. It's not just about regular use of cannabis can increase the risk of psychosis and schizophrenia, I think is the actual terminology. There's a lot of other things that are included there and that's because there was a federal system in place. It is a very restrictive system. It is a very controlled system and it is very clear system and can increase the risk. It also says things like higher THC content can increase or can, can create greater side effects. That there's a whole list of things that we don't necessarily have in this country. So this has been a very, very contentious issue, and I'm at McLean hospital, which is a private psychiatric facility. So you can imagine that we spend a lot of time on this and we've got a lot of, of questions about this because it's a really, really important one. And while there are data that absolutely suggest that there's an association between exacerbation or worsening of symptoms. If you're exposed to high THC products. And I use the term high THC products in air quotes because very often these studies don't actually collect data on the actual products used. They ask, they ask the individuals using cannabis to to tell them, are you using a high potency product? Or I don't know any cannabis consumer says, yeah I got really bad crap, I got bad shit It was really, really low. No one says that everyone is pretty convinced they're using high potency, the better way to do this to actually analyze the actual product that they're using and to do a cannabinoid constituent profile. And then, you know, the idea that cannabis itself causes psychosis is one that is often fairly, I wouldn't say easily dismissed. I would say it's sort of put on the side with the sort of evidence from, from many, many decades suggesting that cannabis has been around for thousands of years. And you know, when rates of cannabis use were highest in this country, the rates of psychiatric psychotic disorders, primarily schizophrenia even Schizoaffective disorder stayed at about one one and a half percent of the general population, very different cannabis culture. However, then versus now it is much more likely that those were the genetic liability or predisposition a family member, for example. In conjunction with an exogenous or outside influence, super super high levels of THC could unlock something that's sort of latent. Does it create it all on its own? I think there's very, that that's a much more difficult argument for people to make, but in the abundance of an abundance of caution out of an abundance of caution if you can possibly warn people or educate people in terms of higher THC levels are more likely to create this or perhaps make you normal more vulnerable to that. You at least allow people to make better decisions because most people are not aware of for example, the thing Todd alluded to before prior to the age of 16, we did a series of studies is age of onset a factor? Does it matter at what age you began using cannabis. The answer overwhelmingly is yes, your brain develops from the back to the front and the bottom to the top. And from a neurodevelopmental perspective you are vulnerable, not just to cannabis but to other substances, to alcohol, to illness to injury while you are developing. When does development end? If only we had those little timers that pop like when you make a chicken, right? We use this age of 25 sorta like the car rental agencies across the country. And you get a huge surcharge. You try to run a car before you 25 that's because some neuroscientists had that gig and say, yup that's that's the age. I would say, you're mostly developed by then. There's still a fair amount of pruning that goes on after that, by the way. But to be brutally honest, the earlier you begin using and if you're using in heavier amounts and more frequently, the more likely you are to have downstream negative effects doesn't mean everybody will. If you add into that equation, a genetic liability that is somebody in your family has it or there's something else going on. It really is something that you want to be mindful of. And so I think the Canadians have done what they can do about warning about, you know, rest during pregnancy they're there it's quite a list. It's not just about psychotic disorders but the reason we don't have it here is we know we do not have a federal system that oversees the cannabis industry. We don't have a legal sort of recreational federal program at this point. It's still illegal at the federal level. People don't understand that my, if you take nothing else home from this today here's this one thing at the federal level cannabis is illegal. It's illegal. You may not use it. That's why you can't use it on campus. You may not use on campus things that are derived from hemp, Things that are less than 0.3% THC there's that there's that constituent again rearing its head, right? That's the most important distinction things that are less than that are illegal. There's some gray areas in there with things like Delta eight, but you can see the problem States have made their own laws regarding the use of cannabis for recreational or adult use as well. versus medical use medical cannabis was legalized in this country first in 1996 in California, it's been used for thousands of years, tracing all the way back to 2,700 BC, right? We don't have a federal current. We used to, it was legal many, many moons ago. It is not legal federally. And that is absolutely a critical piece of this because if if it happened to be illegal or we had some regulation you can Institute these warnings across the board as it is now, policy has outpaced science. We are all playing catch up here. We're trying very hard to fill in the gaps but that's reason that you don't see those those warnings.

Tom Fontana: I did throw in the Canadian guidelines into the chat if you want to see them which speaks to a few of those issues. And I think maybe there was a policy question in there that might be maybe I dunno if people wanted my perspective on it but I think more yours.

Will Jones III:  I'll just say I actually lived in Canada for four years. And one thing that I think the United States is really the Kings of, of capitalism in advertising and marketing. And I do not think, you know, this is my personal opinion but are not as responsible as as Canada is in how they regulate certain things and so, you know, my hope would be that, you know if it does become legal at the federal level that it would be, there would be responsible warnings around it and different things like that I had behind this is what car cigarette cartons in in Canada look like.

[Will Jones III changes his Zoom background to show a photo of a Canadian cigarette box with a large yellow ORAL CANCER warning and a graphic photo of a mouth with oral cancer.]

Will Jones III: So vastly different than the glamorization that we have in the United States with related to tobacco in, in different things. And so I think also countries do things differently. I think there's some things that we can learn from how Canada regulates certain things.

[Will Jones III changes his Zoom background back.]

Will Jones III: The history of what was allowed with the tobacco industry in the United States is really terrible in terms of public health, the lies and science that they were able to deny in order to addict you know, get as many people using as possible. So we, we can learn from other countries like Canada as those things, again just on a state by state basis right now. So the regulations wildly vary by state Colorado is now looking to roll out television ads for cannabis marketing and things like that. But yeah, Canada does things differently. And again I think there's some things that we can learn from that. And also the reality that huge organizations like Phillip Morris like some of our major alcohol companies they have an eye on what's happening in the U S because that's a bigger market just in terms of population. And so it's, I think you may be able to better more effectively regulate it in, in a place like Canada when the big giants that push against any regulation, whether it's, you know a big pharma, big tobacco, big alcohol, big oil you name it. When those players get involved it's a lot harder to put in meaningful regulations. And so we have to be very aware of that here in the United States, as laws change.

[BTW Peer Educator Denezia Fahie appears on Zoom screen.]