There are two extremely polarised schools of thought as to the dangers and safety of cannabis. In writing this article I sought to try to find a middle ground. My position is pro regulation and taxation, but here my journalism attempts impartiality. I started writing about cannabis because I have been told untruths based on observation rather than science, for instance that cannabis caused my schizophrenia. It didn’t. As I researched the medical effects of cannabis I was convinced it is of almost no danger at all. Wrong again. The simplest way to put the danger of psychosis induced by cannabis is that with any drug, a significant number of users will experience unwanted side effects.
Cannabis isn’t just one chemical. There are around 70 chemicals in the makeup of the drug which are known as cannabinoids. Some could be extremely beneficial as medicine. Others in high concentrations are downright dangerous.
The US Drug Enforcement Agency is dogmatically against cannabis use. It published a position paper in January 2011 which lists the understood dangers of cannabis and calls into question its medical efficacy. According to The DEA Position on Marijuana:
“According to a recent Australian study, there is now conclusive evidence that smoking cannabis hastens the appearance of psychotic illnesses by up to three years”.
This is trying to say that cannabis causes schizophrenia but they cannot, because the science just does not support it. The rate of schizophrenia has not changed in a century despite the hippy movement and now, as many as 1 in 10 US university users smoking it (as the same DEA paper claims).
Speaking to a research psychiatrist at Cardiff University in Wales, he cannot dismiss the risk of cannabis induced psychosis. Dr Stanley Zammit says “Iwould say it is very well established that THC can cause acute, transient psychotic experiences. But doubt is around whether it can cause a psychotic illness (i.e. persisting beyond effects of exogenous cannabinoids).”Exogenous cannabinoids are cannabinoids that come from the plant, and differ from endocannabinoids – cannabinoids which are synthesised by the body, something I will look at in a future article.
Delta 9 Tetrahydrocannabinol (THC) is widely understood as being the psychoactive ingredient in cannabis that makes you high, but also causes psychotic symptoms. In an interview with Zammit I did in 2007, he indicated that some clinical trials use THC to induce psychosis as a reliable and effective means of inducing the symptoms in otherwise healthy individuals.
Zammit cites a small scale 2004 paper by DC D’Souza et al – The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Simply, the paper suggests: “These data indicate that Delta-9-THC produces a broad range of transient symptoms, behaviours, and cognitive deficits in healthy individuals that resemble some aspects of endogenous psychoses.” In short, cannabis is shown to cause psychosis, but at this stage further research was required. A larger scale trial was done at Yale, and quoted in the DEA paper.
So, what are the risks of psychosis from smoking weed? No one really knows. The DEA would have you believe:
“Doctors at Yale University documented marijuana’s damaging effect on the brain after nearly half of 150 healthy volunteers experienced psychotic symptoms, including hallucinations and paranoid delusions, when given THC, the drug’s primary active ingredient.”
This research was on 100% THC without any of the other cannabinoids found in the drug, to include cannabidiol (CBD) which is being shown to have antipsychotic effects. The same DEA paper screams that cannabis can have as much as 10% THC, with 69 other cannabinoids, as well as the basic molecules that enable the plant to live.
The worst thing about psychosis is you don’t know you’re suffering it unless you are certain you suffer psychosis in the first place. As a 16 year long sufferer of schizophrenia, I use around 25% more of my mind trying to figure out the realities of a social situation than you, the non sufferer would. I have a very quick and sharp mind and would gladly give someone my right arm in return for a mind that would operate right all the time.
In my 2007 book I interviewed a man who spent 10 years in the same secure psychiatric unit as the British mass murderer Ian Brady. Andrew (not his real name) killed someone in the street and tried to kill someone else. Andrew recounts his experience of psychosis here:
One night I came in and lost the plot – started smashing the decorations up with an hammer. Kaz came down and calmed me down. She went to bed, but I stayed up, sure that someone was going to harm the family. The telly seemed to be talking about me. Hard to explain… It was all of a sudden too. One moment I was fine and the next I was in this parallel universe where people were after me. Completely freaked out. Kaz took the kids out in the morning. I was so paranoid I got tooled up with a load of kitchen knives. The problems were in the house so I had to get out, just outside – anywhere but there. I ran out the garden, jumped over the wall and started walking the streets… Someone jumped up really quickly behind me on a bus so I slashed out, injuring but not killing him. I ran off and slowed down a bit. I was walking the streets again and someone ran up behind me so I stabbed him – this time I pierced his heart.
As well as smoking cannabis Andrew was also drinking very heavily. Alcohol can cause psychosis – as a result I cannot state that he was purely suffering cannabis psychosis. What points to his symptoms being a transient, chemical induced psychosis was that he was let out of Rampton after 10 years. They don’t let people out of there unless there is no risk at all to the public. He says that he ceased suffering psychosis after a few months of enforced cleanliness from all drugs. Would you want to spend the best part of a decade proving your sanity and then have no chance of employment, as well as being watched closely by the authorities for the rest of your life?
One of the difficulties of not regulating the strength of cannabis is that criminals breed the drug to maximise the high. Harry Shapiro is the editor of the UK drug information magazine Druglink. He says that “the THC content of skunk cannabis in the UK is around 2.5 times the strength of imported hash”.
Arizona psychiatrist Sue Sisley suggests that due to the overpowering legislation on cannabis in the US, “hospitals can’t test the makeup of a given bud so we can’t tell whether someone in the ER presenting with psychosis has smoked an unusually strong strain”.
In the UK, anecdote suggests that factory farmed skunk is harvested before CBD can develop in the bud. CBD is known as an antipsychotic chemical which may be so effective that one day it may be used as a medicine for schizophrenia. CBD develops in the bud in the final few weeks of ripening, but in the agribusiness of illegal cannabis production the aim is to get people stoned and no one gives a hoot about the risks of psychosis!
A paper published by Prof Val Curran in 2008 in the British Journal of Psychiatry suggested that CBD acts as a counterbalance to THC. The abstract suggested that “The THC only group showed higher levels of positive schizophrenia-like symptoms compared with the no cannabinoid and THC+CBD groups, and higher levels of delusions compared with the no cannabinoid group.”
Science is seen to be “good” if you can repeat the results by repeating the method exactly. Zammit points out that “they could not replicate the CBD trial. The second study worked only on people who used it recreationally, and not on non cannabis users. This requires more study”.
CBD has been tested on its own. It is has been shown to have good therapeutic benefits and may well be a potent antipsychotic. People have asked though, why it took several years for a comparative study between CBD and an antipsychotic licensed for schizophrenia took so long to be published? Science is about investigation and unless a paper produced has no holes in it, people will always pick!
Shapiro suggests that “there is so much research on cannabis you could fill Wembley Stadium with it”. People feel free to cherry pick the science that suits their stance. Others practice what they preach. I spoke to my psychiatrist and asked whether I could use CBD as an antipsychotic instead of the drugs they prescribe, which are causing me serious health problems? Their response was that they would withdraw all support immediately if I did.
Dr Sisley however, observes that “many of my schizophrenic patients use cannabis to alleviate their symptoms. They consume just enough so they are not demotivated but their symptoms are allayed”. Sisley is pro cannabis, and works with the Multidisciplinary Association of Psychedelic Studies.
Cannabis can cause psychosis. It is unknown as to the rates at which it causes such symptoms because there are so many varieties. Hospitals in the US are barred by law from testing street varieties. Legally bred and harvested strains tend to have less THC and higher levels of other cannabinoids which may well allay psychosis.
In writing this fairly negative piece on cannabis I still think that regulation is the safer outcome. Shapiro again “many people find smoking skunk like consuming half a bottle of gin, where in times past the potency was lower so it used to be like having a pint of beer”. The uncontrolled breeding of ever higher THC content cannabis is likely to lead to an increase in people experiencing psychosis from smoking street weed.
Those blind to the thought that regulation may reduce rates of toxic psychosis among the pot smoking population will scream ever louder for tighter laws against the recreational use of cannabis as incidences of skunk induced psychosis rise. But a sensible approach may well be to legalise it and regulate the content of THC in it. In the European Union, coffee can only have a certain caffeine content. The coffee I drink in the US makes me so wired I don’t know whether it is breakfast or Christmas time! Regulate the THC content in cannabis? Reduce psychosis levels?
Richard Shrubb
