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Even as research into
the link between heavy marijuana use and psychosis continues, there's a
surge of interest in treating them together. Lawmakers around the world
are hamstrung by debates over just how harmful tetrahydrocannabinol, or
THC, the major psychoactive component in cannabis, can be. The most serious concerns are psychosis and schizophrenia. However, my reporting on high-potency marijuana found that vomiting hyperemesis, a vomiting syndrome, is also a worrisome. There’s been an explosion of high-potency vapes, edibles, and concentrated products, such as dabs wax and shatter, with THC levels as high as 98%. This is prompting a regulatory re-think in some of the first US states to legalize weed.
The National Institute on Drug Abuse warns
that the amount used, age and genetics all impact the chances of
psychosis. And a separate study found young men, in particular, face an increased risk of schizophrenia. Confusingly,
many people turn to marijuana to treat anxiety, depression and
suicidality — the same conditions research suggests can be caused by the
drug. Millions also use marijuana and report no problems. That means
that for those rare patients who are diagnosed with psychosis or
schizophrenia occurring with cannabis use disorder — a pattern
characterized by cravings, tolerance and continued use despite physical
or psychological problems — the solution is far from clear.
Connie
Boyd is a Timnath, Colorado, resident whose son was diagnosed with
cannabis use disorder and schizophrenia around 2017 at age 25. She says
he had intermittent delusions in which he believed he was “broadcasting”
his thoughts or being tracked by the CIA. This evolved into constant
hallucinations that he was surrounded by spiders, necessitating care in a
nursing home. Treatment programs and nine different drugs didn’t work,
until she tried an antipsychotic drug, clozapine. “Within three months,
it literally shut off all the hallucinations,” Boyd says. Clozapine is made by companies including Teva Pharmaceutical and Mylan NV, and may also produce a reduction in cannabis craving. Another drug proposed for cannabis use disorder is one that is known to create hallucinations: psilocybin.
Jesse Hinckley,
a director of adolescent psychiatric services and addiction research at
Colorado’s School of Medicine Anschutz Medical Campus, says abstinence
from marijuana is the first line of treatment, and that
antipsychotics like risperidone, olanzapine and aripiprazole are often
tried. While clozapine is highly effective, it carries a risk of low
white cell count and infection. Ben Cort,
the chief executive officer of Foundry Treatment Center in Steamboat
Springs, Colorado, says patients seeking treatment for cannabis-related
problems have surged since the state legalized recreational use. Foundry
treats some of those patients for psychosis — a hard task given the
unpredictability of the condition. Still, the
common perception is that cannabis-induced psychosis isn’t real, making
conversations with patients or their loved ones difficult. “You
can show them every symptom in the book, and they say ‘No, it’s not
weed’,” Cort says. “And I tell them, ‘Yeah, it’s not. It's this 80% THC
distillate you put in your body’.” — Tiffany Kary |