Cannabis and Mental Health

As a researcher, clinician, and educator, I have spent a significant amount of my professional time on cannabis’ impact on mental health. As a clinician, I realized the therapeutic potential of cannabis in mental health and began researching it extensively. In my doctoral work, I called it the most misunderstood medicine worldwide, and I think that it is important to discuss cannabis objectively recognizing that stigma has gotten in the way of learning about this plant.  Most people associate cannabis with harmful and potentially destructive behaviors, and while I agree that it can be abused and is not recommended for vulnerable populations like adolescents and those with a family history of schizophrenia, I am talking about therapeutic use of cannabis. 

In 2017, I co-founded the International Research Center on Cannabis and Health .  I’ve worked on research at NYU and have traveled the world as an invited cannabis and mental health expert to help educate doctors, nurses, mental health clinicians and patients.  I have conducted two studies on clinicians’ knowledge and attitudes about cannabis, and the results are alarming. Most clinicians do not understand the physiological system, the endocannabinoid system, that impacts cannabis’ effectiveness in treating conditions and symptoms. I believe it is important to provide an objective voice about the strengths and weaknesses of using cannabis in mental health treatment.

Cannabis is a plant that contains 100’s of cannabinoids, including THC and CBD.  However, most people don’t realize that cannabis is a compound medicine whose different cannabinoids each with a different effect.  Each cannabinoid affects the brain and body in different ways and research has demonstrated that certain cannabinoids can actually provide therapeutic symptom reduction.

How does cannabis impact mental health?

While we know that cannabis can negatively impact vulnerable populations if not used correctly, it has been demonstrated to have positive effects on mental health symptoms like PTSD, anorexia, anxiety (while it can also exacerbate it too depending on the cannabinoids used), and depression if used therapeutically.  It has also been linked to reducing insomnia and improving sleep, better sex, and harm reduction tools for those in opioid withdrawal. In addition, its impact on pain and other health-related conditions make cannabis a unique medicine that truly can treat mental and physical conditions.  The top 3 reasons people use cannabis (whether its in medical or adult-use states) are to reduce stress, sleep better, and for pain; these are all therapeutic reasons.

But how can cannabis be used effectively?

First, we need to be aware that cannabis does have an abuse potential, so it is important to look at dosage and effects.  Monitoring self-use and working with your qualified clinician to ensure that you maximize your therapeutic effect while minimizing any potential negative behaviors is important. As with any medication, it is important to use the smallest dose possible that is still therapeutic.  We call this the biphasic effect. Too little isn't enough, and too much can cause problems. You don't want to use anything that makes you feel less vital.

Second, using safe sources of cannabis products is a must.  Granted costs for legal cannabis may be more costly; however, the extra costs ensure safer products.  Illicit cannabis products have no safety mechanisms in place to ensure that your products are free from pesticides, mold, heavy metals, and other contaminants is primary.  For this reason, the only safe place is to purchase cannabis products are legal dispensaries where you know products have been thoroughly tested.  The recent vape crisis is a great example of why using legal dispensaries is vital and necessary for healthy use; 98% of all lung disease cases during the vape crisis were from vapes from the illicit market.  

Third, pay attention to the effects on your body. Sadly, most doctors and other healthcare clinicians do not know much about cannabis and the specific effects from individual cannabinoids. In addition, many clinicians don't understand that cannabis can be used in place of multiple medications. It is common for those using cannabis to reduce and/or eliminate the need for pain medication.  We also  know that cannabis can have drug-drug interactions, so consulting a qualified clinician to discuss potential adverse effects would be warranted as well.  

Fourth, it is also important to know how you respond to specific cannabinoids.  Too much THC can induce anxiety. If you tend to be more anxious, adding CBD may reduce the anxiety experienced.  However, too much CBD, might be too sedating thus making THC important in motivating someone.  The best thing to do is to speak with a qualified clinician who can make recommendations like a pharmacist or physician can help you understand the importance of using cannabinoids that may reduce negative reactions to cannabis..  We want the smallest dose possible to achieve the desired effects; remember, reducing the risk of dependency.

I work with patients who have used medical, legal cannabis to treat a variety of their conditions. While I don’t make recommendations, I educate my patients and work to reduce potential adverse reactions and can recommend to other qualified clinicians who can help.