Many cannabis activists are quick to call on its magical powers for, really, any ailment. Have a backache? Hit the vaporizer. Feeling anxious? Eat an edible. Can’t sleep? Stir a tincture into your tea. But in light of ten states that have legalized cannabis, the science community is beginning to back claims of its many medicinal properties—some are even speculating that cannabis could, one day, replace conventional prescription mental health medication. “We have decades of observational studies and case histories [demonstrating that cannabis has mental health benefits] and now early clinical studies showing that cannabis is a great benefit to trauma survivors,” says Chris Conrad, cannabis expert and author of Hemp for Health. Conrad cites additional reports that establish the mental health benefits of cannabis such as a 2014 study that concludes THC “reduces METH-induced brain damage” and a 2008 study that shows cannabinoids initiate “neonatal milk suckling response,” determining that “cannabis-based medicines should be developed to benefit infant failure to thrive.”
But John C. Raiss, M.D., a licensed physician and psychopharmacologist, remains skeptical in regard cannabis’s mental health benefits. “There is one high-quality paper (multi-center, randomized, double-blind, placebo controlled) that suggests cannabidiol (not cannabis) 1000 mg daily may be helpful as an augmenting agent (i.e. added to a patient’s antipsychotic medication) in schizophrenia,” Dr. Raiss says. The study reveals that the group treated with cannabidiol (CBD), which, unlike THC, does not make users feel stoned, were “more likely to have been rated as improved” and “not severely unwell.” The researchers concluded that “[CBD] may represent a new class of treatment for the disorder.”
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“The evidence that [cannabis] causes harm, especially in the young, greatly outweighs the reports of benefits,” continues Dr. Raiss. “See, for example, Madeline H. Meier’s Dunedin Study that followed over a thousand New Zealand kids for thirty-eight years, and saw cognitive decline in adolescent onset users not reversed by cessation of use and suggested a neurotoxic effect of cannabis on the adolescent brain.”
There’s one glaring problem with Meier’s 2012 study, however: Meier eventually reversed her position after additional research. “Short-term cannabis use in adolescence does not appear to cause IQ decline or impair executive functions, even when cannabis use reaches the level of dependence,” says Meier and her team in a 2018 study published in Addiction Journal. “Family background factors explain why adolescent cannabis users perform worse on IQ and executive function tests,” they determine. This does not mean that Meier’s 2012 study was poorly conducted or somehow compromised, but instead reveals just how challenging it is to determine whether persistent cannabis use has any long-lasting effects on the brain.
Although Meier’s initial landmark study fueled cannabis opponents, many cannabis advocates, including Conrad, argue that Big Pharma and political self-interest are largely to blame for marijuana’s bad reputation. “Big Pharma led the international charge against cannabis a century ago. It backed Nixon’s Drug War with an exception for pharmaceutical THC then helped fund the PDFA and “Just Say No” propaganda campaigns of the Reagan and Bush eras,” Conrad explains. In fact, Nixon flagrantly ignored the findings of the Shafer Commission in 1972, which concluded that although “society should seek to discourage use… the criminalization of possession of marihuana [sic] for personal is socially self-defeating as a means of achieving this objective.” The report goes so far as to suggest that “[w]e would deemphasize marihuana [sic] as a problem.” The Shafer Commission’s report was hardly a glowing appraisal of marijuana, but it at least acknowledged that cannabis was not the society-crumbling plague it was made out to be by anti-weed propaganda like 1936’s Reefer Madness.
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“Pharma helped fund opposition to the medical marijuana and cannabis legalization initiatives of the past decade,” continues Conrad. “It donated lavishly to the political coffers of prohibitionists in Congress. There may be a pattern in there if you look closely enough.” The pattern is apparent to anyone willing to pay attention but, despite marijuana’s negative reputation being mostly manufactured, this does not mean cannabis is actually good for the brain.
Dr. Raiss is also not convinced that Big Pharma has anything to fear in the first place. “Since at present there are few demonstrated medical benefits of cannabis, Big Pharma has nothing to be afraid of, and, I suspect, would be happy to develop patented products if anything interesting emerges, much as Johnson & Johnson has developed esketamine nasal spray after ketamine’s benefits became apparent.”
Dr. Raiss’s skepticism runs even deeper. “The cannabis industry, on the other hand, has reason to be afraid of (and attempt to discount, ignore, minimize, and denigrate) the increasing reports of harm associated with cannabis use, following the tobacco, alcohol, and sugar industries’ playbooks.” He cites a February 2019 study published in JAMA Psychiatry that argues “preadolescents and adolescents should avoid using cannabis as use is associated with a significant increased risk of developing depression or suicidality in young adulthood,” concluding that “these findings should inform public health policy and governments to apply preventive strategies to reduce the use of cannabis among youth.” Given the recentness of the study, noteworthy criticism of the findings has yet to appear, but the results are certainly alarming.
Big Pharma led the international charge against cannabis a century ago.
Despite the conflicting research, it’s important to never lose sight of the fact that each and every brain is unique and incredibly complex. Mental health treatment is unfortunately not as simple as applying a bandage and waiting for the healing to begin. “People often substitute cannabis for anxiety medications and know for themselves if it does the job,” says Conrad. “People who suffer from severe mood swings often find that cannabis modulates their temperament. Likewise, a person who is having depression or anger management issues can often tell when and if cannabis helps them—even if not always how.”
Not knowing “how” cannabis helps is troubling for medical professions who can’t in good conscience suggest a treatment that is unverifiable. For Dr. Raiss, to recommend someone replace their mental health medication with cannabis “would constitute malpractice, or an extreme deviation from the standard of care, since the evidence of benefit from cannabis rests on anecdote, the lowest level of scientific evidence,” he says.
Even Conrad recommends caution when replacing mental health medication with cannabis. “A person who is coping with mental health issues is not always the best judge of how cannabis is affecting their behavior. It’s important that the patient has someone they trust who is familiar with their history and will help them monitor its effect on their behavior,” says Conrad. “If one form of cannabis is not working well enough, there are different forms and dosages from high THC macrodosing to CBD microdosing so getting trusted advice is critical.”
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But despite his reservations, Dr. Raiss concedes that many of his patients frequently use cannabis to help them relax at night. “One patient, for example, found that two to three puffs of a largely indica blend helped him unwind,” he says, “and reduce the amount of Seroquel he needed to sleep.”
Conrad shares a similar sentiment. “[Cannabis] gives such a deep, restful sleep and lets you forget the day’s cares and the stressful dreams that otherwise might keep you awake at night,” he says. “Just being rested is good for your mental health.”
Finally, the answer to the question—can cannabis replace one’s mental health medication?—is, well, it depends. Regardless of differing opinions of cannabis, when it comes to mental health, treatment should be personalized, with all options discussed openly and ethically. It’s important to remember that every brain is beautifully complex, requiring its own unique considerations. Whether cannabis outright replaces one’s medications or serves as an augment to other treatments, it’s ultimately up to the individual to decide if the current course of action is working because if cannabis can help someone stay on the path towards wellness then what’s wrong with a little weed?