The first two decades of the 21st century have seen a shift in the public’s perception of therapeutic cannabis use. A drug once seen as a widespread danger to society is now experiencing renewed interest as a treatment for medical conditions, including a number of mental health conditions.1
Unlike other federally approved drugs, which are vetted through carefully monitored clinical trials assessing both safety and efficacy, the legalization of whole plant cannabis products (WPCP) for medical use across states has been mostly decided through popular referendum. Presently, the efficacy and safety of therapeutic cannabis use in all mental health conditions remains equivocal and few medical indications are supported by clinical trial data.
The new wave of cannabis legalization has been accompanied by an increase in the dissemination of industry-driven marijuana advocacy content across all media platforms.2 Consequently, recreational and therapeutic cannabis use is growing nationally without a strong foundation of clinical research to guide its use. Under these new conditions, psychiatrists are increasingly likely to encounter patients who report that they use cannabis to treat their mental health conditions, regardless of its legality in their state.
The current use of cannabis for mental health conditions departs from the traditional paradigm of prescribed medications for clinical practice in 2 specific areas. First, doctors cannot base their treatment plans on high quality clinical trials. Second, doctors cannot reliably restrict access to cannabis as it is easily accessed through either legal or illegal avenues. As a result, many practitioners can find encounters with patients identifying as therapeutic cannabis users to be awkward and anxiety producing.
This brief review explores 5 key issues clinicians can consider when encountering the therapeutic cannabis user.
Dr. Witt-Doerringis a PGY 3 Psychiatry Resident; and Dr. Kostenis Professor of Psychiatry, Neuroscience, Pharmacology, Immunology and Rheumatology, and Vice-Chair, Psychiatry for Research, Baylor College of Medicine.
1. National Academy of Sciences. The Health Effects of Cannabis and Cannabinoids. https://www.nap.edu/download/24625. Accessed April 5, 2018.
2. Krauss M, Sowles S, Sehi A, et al. Marijuana advertising exposure among current marijuana users in the US. Drug Alcohol Depend. 2017;174:192-200.
3. Russo E. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163:1344-1364.
4. Colorado | Department of Public Health and Environment. https://www.colorado.gov/pacific/cdphe/news/marijuana-research-grants. Accessed April 5, 2018.
5. Center for Medicinal Cannabis Research. https://www.cmcr.ucsd.edu/index.php/2015-11-20-20-49-13. Accessed April 5, 2018.
6. Walsh Z, Gonzalez R, Crosby K, et al. Medical cannabis and mental health: a guided systematic review. Clin Psychol Rev. 2017;51:15-29.