In the past 25 years working in the mental health field, I have worked closely with a half dozen psychiatrists and a handful of nurse practitioners. Not one has been in favor of legalizing marijuana. I could quote research that associated cannabis use with late-onset psychosis, anxiety disorders, and (possibly) amotivational syndrome. But you wouldn't believe it if you were not so inclined. The bulk of my career has also been in corrections, especially county jails, in which I regularly see people coming off various substances, including methamphetamine, heroin, bath salts, alcohol, cocaine, opiates, benzodiazapines, and marijuana. Though marijuana does not present the most acute withdrawal syndromes, marijuana use can present the most prolonged and insidious symptoms over time. (The major exceptions would be cocaine or stimulant induced psychosis, as well as pseudo-parkinsonian symptoms caused by stimulants and cocaine. I suggest that several examples of the latter might be Michael J. Fox, Robin Williams, and Anthony Bourdain--tragic.)
Back to marijuana. Although the substance may seem relatively innocuous, the body struggles to clear cannabinoids, which are not water-soluble and thus do not clear through the kidneys. It seems to take the mind even longer to clear from marijuana. For example, it may take six months to regain baseline digit-span retention, a simple measure of intelligence. Increasingly, due to legalization and the barrage of pro-marijuana propaganda, I am seeing more and more people using marijuana to self-medicate conditions such as bipolar disorder, borderline personality disorder, seizure disorder, opiate dependence, and other disorders.
I can say emphatically that marijuana does not help people with bipolar illness. It makes them worse. A lot worse!
Nor does it help people with borderline personality disorder. I have even seen people who once carried a borderline diagnosis, after an extended period of abstinence, lost the diagnosis of borderline. (That's not supposed to happen! I suspect there may be a phenomenon of pseudo-borderline associated with cannabinoid use.)
My jury is still out regarding marijuana and seizure disorders. I no longer fully trust most diagnoses. Especially in prisons and jails, one never really knows what is a seizure, factitious disorder, or something else. Also, I should note that a differential diagnosis of seizure disorder is well above my pay grade and expertise. But I am skeptical.
Using marijuana as a replacement or harm reduction strategy for opioid or even stimulant use disorders might actually make sense. I have talked to hundreds of people who have been on Methadone management and hundreds more who have been prescribed Suboxone. I've also talked to several dozen people who switched from hard drugs to marijuana (arguably also a hard drug, nowadays). Methadone management is not a lifestyle I would wish on my greatest enemy. The second generation opioid management drug, Suboxone, is a bit better, but fundamentally the same. And the drugs that do not get the addict high, such as Naltrexone, which treat cravings, anecdotally seem to work mainly for the highly motivated, such as recovering professionals. So, that mainly leaves marijuana as an alternative to Methadone and Suboxone. Clearly, marijuana would be less of an addictive task-master than either of these. But maybe it is the task-master aspect of these drugs that works as an opiate replacement? I do not know of any data suggesting that marijuana works as an opiate replacement. Like I said, I've talked to at least a dozen anecdotal success cases. However, their marijuana use was not without significant side-effects, as evidenced by their legal consequences, partly a sampling error due to where I work. Furthermore, the use of marijuana as a replacement drug is very complicated because it is also the most likely to show positive on a urine drug screen. Besides, ethically, marijuana is ultimately just another drug. It seems that many, perhaps most, drug addicts need some type of psychological crutch. They have a need to stuff their emotions by getting high on something, and marijuana could be the least harmful of these strategies. But, in reality, even marijuana use is just a cop out.
Other problems do not get better from marijuana use. Anxiety disorders--of course not. Intellectual disability--even further exacerbates acuity. Insomnia--maybe for a while, then makes it worse. Depression--exacerbates. Anger--what a joke.
Another interesting thing that has occurred is the development of CBD oils. Marijuana contains two psychoactive chemicals, in varying degrees of intensity, CBD and THC.
First, CBD is the mellowing agent that gives marijuana users a restful sensation. CBD has become the new snake oil. Who knows, it may have some medicinal value? Caveat emptor.
Second, THC is the stimulating substance that makes the user high and stimulated. Long ago, back when I was in Junior and Senior High School, marijuana was classified as an hallucinogen. If you've ever read Baudelaire's Hashish Papers, you would see how very large quantities of cannabis, ingested, can lead to hallucinatory experiences. But I somehow doubt that was the intent of classifying marijuana as an hallucinogen. I think the intent of classifying marijuana as an hallucinogen related more to the propaganda coming out of the 60s, in which marijuana was considered a mind-expanding and insight-inducing substance.
Interestingly, some of the hallucinogens, lately, psilocybn mushrooms, have shown some oddly promising results in the treatment of alcoholism. Of course, these studies have all been done with very small doses and in controlled laboratory conditions with a psychotherapist to guide the process. The suggestion is that, under properly guided circumstances, these hallucinogenics can be helpful in breaking through walls of denial. Alcoholics are highly repressive creatures. The psilocybn, for example, floods the brain's neurotransmitters and, under the guidance of a skilled psychotherapist, the alcoholic experiences a flood of emotions that breaks down the ego defense mechanisms, especially denial. For example, the alcoholic experiences the overwhelming emotions about how he has disappointed his family, feelings he would normally repress or deny. Once the alcoholic has experienced this insight, which he has previously blocked from consciousness, sobriety becomes a possibility. Of course, it does not guarantee the alcoholic will take the necessary steps to get or to remain sober, but this form of hallucinogenic treatment has been a first step in some case studies.
However--and this is a huge however--this experimental hallucinogenic treatment must be done in extremely controlled conditions and under the direction of a skilled psychotherapist. It is very easy to see how such an experiment could easily go awry. Furthermore, this experiment would be done perhaps only once. Hallucinogenics are extremely dangerous drugs, and the brain's neuro-chemistry is a precarious balance. Regular use (and in some anecdotal case one use) of hallucinogens leads to, um, hallucinations, the main symptom of the very serious mental illness, schizophrenia. These experiments are very dangerous and potentially unethical.
The success of these few experiments using hallucinogenics, in my opinion, points to the real danger of legalizing marijuana. Let's take at face value the propaganda from the 60s claiming that marijuana was a mind expanding substance. Exactly what did they mean? I suspect they were pointing to a similar phenomenon observed in these hallucinogenic experiments on alcoholics breaking down defense mechanisms such as denial. The difference is that, without restraint, marijuana can quickly become a substance the user regularly ingests. Over time, it would be easy for today's strains of marijuana to far exceed the levels that the French poet Baudelaire consumed. As this occurs, the user gradually undoes the defense mechanisms that protected the user's ego or consciousness. To a sophomoric student of Psychology, having no ego defense mechanisms might sound like a good thing. Indeed, some of the popular Psychology in the 60s espoused this kind of breaking down the doors of perception. In reality, having few or no ego defense mechanisms remaining would be a terrible thing. Over time, the person who had dismantled all of his ego defenses would become a puddle of emotions, with no self-confidence, a crippling cynicism, and limited social skills. With chronic use of marijuana, which builds up in the body over time, I believe the users experience this crippling loss of ego defense mechanisms. Ultimately, after years of abuse, they have no ego left to defend.
And that is what's not-so-funny about legalized marijuana.
