Question 1

Does cannabis use increase the risk of psychosis? If so, what are the factors that determine the outcome?

Deepak Cyril D'Souza · Accepted Answer

Yes. The dose of exposure (amount, potency, frequency, duration) is one factor.  Those who have other risks factors for psychosis (e.g., a family history of psychosis) may be more vulnerable.

https://grantome.com/grant/NIH/R01-DA012382-04A1

Question 2

What are the effects of cannabis on higher cognitive functioning? How do we create awareness about this in the context of legalising cannabis?

Deepak Cyril D'Souza · Accepted Answer

Cannabis and some of its constituents produce acute impairments in memory, attention, executive function, impulsivity and risk-taking behaviour, and psychomotor coordination. Some of these cognitive processes are critical for driving a car.

Chronic exposure to cannabis has also been associated with impairments in memory, attention, executive function, motivation and IQ.

We need to educate young people as early as possible with the media platforms that they most subscribe to.

https://healthsci.mcmaster.ca/learningtechlab/news/2020/12/02/weed-and-teens

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037578/

Question 3

Is it true that CBD has anxiolytic and antipsychotic properties?

Deepak Cyril D'Souza · Accepted Answer

CBD may have anxiolytic effects.  Whether it has antipsychotic effects remains an open question with some studies showing such effects but others not showing such effect.  We still need more convincing data. But, importantly the CBD present in cannabis is not enough to produce antipsychotic effects.

Question 4

Is there data to suggest that cannabis (THC and/or CBC) is useful in treating mood and anxiety disorders and trauma? Why do you think that, anecdotally, people report relief from symptoms by using these products?

Deepak Cyril D'Souza · Accepted Answer

No, several studies have concluded that there is no convincing evidence.  Recently Black et al., 2019 conducted a metaanalysis of all studies between 1980 and 2018 and concluded that there remains “insufficient evidence” for using cannabinoids to treat depressive disorders and symptoms, anxiety disorders and symptoms, ADHD, post-traumatic stress disorder, Tourette syndrome, or psychosis. What individuals may be reporting is a transient disconnection from their problems, which doesn’t last long, but with repeated use will lead to tolerance and dependence.

Question 5

Does long-term use of THC and CBD lead to tolerance, dependence and withdrawal syndromes?

Deepak Cyril D'Souza · Accepted Answer

Using cannabis and its principal active constituent THC does lead to tolerance, dependence and withdrawal.  This may not be the case with CBD.

https://www.bbrfoundation.org/content/study-gauges-impact-heavy-chronic-cannabis-use-cognition-and-psychosis-related-phenomena

Question 6

Does the use of THC and CBD stimulate the brain's reward system and the release of dopamine like known substances of abuse?

Deepak Cyril D'Souza · Accepted Answer

THC but not CBD does increase dopamine in the reward system but to a lesser extent than other drugs like heroin, cocaine and nicotine.

Question 7

What is the best approach to treat cannabis addiction in a patient with history of cannabinoid hyperemesis syndrome?

Deepak Cyril D'Souza · Accepted Answer

To quit!!

Question 8

If cannabis can both cause mental illness and be helpful in treatment of mental illness, how do you know when it is helpful or unhelpful?

Deepak Cyril D'Souza · Accepted Answer

The current state of the evidence is that cannabis and THC is generally harmful to people with psychiatric conditions.

Question 9

I've seen research implicating abnormal levels of endogenous cannabinoids in depressive disorders, eating disorders and schizophrenia. What might this mean for clinical practice?

Deepak Cyril D'Souza · Accepted Answer

It may mean that altering endocannabinoid levels (not with cannabis) may offer an approach to treat some of these conditions/symptoms.
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949116/

Cannabis and Mental Health

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