Tag Archives: psychosis

Opioids kill One Way; Cannabis Kills in Another Way

By John Dossett, MD, South Londonderry Township, Pennsylvania, originally published in Penn-Live on July 16, 2017, as one of the top five editorials of the week.

The Centers for Disease Control (CDC) is reporting that between 30,000 and 40,000 Americans are dying each year from opioid overdoses. Most of these are not suicides but, are the consequences of people using “stuff” which is profoundly more potent than they imagined.  From our local communities, to the state, and federal government levels, we are alarmed and we should be.

Parallel to the “opioid epidemic” is the “cannabis epidemic” which is going unnoticed and unreported. We see weekly hype about so called “medical marijuana,” but, little about the tragic consequences of cannabis overdoses.

Why? One reason is that opioid overdoses kill and cannabis takes the lives of its victims in a less dramatic way.  Cannabis-induced psychosis robs the victims of their meaningful life.

The proverb says, “There are many ways to lose one’s life and dying is just one of them.”

The parallel to opioids is that the “weed” of today has been hybridized (genetically engineered) to be 5 – 6 times more potent than the weed of 20 years ago (4% THC compared to 19% THC).  In addition, the contemporary delivery systems (example- vaping) increase the amount of THC getting to the brain. These unexpectedly high “doses” of today may include manic psychosis and schizophrenia like symptoms. The victim didn’t understand what she/he was getting. What was expected to be a few hours of pleasure has become a life-changing psychosis.

I predict that our fascination with “medical marijuana” will only accelerate this tragic epidemic of THC-induced psychosis.

If there is to be a place for “medical marijuana,” give it to the FDA where it can be studied by legitimate scientists who are not funded by the producers, distributors and charlatan practitioners. Clearly, the profits are huge and the costs to human lives are huge.

There may be a few serious conditions in which a small amount of cannabis helps to relieve suffering. Example: End stage cancer. Responsible physicians will use it wisely and compassionately just as they do with opioids.

The tragic hidden problem is aided by a very small number of “charlatan physicians” who will sell their souls to the callous industry. For a fee and without being seen, cannabis users can receive a “certificate of need.” This document allows the user to go into a retail cannabis dispensary and purchase whatever he/she wants from a large inventory of cannabis products.
Said again, opioids kill by suppressing respiration. Cannabinoids ruin lives by inducing psychosis.  Both are tragic.

Dr. Dossett is a pediatrician in Hershey, Pennsylvania

Marijuana through the eyes of a doctor in Emergency Medicine

 Warnings from a Doctor

by Brad Roberts, MD:  I recently finished my residency in emergency medicine and began to practice in Pueblo, Colorado. I grew up there, and I was excited to return home. However, when I returned home, the Pueblo I once knew had drastically changed.  (Above photo is of people lining up at the opening of a pot dispensary in 2014.)

Where there were once hardware stores, animal feed shops, and homes along dotted farms, I now find marijuana shops—and lots of them. As of January 2016, there were 424 retail marijuana stores in Colorado compared with 202 McDonald’s restaurants.These stores are not selling the marijuana I had seen in high school.

Multiple different types of patients are coming into the emergency department with a variety of unexpected problems such as marijuana-induced psychosis, dependence, burn injuries, increased abuse of other drugs, increased homelessness and its associated problems, and self-medication with marijuana to treat their medical problems instead of seeking appropriate medical care.

I had expected to see more patients with cannabinoid hyperemesis syndrome (and I have), but they were the least of my concern. Our local homeless shelter reported seeing 5,486 (unique) people between January and July 2016, while for the entire year of 2013 (before recreational marijuana) that number had been 2,444 people.2

Most disturbing, we weren’t seeing just homeless adults but entire families. It is a relatively common occurrence to have patients who just moved here for the marijuana show up to the emergency department with multiple medical problems, without any of their medications, often with poor or nonexistent housing, and with no plan for medical care other than to use marijuana.

They have often left established medical care and support to move here for marijuana and show up to the emergency department, often with suitcase in hand.

Increasingly Potent & Dangerous Drug

This new commercialized marijuana is near 20 percent tetrahydrocannabinol (THC, the psychoactive component of cannabis), while the marijuana of the 1980s was less than 2 percent THC.

This tenfold increase in potency doesn’t include other formulations such as oils, “shatter” (highly concentrated solidified THC), or “dabbing” (heated shatter that is inhaled to get an even more potent form) that have up to 80 or 90 percent THC.3

The greatest concern that I have is the confusion between medical and recreational marijuana. Patients are being diagnosed and treated from the marijuana shops by those without any medical training. I have had patients bring in bottles with a recommended strain of cannabis and frequency of use for a stated medical problem given at the recommendation of a marijuana shop employee.

My colleagues report similar encounters, with one reporting seeing two separate patients with significantly altered sensorium and with bottles labeled 60 percent THC. They were taking this with opioids and benzodiazepines.

In some cases, places outside of medical clinics, like local marijuana shops, are being used to give screening examinations for medical marijuana cards.4 Reportedly, no records are available from these visits when requested by other medical providers. A large number of things treated with marijuana, often with no cited research at all or with severe misinterpretation of research, are advertised online.

These include statements that marijuana treats cancer (numerous types), cystic fibrosis, both diarrhea and constipation, hypoglycemia, nightmares, writer’s cramp, and numerous other conditions.5–7

Although there are likely some very effective ways to use the cannabinoid receptor (probably better termed the anandamide receptor), putting shops on every street corner and having nonmedical personnel giving medical advice is a very poor way to use this as a medicine.

Furthermore, to suggest that combustion (smoking) be the preferred route of medication delivery is harmful.3,8–10 I am also concerned that this is being widely distributed and utilized as a medicine prior to safety and efficacy studies having been completed; widely varying dosing regimens, concentrations, and formulations are being developed, sold, and utilized.

Patients are not being informed of the adverse effects associated with marijuana use, but instead, they are being told, “There are no adverse effects.” I am in favor of using the anandamide receptor for treatment purposes. However, we should do this safely and appropriately. What is occurring now is neither safe nor appropriate.

There are numerous adverse effects of marijuana that are significant. Marijuana use may lead to irreversible changes in the brain.3,9,11,12 Marijuana use correlates with adverse social outcomes.3

It is strongly associated with the development of schizophrenia.13–16 Dependence can lead to problem use.17,18 There are adverse effects on cardiovascular function, and smoking leads to poor respiratory outcomes.3,19,20 Traffic fatalities associated with marijuana have increased in Colorado.1

Pregnant women are using marijuana, which may lead to adverse effects on the fetus, and pediatric exposures are a much more common occurrence.21,22

This photo represents a few of the 270 Pueblo physicians who signed a petition last fall to opt out of marijuana for the city and county.

Different Approach Is Needed

We should approach mass marijuana production and distribution as we would any other large-scale public health problem. We should do what we can to limit exposure, and we should provide clear, unbiased education.

In the case of prevention efforts being unsuccessful, we need to provide immediate treatment and assistance in stopping use. If we are going to use this as a medication, then we should use it as we use other medications. It should have to undergo the same scrutiny, Food and Drug Administration approval, and regulation that any other medication does. Why are we allowing a pass on a medication that very likely would carry with it a black-box warning?

As emergency physicians, we are on the front lines. We treat affected patients; we need to be at the forefront of public policy recommendations at both state and national levels.

Originally published by ACEPNow,  a journal of Emergency Medicine.    We also published the testimony of another emergency doctor in Pueblo, Dr. Karen Randall.

marijuana-suicide-risk

The Common Element in These Suicides: Marijuana

The common element in all these suicides or self-inflicted deaths was marijuana.   Marijuana was the factor, not alcohol or other drugs…………in all cases.  (Read Part 1 and Part 2)

Marc Bullard, 23      Colorado

Brant Clark, 17        Colorado

Tron Dohse, 26        Colorado

Luke Goodman, 23      Colorado, traveling from Oklahoma

Daniel Juarez, 18     Colorado

Shane Robinson, 25      California

Rashaan Salaam, 41      Colorado

Levy Thamba, 19         Colorado, traveling from Wyoming

Hamza Warsame, 16       Washington

Andy Zorn, 31          Arizona

marijuana-suicide-risk
These four young men died in marijuana-related suicides. Clockwise from left, Daniel Juarez, Colorado, (photo, CBS News), Shane Robinson, California, Hamza Warsame, Washington (photo, Seattle Times, from the family) and Andy Zorn, Arizona.

Four of these victims — Warsame, Thamba, Juarez, Clark — had experienced pot-induced psychosis during the period leading to their deaths.  Juarez was an outstanding soccer player who got very high with a friend the night he stabbed himself 20 times.   The suicide report showed he had 38.2 ng of marijuana in his blood, eight times the limit for Colorado drivers. Toxicologists tested him for methamphetamine and other substances, but the results turned out to be negative. Although the death occurred in 2012, CBS News obtained the police report in 2015 and made it public at that time.  Juarez´s sister claims he would not have killed himself had he not gotten stoned that night.

Suicidal thoughts can come on very quickly while under the influence in individuals who were not previously suicidal. The suddenness of suicidal ideation means that intervention may be impossible. 

Dohse’s death was determined to have been an accident. Unable to find his keys, Dohse climbed up the apartment building and fell.  The toxicology report 27.3 ng. of marijuana in his blood, but no other drugs or alcohol in his system.  As his sister told CBS, she believes marijuana impairment led her brother to make poor decisions the night of his death.  (Read Part 1 for more background on Warsame, Dohse, Juarez and Clark)

Levy Thamba, left, and Kristine Kirk, right. Both died shortly after marijuana edibles went on sale in Colorado.

The story of Levy Thamba is particularly tragic since he was on a student visa to this country.  He came from the Democratic Republic of Congo to study engineering in Wyoming.  While visiting Denver with friends, he tried a marijuana edible for the first time.  It was a pot-infused cookie, the effects of which don´t appear immediately. About two hours later, he became acutely psychotic, thinking pictures were jumping off the wall. The friends calmed him down before going to sleep, but his psychosis returned.   He ran from his room to the sixth floor balcony, jumping to his death.

Thamba’s death is often described along with the death of Kristine Kirk.  She called 911 because her husband, Richard Kirk, wanted her to shoot him, after he ate a marijuana candy.  By the time, help came, he shot Kristine, mother of their three children, instead.

Bullard, Salaam and Robinson appear to have been suffering from depression as a result of heavy and/or extended pot use.  Marc Bullard was “dabbing.”  Andy Zorn, a veteran who had been taking medical marijuana, knew he had to quit marijuana to survive.  But he couldn’t quit and so took his own life. (Many people begin smoking pot after being told “it’s not addictive.”)

Marijuana Withdrawal is a Risk, Too

Although Shane Robinson had experienced two periods of pot-induced psychosis, he was having marijuana withdrawal syndrome at the time of his death.   According to a program of Dr. Drew Pinsky back in 2003, there is “an extraordinarily high incident of suicide in the first six months of marijuana abstinence.”

Most striking about the youths we describe is that they did not begin pot use because of depression.  All of these deaths occurred in marijuana-friendly states where the social situation was an influence on their pot use.  Lori Robinson, Shane’s mother, warns that educating against drugs and modelling a healthy lifestyle without drug use doesn’t work today.  It is no match for current  cultural trends and government policy which normalizes pot use.

Most who die in marijuana-related suicides are male, but women and girls are still at risk.  One of our supporters attempted suicide in her 20s after years of daily pot use, failed relationships and domestic violence.  Her attempt was not successful.  Today she is 29 years sober and her survival is a blessing.   Not all people will be as lucky. Males are generally more successful in suicide attempts, because their methods are often more efficient.

Pot is the Common Element, not an Underlying Mental Health Issue

These youths banish the claim that mental health problems always come before the marijuana use.   (A strong misconception is that mental illness after using pot only affects those with previous mental health issues.)  The deaths described here include active psychotic reactions at the time of marijuana use, as well as depression from long-term use.

The lives of these young men need to be a warning to states trying to legalize marijuana.  Suicide rates in Colorado have reached all-time highs and each one of Colorado’s 21 health regions had a suicide rate higher than the national average, according to a February report by the Colorado Health Institute.

When the pot industry tells us that “no one ever died from marijuana,” they’re lying.   Maybe it is time for the CDC to start tracking marijuana-related deaths.

These 10 deaths are just a few of the many self-inflicted deaths related to marijuana use.  Lori Robinson has assembled more stories of marijuana-related deaths and psychosis on the website of Moms Strong.  Read these stories on momsstrong.org.

Can Genetics Explain Why Pot is Dangerous to Mental Health?

First Time Marijuana Use Can Result in Crippling Mental Illness

On February 2, 2017, Psychiatrist.com published the case of a 20-year old man who went into psychosis from first time marijuana use.   The paper reveals: “Several first-time, non-chronic cannabis users have presented to our clinic with psychosis or thought disorders lasting months after first- or second-time cannabis use.”  The authors work at Columbia University Department of Psychiatry and the New York State Psychiatric Institute.

Why do some people have a predisposition for psychosis and schizophrenia from marijuana use? It can’t entirely be explained coming from a family with history of mental illness.   Another case study of a young man with bipolar had no family history for mental illness.  His diagnosis of bipolar disorder seems uniquely connected to the marijuana use.   These cases are familiar to families involved with Parents Opposed to Pot.

Some research suggests that those with the c/c variant of the AKT1 gene are more susceptible to schizophrenia if they use marijuana.  Those with the Val/Val or Val/Met variants of the COMT gene appear more likely to be susceptible than those with the Met/Met variant of COMT.   Other variables include age of starting to use pot, frequency of use and the strength of the marijuana.

Seriously, how many young people know their AKT1 and COMT gene variations before they start using marijuana?  And there are many additional genetic factors, yet to be isolated, that clearly contribute to susceptibility in others.

Why isn’t NORML, Marijuana Policy Project or Drug Policy Action educating youth about these hidden risk factors?  It can ruin someone’s life if they use marijuana and it turns out they are one of the unfortunate.    NORML has always known of this link to schizophrenia.  Drug Policy Action dismisses at current science with an evasive explanation on their website.

A comprehensive study from Finland suggests the risk with marijuana for a chronic schizophrenia spectrum disorder from marijuana use is far greater than with any other drug.

Anyways, genetics isn’t foolproof either.  Many women still get breast cancer even if they don’t have the BRCA1 and BRCA2 gene variations known to raise susceptibility.    The best option for avoiding a mental health disorder related to marijuana is complete avoidance of marijuana.

Currently, the average strength of marijuana sold in Colorado and Washington is more than 20% THC.  This means it is 5-10 times stronger than the marijuana of the ’70s and ’80s.   One Washington hospital announced last April that it has 1-2 new psychosis patients every day.   Legal, regulated markets increase rather than decrease the risk.

Read our other articles on the marijuana-psychosis connection:           Is Marijuana a Safe Drug?

Marijuana-Psychosis

10 Myths Marijuana Advocates Want You to Believe

Marijuana is Connected to Psychosis and Schizophrenia

My Marijuana Psychosis Sent Me to the Hospital

Dr. McKeganey Warned of the Marijuana-Mental Illness Links

In January, the National Academy of Sciences released a comprehensive review of multiple studies on marijuana.    The report is available here.