M Kaleem Arshad MD, former President of Louisiana Psychiatric Medical Association addresses the issue of marijuana in the mental health arena.
There is an ongoing heated debate and controversies surrounding this issue, says M Kaleem Arshad MD. There is passionate discussion in medicine and public about marijuana use by psychiatric patients. The role of marijuana use in causation or exacerbation of psychiatric symptoms. a As well as the therapeutic role of medical marijuana in the treatment of certain psychiatric conditions.
M Kaleem Arshad MD states, “Marijuana has become the most commonly used illicit drug in the USA. About 22 million people use marijuana at least once a month. Men use marijuana twice as often as women and marijuana use is widespread among adolescent and young adults. The public debate regarding marijuana and increasing legalization of both medicinal and recreational marijuana. This has led to a public perception that it is a generally harmless substance.”
M Kaleem Arshad MD, who is a Distinguished Life Fellow of American Psychiatric Association (APA) states that “APA ‘s official stance continues to be that marijuana has no legitimate role in the treatment of any psychiatric condition. This conflicts with the generally positive and more favorable attitude of public and patients about marijuana.” Marijuana use is widespread in psychiatric patients and many patients openly claim that marijuana helps with symptoms of anxiety, depression and bipolar disorder. More and more states are including post-traumatic stress disorder as a qualifying condition for treatment with medical marijuana.
M Kaleem Arshad MD indicates that US Federal Government still classifies marijuana as an illegal drug. With no legitimate medical use. In the United States, federal and state laws regarding the medical use of cannabis and cannabinoids are in conflict and have led to confusion among patients, caregivers, and healthcare providers. More than half of the states in the nation have enacted laws to legalize medical marijuana. Several states and the District of Columbia have legalized the adult recreational use of marijuana.
M Kaleem Arshad MD says that psychiatrists, at times, have shied away from addressing marijuana use by patients. Dr. Arshad feels psychiatrists need to start having a more frank interchange with their patients regarding this issue.
Risk of Disorders
M Kaleem Arshad MD added that there have been studies linking marijuana to increased risk of psychiatric disorders. Some including schizophrenia, depression, anxiety, and substance abuse disorder. Again there have been inconsistencies as to the extent that this happens.Then again the risks may vary depending on the extent of use and age when use started. There is a strong genetic component to this vulnerability as to how use of marijuana can progress to full blown use of other illegal drugs.
That’s why some have called marijuana a gateway drug. Recent research indicates that patients who have a certain variant of a specific gene have seven times more risk of developing psychosis when engaging in frequent use of marijuana. The onset of marijuana use is adolescents also may increase the risk of psychosis. Use of marijuana has been known to produce acute psychotic reaction in some non schizophrenic patients. Moreover in some patient population marijuana can adversely affect the course and prognosis of schizophrenia.
M Kaleem Arshad MD added that marijuana use, for years, has been associated with a-motivational syndrome where there becomes a decreased drive and motivation in typically rewarding and pleasurable activities. This may be related to certain brain changes connected to early onset and consistent marijuana use. A lot of these changes are connected to the neurotransmitter, dopamine, which plays a major role in motivational component of reward -motivated behavior.
Dysregulation of dopamine in the brain has long been known to be related to psychiatric illnesses like schizophrenia and depression. More studies and research are needed to further validate this hypothesis related to the a-motivational syndrome and use of marijuana.
M Kaleem Arshad MD says acute heavy use of marijuana can lead to an intoxicated state. There are observable adverse effects on short term memory. Also attention span, judgement, heightened anxiety and paranoia. Intoxication also affects muscular balance, coordination and reaction time. There is a direct relationship between blood marijuana concentration and impaired driving ability. Marijuana, the illicit drug most frequently found in the blood of drivers who became involved in vehicular crashes, including fatal ones.This, more problematic because,since 1990 ,there has been almost a four fold increase in potency of marijuana available to the public. About half a million medical emergency visits a year involve marijuana use.
Even if the emergencies are not directly related to intoxication. Because eating and drinking marijuana delivers marijuana to blood steam at a slower rate, it can inadvertently lead to more use than intended. Persistent and long term use of marijuana can lead to impaired learning, a possible decline in IQ and can also distort sleep structure.
M Kaleem Arshad MD reports that it is also debated whether marijuana is addictive or not. There is a clear indication of a potentially addictive drug. Continued use of marijuana by some in face of personal ,family and professional impairment coupled with withdrawal symptoms point toward the addictiveness of marijuana.When marijuana becomes discontinued after persistent use, withdrawal symptoms like irritability, restlessness, disturbed sleep and appetite become experienced by patients.
M Kaleem Arshad MD states that medical marijuana becomes used for the treatment of several medical conditions including migraine headaches, epilepsy, muscular spasticity, movement disorders and AIDS. Also used as appetite stimulant for nausea and vomiting related to chemotherapy for cancer.
M Kaleem Arshad MD states, “in spite of multiple uses for medical conditions, the use of medical marijuana in psychiatry has been scarce.” There have been curbs on studies to find the therapeutic effects of medical marijuana in psychiatry. Thousands of combat veterans have passionately advocated the use of marijuana. This was to help them with treatment resistant post traumatic stress disorder. New York recently joined more than half of the states in the nation to include PTSD in the list. This list specified conditions that qualify for medical marijuana. Political pressure is building to obtain approval for more studies validate the benefits of medical marijuana. Primarily in psychiatric conditions specifically PTSD.
M Kaleem Arshad MD indicates that the debate about various aspects of marijuana and medical marijuana will continue. For years to come and he doubts whether we will ever come to a national consensus regarding is issue
M Kaleem Arshad MD is a diplomate of American Board of Psychiatry and Neurology. He has practiced psychiatry in New Orleans area since 1990. He has directed several psychiatric hospitals and programs in his professional career .