As I was writing this story, Leah texted me from her husband’s bedside at Cedars-Sinai Hospital: “LA Times, front page article, ‘Cannabis Hedge Funds Rush to Join Green Rush.’” We both wanted to vomit. Our two sons are casualties of this “green rush” movement, a movement to profit from making today’s highly potent strains of marijuana — at the expense of our youth….and their families. We will never address America’s mental health crisis until we accept that marijuana is the trigger that starts too many young lives unraveling.
Leah’s husband, Lee, suffered a major medical crisis, as if losing their 20-year-old son 32 months ago to suicide wasn’t enough for the family. Ed and I met Lee and Leah in the grief series; the four of us share a special bond. We do 5K walks annually in memory of our sons. On Mother’s Day, we took our families to Ojai together.
The Tragedy of Brandon
Leah said to our group back in 2012, “My son died of mental illness.” I didn’t say much, initially, but as the story unfolded and there was no history of psychosis in either family line, I thought marijuana had somehow played a role. I followed a hunch and began asking more questions. She looked at Brandon’s journals and saw his entries. “Am I having drug withdrawals?” he asked, trying to explain his racing thoughts. When he had to be hospitalized, he was convinced his lungs weren’t working.
Brandon died of suicide after being released from a three-day psych hold while experiencing psychotic symptoms tinged with mania (Guess what drug he had stopped using two weeks before entering the hospital…that’s right– cannabis). Despite telling numerous people in the hospital that he had just stopped marijuana use, none of the hospital staff raised a red flag that he was experiencing drug withdrawal symptoms. After Brandon left the hospital, he was convinced he needed a lung transplant despite doctors telling him there was nothing wrong with his lungs. He felt his breathing wasn’t right and was convinced he had caused it because he hadn’t stopped smoking cigarettes.
Brandon had become manic about four months earlier while smoking pot. When his mom expressed concern that he was becoming addicted, he just laughed because pot was a natural herb, not part of big drug companies making big $. Unfortunately Leah wasn’t aware that it’s best to come off pot gradually, under supervision. Unless psychiatrists are also certified for addiction treatment, they often don’t recognize marijuana withdrawal. Brandon had taken it upon himself to get a “medical marijuana” card, because he was having “anxiety.” Leah didn’t mind at the time, despite Brandon’s youth and undeveloped brain. As long as a doctor authorized it, she reasoned that it must be safe and legitimate. Before that time, he was using synthetic marijuana, which had alarmed her.
How Marijuana Becomes the Problem
Sorry, but I want to share what I truly believe is happening in every town across America, not just to my son, to Lee/ Leah’s son. If Leah and I hadn’t met, she would have accepted “Brandon died of a mental illness.” Rather than telling our children they should avoid having children and blaming it all on faulty genes, as some medical practitioners would advise, consider the environmental effects like marijuana. I think you should advise any child, teen or young adult to practice optimal brain health and avoid all substances that strongly alter the brain. The medical evidence is the marijuana manipulates the brain more than any other drug.
Before my son had his first psychotic episode in 2009, he suffered a terrible knee injury in a boating accident that same year. It required knee surgery and 9 months of physical rehab. It’s likely that Ryan started using a lot more marijuana to treat “pain” just as the medical marijuana advocates suggest — without giving any regards to proper dosing, strength and time intervals that a pharmacy is required to give. He was living with his fiancée at the time, so we were not aware of this choice, or that he had already been using marijuana for about three years. The accident, surgery and pain were the perfect excuse for him to use a lot more marijuana–plus he wouldn’t take the pain meds because they gave him nausea. Pot was apparently the treatment he chose, but we didn’t know it.
So the pattern emerges–using marijuana for a few years, increase the usage for “medical” reasons (in this case an accident followed by surgery and pain), and, then at some point — psychosis.
Close to Home: Amanda Bynes
Another example of the marijuana – psychosis pattern is former child star Amanda Bynes. She went to the same high school as my son; they were born in the same year, but one year apart in school.
Last year she was in treatment at the same psychiatric hospital in Pasadena where Ryan had been at one time. I don’t know her or her parents, but I heard she had some excellent treatment there (wish my son had been treated as well). Afterwards, her parents had a one-year conservatorship for her. Her mother asserted that the effects of marijuana were her main psychiatric problem, not bipolar or schizophrenia, as had been a rumored.
Amanda Bynes did well and looked amazing during most of 2014, until her parents’ conservatorship ended. Then in late summer, when the hold had ended, Amanda had some episodes and accused her father of terrible things. How could that young woman, who had heard that THC alters brain chemistry while in rehabilitation, return to using pot again? The relapse speaks volumes as to how addictive marijuana really is, and how marijuana use alters brain chemistry.
Like Amanda Bynes, Ryan seemed completely healthy to us after his “first episode” of psychosis. Both Amanda Bynes and Ryan went back to the same drug that damaged their young minds. No one knows which brains will unravel with marijuana. Is the risk worth it for anyone? In this country, I’ve found a few psychiatrists, Dr. Stuart Gitlow of Rhode Island, Dr. Christian Thurstone in Denver, Dr. Thomas Carter in Seattle, and some psychologists, who understand the link between marijuana use and mental health problems. Mental health treatment and addiction treatment need to be aligned more closely. A Postscript describes when and how to stop these problems.
Recommended for educating school and community groups: In a 3-minute video, Crystal Dilworth explains how marijuana — even in small amounts — affects the developing brain, and changes its structure. She makes a compelling case for why not to use for those under 25.
Medical marijuana tries to bypass discussion of the mental health risks. Marijuana is linked to long-term psychiatric problems such as schizophrenia, anxiety and psychosis. There is mounting research to suggest that youth usage of marijuana greatly increases the chance for both depression and suicide, as recently reported in the The Lancet Psychiatry Journal.
The PTSD Marketing Strategy
It was a good publicity stunt, but a cruel trick. The marijuana industry recently staged an event in Denver to attract veterans. They gave out free marijuana for Post Traumatic Stress Disorder (PTSD). PTSD is very real, and it’s a condition to be taken seriously.
The medical community should find solutions that would bring veterans back to their previous state of functioning before combat. Louis Zamperini, the hero of a book by Laura Hillenbrand and movie directed by Angelina Jolie, Unbroken, had severe PTSD from World War II. He had been beaten in a Japanese prison camp and lost at sea 46 days on a raft. It’s unlikely he would have healed and charged forward so well if marijuana had been offered as the solution. The movie will be in theaters on December 25.
Marijuana numbs certain emotions. It also effects memory. PTSD symptoms are different for different people, but it can include numbness, too. If fear, numbness and depression are present with PTSD, there should be a means that re-build connection to everyday life, rather than avoid the reality of life. Dogs and Yoga are amongst the best treatments for rebuilding connection. Time is a great healer, too.
Handing out free so-called “marijuana medicine” makes a mockery of recovery. It’s hoped our veterans could get back to work and not face long-term disability. Keeping “patients” addicted and under the thumb of medical marijuana industry may do the opposite. The best book on the subject, Judith Lewis Herman’s Trauma and Recovery, doesn’t suggest masking memory. Our first choice should always be therapies that go to the root of the problem, rather than masking the symptoms. Medical marijuana has the potential for masking symptoms. It also risks making a person apathetic and numb. It could give the illusion of getting better without deep healing.
Why does marijuana cause dependency? As explained in a testimony, marijuana usage interferes with the natural processes and messes with brain chemistry. After stopping marijuana use, irritability, anxiety, depression, nervousness, restlessness, insomnia and and suicide can be part of marijuana withdrawal. As time can heal marijuana withdrawal symptoms, time can heal PTSD. If we want veterans to not be permanently disabled, Congress should not allow marijuana for veterans suffering from PTSD.
A Cruel Attempt to Treat Psychiatric Disorders
Marijuana may increase the burden of mental illness. It is well-known in medical circles that marijuana makes the course of mental illness worse and successful treatment less likely. In fact, marijuana is the most common illicit drug to trigger a psychiatric disorder. For this reason, extreme caution should be taken before recommending marijuana to anyone, for any reason.
There’s strong evidence that mental illness is increasing in America. According to Robert Whitaker, author of Mad in America and Anatomy of an Epidemic, an increase in bi-polar disorder is driven in part by the expansion of diagnostic boundaries, but it is also being fueled by the widespread use of illicit drugs.
Whitaker explains that studies of first episode bipolar patients, roughly 1/3 suffered their first bout of mania or mood instability after they had abused illicit drugs — amphetamines, cocaine, marijuana and hallucinogens. Marijuana, as the most widespread of the illicit drugs, poses the most risk. (See 10 Marijuana Myths Advocates want you to Believe)
A culture of medication teaches our children to look for easy solutions; it may be influencing the widespread desire to self-medicate with marijuana and other drugs. Psychiatric medications are over-prescribed — anti-depressants, as well as anti-psychotics and ADHD medications. Whitaker also believes that the use of psychiatric stimulants and anti-depressants increases the risk of getting the bipolar diagnosis.
Leafly, a cannabis company in Seattle run Privateer Holdings, solicits users by advertising 88 strains of marijuana to cure bipolar disorder, depression, anxiety and ADHD. This type of advertising should be censored due to the lack of evidence and high risk for psychosis that comes with marijuana. Any psychiatric treatment demands strict oversight by a qualified medical practitioner, and is often done on a test basis. Medical marijuana “providers” often don’t have to meet standards or qualifications, other than being at least 21 years old.
Prevention over Substituting Addictions
Those who disagree with medical marijuana do not necessarily advocate for the alcohol or pharmaceutical industry.
Some of us notice that people who become addicted to any drug usually began their drug usage with marijuana, which is another reason we wish to prevent youth from using it at all costs. In fact, when it comes to teens and young adults, addicts almost always begin their drug usage as a marijuana user. The marijuana industry gives lip service to wanting to keep it from those under age 21, while using the social media and other tactics try to get young people to support them.
Opiate Addiction Solved by Marijuana ????
Recently an article suggested that marijuana can be a tool to beating opiate addiction, because of a study which opined that states with medical marijuana have fewer opiate overdose deaths. The study shouldn’t be interpreted as proof that medical marijuana brought a drop in opiate use or death.
States with the highest marijuana usage, including use by ages 12-17, tend to also have the highest opiate pill, cocaine and heroin usage. Oregon, Colorado and Vermont will need to limit youth marijuana usage, if they truly want to bring down other problems. To a certain extent the current heroin problem has arisen because people addicted to the opiate pills have been unable to get the pills.
The logical way to avoid death by opiate overdose is to keep it in the hands of only those who need it, teach responsible use, and avoid over-prescribing. Not everyone who uses opiate pills needs to get addicted. Many people use vicodin, percocet and oxycontin only for the limited duration until the pain is gone. Twisted, illogical thinking is suggesting that we must substitute one addiction with a drug that can also work on the mind and cause psychosis.
If we are to solve the problem of addiction in a lasting way, we need to help children and teens not begin to use. We emphasize proper usage, not substituting one addiction for another, or “lilypadding” from drug to drug. Prevention before abuse starts has the BEST chance of success. (Follow our blog to get Part 3 of The Medical Marijuana Hoax, to be published in December.)
In fact, about 15% of all users and a much higher percentage of heavy users will experience psychotic symptoms.1 Half of those individuals will become chronically schizophrenic if they don’t stop using.2 Fortunately, some do stop using because psychosis is not pleasant and they wisely recognize that pot caused their problems. Myth #2. Marijuana-induced psychosis must be due to other contaminating drugs.
Clinical studies under controlled laboratory conditions have shown that administering the pure, active ingredient of pot, ∆9-THC, elicits psychotic symptoms in normal volunteers.3 In addition, epidemiological research of nearly 19,000 drug abusing Finnish subjects showed that it was not LSD, amphetamine, cocaine, methamphetamine, PCP or opiates that most consistently led to a diagnosis of long term schizophrenia, it was marijuana.4 Thus, if you lace your LSD with marijuana, you are more likely to go psychotic. Myth #3. If marijuana is associated with the development of chronic psychosis (schizophrenia), it is only because the patients are self-medicating. Correlation does not equal causation.
Actually, four studies have been carried out in Europe to ask the question which comes first, the marijuana use or the schizophrenia. The research was designed to follow thousands of young teen subjects through a course of several years of their lives, and to ask if those who were showing symptoms of psychosis at study onset were more likely to begin smoking pot, or were those who were normal but began smoking pot during the course of the study more likely to become psychotic. Three of the studies5 convincingly showed that the evidence for marijuana triggering schizophrenia was strong, whereas the evidence for self-medication was weak. The fourth concluded that both were happening — marijuana was triggering psychosis and psychotic individuals were self-medicating.6 Myth #4. Those who become schizophrenic from marijuana use were destined to become so anyway because of their genes.
The truth of the matter is that no one is destined to become schizophrenic. Even in the case where one member of an identical pair of twins has schizophrenia, only about half the time does the other twin become schizophrenic as well.7 Thus, there is ample room for environmental factors like marijuana to make a difference between leading a normal life and not. Myth #5. Studies showing links between marijuana and psychotic disorders like schizophrenia are “cherry picked” to exclude negative studies.
A very large review of all relevant published papers was conducted by a group of researchers from around the world and published in the prestigious medical journal, The Lancet. No attempt was made to exclude results that were negative. The results they obtained by merging all the studies was that marijuana use approximately doubles the risk for schizophrenia.8 Later research has shown that the risk goes up to 6-fold if the use is heavy or if the pot is strong 9 (similar to the strength of marijuana that is coming out of Colorado now). Myth #6. Marijuana makes you mellow and less aggressive.
This is certainly not the case for the 15% who experience psychotic symptoms and the subgroup who then go on to develop a chronic psychosis. These individuals are up to 9-times more likely to commit serious acts of violence than people whose schizophrenia has nothing to do with drug use.10 Just a few of the very recent high profile cases here on the East Coast include January’s Columbia Mall shooter Darion Aguilar and “multiverse”-ranting Vladimir Baptiste, who drove a truck through a Towson, MD TV station in May. Somewhat less violent cases include White House episodes: Oscar Ortega, charged with shooting at the White House, ex-Navy Seal employee David Gil Wilkerson charged with threatening the life of the President and most recently, fence jumper Dominic Adesanya who is charged with attacking the White House guard dogs this October. In the Rocky Mountain region, soccer dad Richard Kirk became psychotic after his first use of marijuana edibles for his back pain, and while hallucinating that the world was going to end, shot his wife to death as his children listened through a closed door.On the West Coast, the mentally ill marijuana user Aaron Ybarra shot one student dead and wounded two others on the campus of Seattle Pacific University. In Ottawa this past week, rifleman Michael Zehaf-Bibeau was originally thought to have terrorist ties after he killed a young guard at the Capitol, but instead his friends paint a picture of psychosis and law enforcement records reveal more than one arrest for marijuana possession. All of these individuals exhibited psychotic symptoms prior to their acts and their mental illness could be traced to their marijuana habit in my opinion. Myth #7. Marijuana is good for the symptoms of PTSD and by keeping this drug from our veterans, we are depriving them of an important alternative treatment.
Veterans Affairs Administration studies have shown that those with PTSD who smoke marijuana make significantly less progress in overcoming their condition.11 PTSD victims are already more vulnerable to psychosis and it comes as no surprise that clinicians have witnessed psychotic breaks in PTSD patients who begin marijuana12 because of the abundant literature showing an association between marijuana use and the subsequent development of psychosis. While the symptoms that afflict PTSD patients (anxiety, depression, panic) may be temporarily relieved while the subjects are “high”, these very same symptoms are exacerbated in the long run.13 Even in the context of polydrug use, it is the degree of marijuana use that correlates most significantly with anxiety and depression.14 Myth #8. Marijuana is less dangerous than alcohol and will reduce alcohol consumption, so we’ll end up with safer roadways.
In terms of mental health, marijuana is more dangerous on all counts (depression, anxiety, panic, psychosis, mania). As far as our roadways go, marijuana all by itself impairs driving. Whether it is better or the same as alcohol in that regard is still a matter of debate. What is known is that users all too frequently do both, and this combination is particularly hazardous. The interaction between the two drugs is synergistic,15 not additive. So you end up with someone who is wildly impaired. Myth #9. Laws don’t make a difference to rates of marijuana use
Some of the best data available on youth use in regards to laws comes from Europe, where they have a wide range of marijuana laws between the countries. The European organization ESPAD has studied youth use (15 to 16 year olds) across different countries every four years. The two most recent ESPAD reports (2007 and 2011) show that countries with legalization or defacto legalization (The Netherlands, Czech Republic, Italy, Spain) have on average a 3-fold higher rate of youth use than countries in which it has remained illegal. In our country, differences in decriminalization laws have existed between states for several years. If you break out the states with lenient decriminalization laws that also submit data to the CDC to track youth use (CO, AK, MA, ME), their rate of youth use (9-12th grade) is significantly higher (~25% higher) than states that have strict decriminalization codes and report to the CDC. Lenient codes include a low civil fine with no increase in penalties for repeat offenders, no requirement for drug education, no requirement for drug treatment, and no community service. Outright legalization and dedicated recreational pot shops in this country has not been around long enough for the effect on youth use to be determined. Myth #10. The Drug War on marijuana is too expensive.
It is hard to put a price on the damage done to someone’s life if they develop a chronic psychosis like schizophrenia or psychotic bipolar disorder. But if economics must be considered, the cost of just schizophrenia alone to our country is approximately $64 billion per year, accounting for treatment, housing and lost productivity.16 If all adults were exchange their glass of wine or two over the weekend for a joint or two, our rate of schizophrenia would be expected to double. That $64 billion per year would pay for the drug war on marijuana and much more. Brief Bio for the author: Dr. Christine L. Miller obtained her B.S. degree in Biology from the Massachusetts Institute of Technology and her Ph.D. degree in Pharmacology from the University of Colorado Health Sciences Center. For over twenty years she has researched the molecular neuroscience of schizophrenia, ten of those years at Johns Hopkins University. She is semi-retired, conducting occasional biomedical consulting on medical cases and an active volunteer for SAM-Maryland (Smart Approaches to Marijuana). Citations:
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- Arendt M, Mortensen PB, Rosenberg R, Pedersen CB, Waltoft BL. Familial predisposition for psychiatric disorder: comparison of subjects treated for cannabis-induced psychosis and schizophrenia. Arch Gen Psychiatry. 2008;65(11):1269-74. Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9…………….. ↩
- D’Souza DC, Perry E, MacDougall L, Ammerman Y, Cooper T, Wu YT, Braley G, Gueorguieva R, Krystal JH. The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology. 2004 Aug;29(8):1558-72. Morrison PD, Nottage J, Stone JM, Bhattacharyya S, Tunstall N, Brenneisen R, Holt D, Wilson D, Sumich A, McGuire P, Murray RM, Kapur S, Ffytche DH. Disruption of frontal θ coherence by Δ9-tetrahydrocannabinol is associated with positive psychotic symptoms. Neuropsychopharmacology. 2011;;36(4):827-36. Bhattacharyya S, Crippa JA, Allen P, Martin-Santos R, Borgwardt S, Fusar-Poli P, Rubia K, Kambeitz J, O’Carroll C, Seal ML, Giampietro V, Brammer M, Zuardi AW, Atakan Z, McGuire PK. Induction of psychosis by Δ9-tetrahydrocannabinol reflects modulation of prefrontal and striatal function during attentional salience processing. Arch Gen Psychiatry. 2012 Jan;69(1):27-36……………. ↩
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- Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370:319–328…..… ↩
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- Bonn-Miller, Marcel O.; Boden, Matthew Tyler; Vujanovic, Anka A.; Drescher, Kent D. : Prospective investigation of the impact of cannabis use disorders on posttraumatic stress disorder symptoms among veterans in residential treatment. Psychological Trauma: Theory, Research, Practice, and Policy, Vol 5(2), Mar 2013, 193-200………. ↩
- Pierre JM. Psychosis associated with medical marijuana: risk vs. benefits of medicinal cannabis use. Am J Psychiatry. 2010 May;167(5):598-9. ……… ↩
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