Practicing psychiatry offers perspective on cannabis's popularity and risks.
The privilege granted psychiatrists to hear the most intimate facets of people’s lives, combined with the authority and responsibility to administer medications appropriately and safely, gives them a unique perspective on cannabis use.
Firstly, cannabis magnificently illustrates the direct connection between our brain and our mind. Even small amounts of the molecules produced by cannabis plants (primarily THC and CBD) markedly change the basic texture of our experience. The brain is a colony of individual nerve cells, called neurons. Neurons are essentially one-celled organisms that can live independently when placed in a petri dish. Together, the roughly 86 billion neurons making up our brain are so delicately and intimately interconnected with each other that they control the body’s muscles, affecting what we hear, see, smell, feel, and think.
Above all else, this nearly three-pound colony of coordinated neurons also generates our conscious experience. How consciousness emerges from this neural activity is not fully understood, but it is directly experienced by all of us. And when the chemistry in cannabis alters how our neurons interact with each other, we feel very different.
As scientists unraveled the mystery of how THC and CBD interact with neurons to make us high, they uncovered fundamental secrets of how the brain works. Chemistry inherent in the brain that cannabis resin closely imitates is responsible for regulating all the brain’s neurotransmitter systems, such as dopamine, serotonin, GABA, etc. This inherent system is the master neurotransmitter, and cannabis energizes this master regulator system far above its normal level.
Unlike with most other psychoactive drugs, consciousness altered by cannabis remains undimmed. But what we are conscious of is altered enough that we see the world, outside and inside, differently (see my post,
"How Cannabis Makes Everything So Interesting"). The mind and brain are yoked together, and few things illustrate that as well as experiencing cannabis. For many people, this is an awesome experience.
Secondly, psychiatrists stand at the bottom of an escalator that delivers the most seriously mentally disturbed people. Those with schizophrenia, bipolar disorder, major depression, and others disabled by mental illness enter our offices, pleading for whatever relief we might have to offer, which often involves medication. As a result, and because I practiced addiction psychiatry, I have seen far more individuals who have been harmed by using cannabis at too early an age, too frequently, too much, or in the face of other complicating mental problems than has the average person.
Overstimulating the brain’s master neurotransmitter system ultimately weakens it, which disrupts the regulation of the rest of brain chemistry. Like an emergency room doctor who repeatedly witnesses the carnage of gun violence, I have repeatedly seen adolescents’ lives turned and twisted by devotion to cannabis in ways that change the trajectory of their future. On the one hand, I know epidemiology shows that these disasters are a small minority of those who ever try cannabis. But, on the other hand, I have seen the wrecks and know that harm is possible, even when it is not the norm.
Thirdly, I have seen the reality of medical benefits from cannabis and understand why modifications of the brain’s inherent master cannabinoid neurotransmitter system can treat physical illness. In addition to modifying our inherent cannabinoid chemistry, THC and CBD are also powerful anti-inflammatory and anti-oxidative agents. Just as botanicals in the past gave way to safer and more powerful medications with known doses (e.g., foxglove tea leading to digitalis for heart failure), raw cannabis will lead to an array of newer, safer, and more powerful medications to combat pain, brain trauma, epilepsy, autoimmune, and degenerative disease, to name but a few.
All medications have unintended side effects, and this includes medical cannabis. Addiction is only one of many possible negative side effects. For example, people with multiple sclerosis can experience significant relief from painful muscle spasms, but those who use cannabis for this relief have unfortunately been shown to have an earlier decline in cognitive functioning. Ongoing daily use of cannabis, even for legitimate medical purposes, can lead to a subtle decline in memory, executive functions, the ability to assess the probability of risk, and even sensitivity to subtle emotional cues. All medications, and especially powerful medicines, need to be given only when well-diagnosed illnesses have a reasonable expectation of benefit, and with careful monitoring for potential unwanted side effects and untoward interactions with other medications. There is a role for medical use of cannabis products, but it needs to be handled with the same care, discretion, and monitoring we expect to receive for any strong pharmaceutical medication.
Finally, I have watched as political and moral polarization creates so much damaging debate about cannabis that meaningful dialogue is pushed aside. Those who oppose cannabis and those concerned about public health both use science and data to confront cannabis advocates. They make the mistake of believing objective facts are more important and more convincing than the subjective experience of the Cannabis Culture community. Those who use cannabis for recreational, spiritual, or medicinal reasons attribute important personal meaning to their experience. When hammered with objective facts by those who have not listened to, do not understand, or, frankly, disrespect the meaning of people’s direct experience of cannabis, the Cannabis Culture community turns a deaf ear and is repelled. One of the most fundamental lessons practicing psychiatry has driven home for me is that what I think is often less important to other people than having what they think listened to first.
I summarized the objective facts discovered by science in my book From Bud to Brain (2020), but I was quickly dissatisfied with how it told only half the cannabis story, as fascinating as the scientific story is. The other, subjective half, now told in Marijuana on My Mind: The Science and Mystique of Cannabis (2022), is equally fascinating. This half, like much of good psychiatry, involves more listening than telling.
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