Recreational, private use of federally licensed cannabis is scheduled to be legal in Canada as of Oct. 17, 2018.
According to Statistics Canada, marijuana use is highest in individuals that are 18 to 25 years old – which is the same demographic in which mental health-related conditions are especially prevalent. Despite these statistics, relatively little scientific clinical evidence has been conducted on the mental health effects of marijuana use.
Due to this lack of evidence supporting the therapeutic potential of cannabis for mental health, health-care professionals may understandably be hesitant to prescribe medical cannabis to their patients.
Sarah Hanlon, Leafly Ambassador and Big Brother Canada winner, said it took about eight years to get signed up medically. Hanlon mentioned that stigma also played a role in this delay.
“As a young woman who wore ripped jeans and band Tee-shirts, doctors would take one look at me and dismiss me immediately,” Hanlon says.
Although formal methodological studies are lacking, there are still observational studies and patient experiences that can help guide clinical use of cannabis for mental health conditions.
Dr. Jonas Vanderzwan has been a practicing physician for more than 15 years. Vanderzwan recently entered the cannabis realm as the Medical Director and Chair of the Clinical Advisory Board at WeedMD, a Health Canad-approved, licensed producer of medical cannabis.
Vanderzwan has prescribed medical cannabis to about 1,000 to 1,200 patients. A fraction of those patients have mental health concerns including depression, anxiety, PTSD, ADHD and primary sleep disorders.
“As a cannabis prescriber, I come into contact with hundreds of patients using cannabis which has contributed to a broad knowledge base regarding clinical experience,” Vanderzwan says.
Vanderzwan believes patient accounts should be taken more seriously by health-care professionals.
“There is certainly a lot of anecdotal patient reports regarding cannabis success and I don’t think those should be dismissed,” Vanderzwan says.
Danah Khalil, a Youtube content creator, runs a channel called She Rips, which details her use and experiences with marijuana. Khalil has used medical cannabis for about two years.
“Marijuana has helped me drastically in terms of my depression and anxiety,” Khalil says. “Whenever I am under the influence of marijuana I am more optimistic about the world and myself, which is something that has been really beneficial in getting me through this state of depression.”
Hanlon reports a similarly positive effect.
“I use cannabis therapeutically to help myself relax. I am a person who is always in my head and cannabis helps me feel connected to the things and people around me,” Hanlon says.
Similarly, an anonymous cannabis user, who reports having occasional anxiety attacks and bouts of depressive symptoms, says it has a relaxing effect
“It puts me at ease. I have seven-day work weeks, with each day having an eight-hour commitment,” they say. “What helps me get by is the fact that I can smoke at the end of the day. I relax. I’m focused.”
These personal accounts are consistent with what is known about using cannabis. Cannabis contains chemical compounds called cannabinoids, which bind to receptors in the brain to mediate its effects. Two main types of cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD).
“THC is the chemical that recreational users would consume in an effort to feel a recreational high. However, THC can also have therapeutic effects. It has been shown to be a very good sedative, and it’s also a painkiller,” Vanderzwan says.
“CBD, on the other hand, does not typically cause any degree of intoxication and has been shown to be beneficial in reducing seizures, and it’s an anti-anxiety molecule.”
It appears that different strain-dominant types can be helpful in targeting different symptoms. However, some users report feeling no different when using different strains.
“It’s funny because I used to have one of those strain journals (notes you make to yourself about how different strains make you feel), but I stopped after a while because I was kind of writing the same thing every time,” Khalil says.
“I don’t really find much difference between strains myself,” Hanlon echoes.
Vanderzwan also highlights that there are different ways in which patients can administer medical cannabis to achieve different effects.
“At initial onset and introduction of the medical market, the only options for patients was the dried flower, Vanderzwan says. “Over the last couple years, edible cannabis oil has been introduced, which is a game-changer.”
Vanderzwan says vaporizing or smoking offers immediate relief, with the most impact observed typically 10 minutes after consumption. However, he notes, this method also wears off quicker, within two to four hours.
“With edible oil, you put it under your tongue, leave it there for 30 seconds and then swallow,” Vanderzwan says.
The advantage of this method is that it is more discreet. However, it takes a while to work and effects are usually seen two hours after consumption. The benefit is that effects of edible oils last much longer, typically in the six- to eight-hour range.
“I use cannabis therapeutically to help myself relax. I am a person who is always in my head and cannabis helps me feel connected to the things and people around me.” -Sarah Hanlon, Leafly Ambassador
Medical cannabis can also be used in conjunction with most traditional pharmaceuticals used for mental health concerns, such as SSRI and SNRI pills.
“The vast majority of my patients are typically already on conventional pharmaceuticals and cannabis is used as an adjunctive treatment,” Vanderzwan says.
Khalil has been on medications since April 2017. Khalil was previously on Cipralex, and now uses Prozac in conjunction with cannabis.
“The medication has been beneficial,” Khalil says. “But I do not think it would be as beneficial without the help of weed.” This suggests the effects of cannabis may help enhance the effects of traditional pharmaceuticals.
But cannabis can cause some negative experiences, with dry mouth being the most reported. There can also be feelings of withdrawal when stopped, which Vanderzwan says could last anywhere between five to seven days and are mild in nature.
However, for some, little to no effects are noticed when stopping. While Hanlon was on the cast of Big Brother Canada, she had to stop using medical cannabis.
“It was amazing how my body was able to cope and bounce back OK. It just goes to show that even the biggest potheads can stop and excel and be fine,” Hanlon says.
“But in terms of serious side effects,” Vanderzwan says, “I just haven’t seen it, which is more than I can say for some of the other medications we would conventionally prescribe such as benzodiazepines, which we know can impact cognitive functioning, especially in older patients.”
Vanderzwan also notes that cannabis should not be combined with benzodiazepines.
“When using both in combination, and specifically high THC cannabis, the cannabis could potentiate the sedating effects of the benzodiazepines,” Vanderzwan says.
“The concern is, we do know that cannabis could increase the likelihood of precipitating a psychotic event,” Vanderzwan says.
The literature on marijuana use and risk of developing psychosis is well-established. According to the Royal College of Psychiatrists, regular use of marijuana doubles the risk of developing schizophrenia or having a psychotic episode.
Research suggests that there is also a link between early cannabis use development of mental health problems later in life, especially in those with a family history of psychosis.
With legalization, Canadians will hopefully be able to learn more about the health effects of cannabis – both positive and negative – so health-care providers are better able to guide their patients when prescribing medical cannabis for mental health concerns.
The upcoming legalization might also help address the stigma surrounding cannabis use.
“I am very hopeful that (legalization) will normalize cannabis so that people can see it for what it is clearer – and that is a medical and therapeutic plant,” Hanlon says.
By Christina Gizzo