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Running Head: MARIJUANA USE AND PHYCHOSIS DEVELOPMENT.
1
DRUGS AND MENTAL HEALTH 14
Marijuana Use and Psychosis Development
Xiomara Perez
Yhenlyss Herrera
Annly Rivero
Raciel Alonso Garcia
Alexander Montane
Universidad Ana G Méndez
NURS-640-O
Instructor: Dr Alejandro Torres
Marijuana Use and Psychosis Development
Recent research studies of substance abuse and misuse have shown that there has been a significant increase in psychotic disorders, i.e., “schizophrenia and schizoaffective disorders.” According to the observation of the majority of psychotic patients, cannabis or marijuana is considered one of the most commonly misused drugs that continuously exhibit the association of its massive consumption rate and the development of psychotic disorders. Despite the availability of little evidence, there is still a lot of “heated debate” about some discussed effects of the use of cannabis. Some of the widely witnessed findings of the increasing rate of the consumption of cannabis were among the young generation in most of the first world countries, where about 20% to 70% portray signs and symptoms of psychotic illnesses (Castle, Murray, & D’Souza, 2011).
Moreover, cannabis has continued to be linked with approximately 25% of the total psychotic cases. One of the main reasons this assumption has been so conclusive is that cannabis is widely known for generating milder effects compared to most intoxicating substances like alcohol. One of the profoundly affected subgroup users of cannabis is usually individuals who are prone to mental issues. The occurrence of such disorders is generally known as cannabis-induced psychosis, where patients are known to exhibit a disconnection with reality or experience a frightening mental breakdown (Hanna, Perez, & Ghose, 2017). Due to the uncertainties of these correlations, most research is based on the perception that most of the individuals who have this experience are usually prone to such illnesses.
Besides its origin causes, psychosis is a very devastating and damaging mental health illness that usually necessitates significant medical response and attention. On the other hand, there has been an increasingly growing concern across the globe where the number of psychosis patients has continued to rise. In the US, the issue of psychosis among young people has become rampant, especially due to the legalization and promotion of the use of cannabis in most states today (Evins, Green, Kane, & Murray, 2013). Therefore, it’s due to this reason that this paper will focus on evaluating the association between the use of cannabis and the development of psychosis disorder, i.e., schizophrenia.
Literature Review
Chemical analysis of cannabis indicates that the plant is made of various types of compounds, but the two most noted are “delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD).” Through the interaction with the “endocannabinoid system,” the THC compounds are considered responsible for the production of psychoactive effects immediately after it has entered the bloodstream. It’s due to the THC molecule and brain (endocannabinoids) that permit communication between the nerve cells. As similar to the way a key fit a lock, THC has the capability of biding itself to become the part of these nerve cells widely known as the CB1 receptor. Therefore, the feeling of one getting ‘high’ comes; as a result of the THC effectiveness in attaching itself to the CB1 receptors compared to the natural endocannabinoids. Nonetheless, cannabis is still considered as “soft” drugs with less mild effects than other “hard” drugs like heroin or cocaine (Murray, Quigley, Quattrone, Englund, & Di Forti, 2016).
On the same note, there has been an increasingly growing perception among adults that there are no adverse risks involved in the continuous use of cannabis. These misconceptions among adults were profoundly contributed by the pervasiveness of cannabis in correlation to its “relatively low lethality.” In support of this statement, it has been noted that some of the individuals who stopped using cannabis after they left college are gradually picking up the habit again. However, many have also failed to note that the THC content ratio has drastically increased since the 1970s and 1980s. By comparing the 2008 ratio, the THC levels have spiked from 8.9% to 17.1% in 2017, which also comes with considerable harmful effects (Vadhan, Corcoran, Bedi, Keilp, & Haney, 2017).
Furthermore, since the 1970s, the prevalence of cannabis consumption has dramatically increased where the proportional age of first use has steeply dropped. Today, the majority of known users are considered to exist between mid-to-late teens, which is a significant essential point in life for the psychosocial transition. It’s at this point in life personal misadventures can have an overwhelming effect on individual chance in life both academically and socially (Pierre, 2011). Through the review of epidemiology studies in the US, Canada, Australia, and New Zealand, individuals who used cannabis for either pleasure or other reasons showed a significant development of dependence on cannabis and the use of other toxic drugs, which later related to the occurrence of psychotic signs and symptoms.
As stated earlier, the use of cannabis has become widespread among adolescents and young adults in most developed countries. Today, cannabis is considered one of the most popular recreational drugs of choice, where, according to the recent study, it has over 192 million consumers all around the world. Through the review of the study taken in 2016, it’s estimated that about “14% of students in the 10th grade, 25% of students in the 12th grade, and 22% of college students” are occasional cannabis users. The report indicated that these numbers had been dramatically rising. For example, in comparison to the same study carried out in 2007, the prevalence rate of cannabis consumption among 12th-grade students grew from 19% to 25%, and it’s only expected to be worse with time (Hanna et al., 2017).
Apart from the commonly known ways of consuming cannabis through smoking, technology has revolutionized its usage by the development of vaping pens, which have become so prevalent in the market. The development of vaping gadgets has become one of the many tools that continuously promote the abuse of cannabis among the younger generation. Among the four groups, childhood and adolescent exposures are one of the highly influential subgroups that continue to regenerate massive public concern (Evins et al., 2013). It’s between these two groups that most of the individuals have been reported to experience cognitive impairment issues, which result to lower achievement and satisfaction in life.
Over the years, there have been various researches focusing on the effects of short and prolonged use of cannabis. The main factor incorporated in this research includes the observation of the use of the drug for other purposes, ages, and gender. In almost all the reports, the findings indicated a variation of the drug effect in regard to gender. Male individuals portrayed as a sense of more significant “cannabis-induced high” compared to their female associates. The same results showed that females had less cannabis consumption rate as compared to their respective male counterparts, i.e., where it was only 1 in 4 for girls and 1in 3 for boys (Castle et al., 2011). However, it is continuously becoming a challenge in trying to obtain or assure the credibility of some of the findings since some of the variables like family genes and other social vulnerabilities can exhibit a lot of unwanted results.
In almost all research reviews, at least three distinct hypotheses are used to entail the correlation between cannabis and schizophrenia. The first hypothesis states that cannabis can cause schizophrenia among persons considered to be safe from developing the psychotic disorder unless they get exposed to the drug (Vadhan et al., 2017). Despite the simplicity of the statement, researchers have reported various challenges during this hypothesis’s investigation process. In making sure that the approach succeeds, there should be a comprehensive overview of the estimated dose of cannabis, which can be stated as an inducing factor of psychosis. Most researchers are known to use 50 times or more exposure to capture the most substantial and useful diagnostic criteria for cannabis-induced psychosis. On the other hand, there is a significant risk of false diagnosis and positive association of cannabis-induced psychosis since it can take even weeks before cannabis metabolites are identified (Evins et al., 2013).
Following the above evaluation, the second hypothesis proposes that individuals with schizophrenia can be attracted to the use of cannabis as a preventive measure of the premature signs of the impact of schizophrenia. This hypothesis has continuously faced criticism on whether it’s possible since the majority of the patients are observed to be motivated by their reasons, which included recreation and pleasure. However, through this approach, there has been promising research explaining the potential positive impact of the use of cannabidiol in treating schizophrenia disorder (Pierre, 2011). With this understanding, the second hypothesis can be effectively strengthened in the event where respective individuals stand to gain from the consumption of cannabis. Moreover, in the line of the assessment, some of the individuals will exhibit “short-lived acute reaction” to cannabis while others will continue to progress to “long-term difficulties” (Evins, Green, Kane, & Murray, 2012).
The third hypothesis suggests that there is always a mutual source that may include a shared genetic liability that is responsible for the association between cannabis and schizophrenia. In the past few years, this hypothesis has been one of the most widely reviewed through various sophisticated methods. For example, Mendelian randomization has been actively used to evaluate the link between these two factors of study utilizing a genome database (Murray et al., 2016). Although there has not been a conclusive finding of a genetic relationship, it’s still considered possible. However, much of the influence would be considered to come from the individual’s environment.
The Association Between Cannabis and Psychosis
As stated in the above discussion, various theories have been developed in the effort of trying to explain the association between cannabis use and psychosis development. Through some of the research studies, cannabis is identified to be one of the possible factors that may tend to trigger schizophrenia and other psychotic disorders. In most research, one of the primary focuses has been direct to the study of neurobiological changes caused by the use of cannabis, particularly in how this development induces psychosis among persons. The silver lining of this approach’s use is that through the understanding of the process, it can also be reversed to attain effective treatment outcomes for psychotic disorders. In line with some of the earlier mentioned hypothesis, the most identified link possibilities include “1) acute intoxication leading to ‘psychotic-like’ experiences, 2) the hypothesis of self-medication’ for symptoms of psychiatric diseases such as the negative symptoms of schizophrenia, depression, or dysphoria, 3) the vulnerability these, and 4) shared genetic factors and common sociodemographic factors” (Pierre, 2011). However, one of the most widely known and identified studies of the consumption and development Sharedenia was the 15-year trail research of 50,465 Swedish male recruits.
The research reported that individuals exposed to the use of cannabis before the attained age of 18 were 2.4 times at higher risk of developing schizophrenia than their counterparts who were not exposed to the use of cannabis. These risks were also closely associated with the frequency rate of cannabis usage (Ortiz-Medina et al., 2018). Following the same Swedish cohort later after 27 years, there was significant evidence indicating “a dose-response” correlation between the rate of cannabis consumption and the increasing risk of being diagnosed with schizophrenia. The same results have also been newly applied and reinforced by other longitudinal researches carried out in the Netherlands, German, and New Zealand.
On the same note, researchers have continued to review the association of the study by evaluating scientific evidence availed at the moment of the study. Some of the widely witnessed criticism is the continuous suggestion for proper genetics studies of the observed participants. For instance, in a research carried out in New Zealand, individual who used cannabis and had “A variant allele of the COMT gene,” were noted to be in 10 times risk of developing psychotic symptoms, unlike in the case of persons who did not have “allele” but participated in the use of cannabis. The other issue was the increasing emphasis on stress as part of the negative impact of cannabis (Castle et al., 2011).
In contrast to the above findings, the “self-medication hypothesis” has been characterized as cases where individuals with psychotic disorders usually turn to the use of cannabis, thus relieving their undesired and distressing symptoms. Like in the other models, it has also been highly criticized by various scholars. For example, in the 25 years Christchurch longitudinal study, persons who were exposed to the use of cannabis at the age of 18 displayed severe psychotic symptoms, which were witnessed in 3 to 7 years later. Nonetheless, the same symptoms at the age of 18 were observed to oppose the use of cannabis rather than stimulating its consumption. With this in mind, it’s therefore conclusive to state that “the path of causality is from cannabis use to psychotic symptoms” (Ortiz-Medina et al., 2018).
Although there is no comprehensive study review on the neurobiological processes involved in the relationship between the use of cannabis and psychosis development, there are still various theories and models that have been developed to untangle these phenomena. When cannabis is ingested through smoking, vaping, or eating edibles, it produces super physiologic effects that, in turn, attacks the targeted receptors widely known as “endocannabinoid” and thus seizing the normal functioning of the system (Murray et al., 2016). At this point, it’s essential to note that the endocannabinoid system has a vital role in the neurological development processes and maintenance of expression throughout the life of any individual. Through the continuous use of cannabis, brain development can be enormously affected by the various released neurotoxins. The extension of these damages can comprise the alteration of gene expression of neural development, neurochemical communication, and a severe effect on the brain tissues. By the damage or impairment of synaptic plasticity, there is a high chance that cannabis has already made the respective individual susceptible to psychosis (Pierre, 2011).
Following some of the recent studies, the individuals who use cannabis and by chance carry a particular variant of the “AKT1 gene”, are considered to be at most risk of attaining psychosis. The AKT1 is characterized as an enzyme that produces dopamine, which is later used to activate striatum through stimulation. According to the research findings, persons with occasional use of cannabis and who also had this variant were at risk of developing psychosis seven times higher than those who did not use it (Castle et al., 2011). On another study, the same above concept was identified on individuals who used cannabis and possessed a precise “variant of the gene for Catechol-O-methyl transferase (COMT).” This enzyme is widely known for corrupting neurotransmitters such as norepinephrine and dopamine (Evins et al., 2012).
Also, research has identified that THC is widely known to affect parts of the brain that are accountable for hallucinations and psychosis. THC usually commands the excessive production of glucose in the left temporal area, which is linked to the primary psychosis dysfunction. The results of this effect commonly turn to a catastrophic turn of events, especially for persons prone to mental health conditions. On the other hand, studies have shown that in the past decade, the THC level component has significantly risen by over two-folds (Pierre, 2011). One research was carried out to explore the credibility of this thesis; it was discovered that 78% of patients who used high-potency cannabis were more vulnerable to first-episode psychosis than the 38% patients who were in the control group (Ortiz-Medina et al., 2018). By this, we can note that the use of cannabis has significant potential harm among individuals, especially those who possess some of the discussed variants. It has also been observed that cannabis can also affect psychotic patients whose health outcomes can be significantly affected.
Analysis and Recommendations
Throughout the review of this paper, one of the considerable gaps that I have noted includes the issue of sex and gender equity in research (SAGER). The majority of the researchers have focused their studies on male persons and largely exempt a critical evaluation of the association between the use of cannabis and the development of psychosis or schizophrenia in women. The inclusion of females in some of these studies will not only expound our understanding, but it will also allow us to have a more knowledgeable insight into men. The aspect of cultural diversification has been highly ignored where the majority of studies have occurred in western countries, discerning the fact that cannabis is used all around the world. Through the limited etiological focus, there is no guarantee of the credibility of most of the notable findings (Vadhan et al., 2017). It is, therefore, significantly essential to cover all the cultural aspects of life since they have a significant contribution to most of our physiological and psychological behaviors.
With the increasing doubts in the fundamental link between cannabis and psychosis, there should be a proper evaluation of the possible benefits and costs of various guidelines actions. Therefore, the enactment of this strategy should begin by educating young people on the dangers involved in the use of cannabis. To effectively capture most of the targeted groups, it’s essential to start by assessing how best to approach the subjects and notably asking them some of the most effective approaches they would like to observe (Evins et al., 2013). According to recent reviews in the US, it’s highly vital to educate young people about the risk of becoming dependent on cannabis. The enlightenment of this topic should also be included in the school curriculum, thus cutting off the increasing misconception and continuous negligence associated with very harmful repercussions at the individual and community level.
However, persons who are considered to be frequent cannabis users may tend to experience a lot of withdrawal symptoms after they stop using cannabis. Some of the symptoms that individuals usually exhibit during withdrawal include cravings, irritability, depression, anxiety, fatigue, and insomnia or hypersomnia. At this ‘quitting’ stage, individuals can have a very high chance of relapse if they are not well monitored. Through proper evaluation of the patient characteristic signs and symptoms, N-acetyl cysteine, oxytocin, Gabapentin, and nabilone, are some of the best pharmacological medications for withdrawal. Meanwhile, atomoxetine, mixed-action antidepressants, buspirone, selective serotonin antidepressants, and bupropion are one of the most effective medicines that can be used to treat cannabis dependence. In further review, it’s essential to understand that treatment for the person who has developed psychosis may be a bit different (Castle et al., 2011). The treatment should be carried out by targeting the underlying disorder while also addressing the dependence of cannabis itself.
Conclusion
Apart from the various uncertainties, the continuous use of cannabis can be characterized as one of the significant factors contributing to the increase of risk of psychosis or schizophrenia among individuals. This relationship can be explained through the approach of various models which include: Acute intoxication leading to ‘psychotic-like’ experiences, the hypothesis of self-medication for symptoms of psychiatric diseases such as the negative symptoms of schizophrenia, anxiety, depression, or dysphoria. The vulnerability hypothesis shared genetic factors and common sociodemographic factors.
Following some of the approaches like self-medication, it can be noted that there are high chances of finally establishing the “cause-effect relationship” (Pierre, 2011). One of the most profound methods that can be applied as a reliable gauge in assessing the risk of developing psychosis is the use of dose and frequency of cannabis consumption. It should be noted that some persons are expected to appear sensitive to the exposure of limited cannabis. There is no conclusive reason for this reaction as to whether it caused by other factors like genetics or the increasing potency of cannabis (Evins et al., 2012).
On the other hand, there is a significant need for reviewing some of the research policies that will enable studies to be carefully approached through a balanced blend of inquiry. Before beginning any of these studies, researchers must have a proper evaluation of all the conflicting interests, including the issue of sex and gender in research and cultural diversification initiatives (Vadhan et al., 2017). The other aspect that should be diligently evaluated by both the state and the federal government is the lack of required research effort in the study of cannabis exposure concerning public health. It’s due to this reason that there is still no conclusive research finding that explains the increasing uncertainties. As most US states continue to indulge in the use of cannabis as a recreational drug, there should be measures to educate the public and especially young people about the harmful effects of the use of cannabis (Hanna et al., 2017).
References
Castle, D., Murray, R. M., & D’Souza, D. C. (Eds.). (2011). Marijuana and madness. Cambridge University Press.
Evins, A. E., Green, A. I., Kane, J. M., & Murray, R. M. (2012). The effect of marijuana uses on the risk of schizophrenia. J Clin Psychiatry, 73(11), 1463-1468.
Evins, A. E., Green, A. I., Kane, J. M., & Murray, R. M. (2013). Does using marijuana increases the risk of developing schizophrenia? J Clin Psychiatry, 74(4), e08.
Hanna, R. C., Perez, J. M., & Ghose, S. (2017). Cannabis and development of dual diagnoses: a literature review. The American journal of drug and alcohol abuse, 43(4), 442-455.
Murray, R. M., Quigley, H., Quattrone, D., Englund, A., & Di Forti, M. (2016). Traditional marijuana, high‐potency cannabis, and synthetic cannabinoids: increasing risk for psychosis. World Psychiatry, 15(3), 195-204.
Ortiz-Medina, M. B., Perea, M., Torales, J., Ventriglio, A., Vitrani, G., Aguilar, L., & Roncero, C. (2018). Cannabis consumption and psychosis or schizophrenia development. International Journal of Social Psychiatry, 64(7), 690-704.
Pierre, J. M. (2011). Cannabis, synthetic cannabinoids, and psychosis risk: What the evidence says. Current Psychiatry, 10(9), 49-58.
Vadhan, N. P., Corcoran, C. M., Bedi, G., Keilp, J. G., & Haney, M. (2017). Acute effects of smoked marijuana in marijuana smokers at clinical high-risk for psychosis: A preliminary study. Psychiatry Research, 257, 372-374.