The cannabis paradox: A duality of historical remedy and contemporary psychiatric risk

“ It may be given in considerable doses with perfect safety and the best results. For patients in early life it seems to fill the [Pg 113] place occupied by cannabis indica in the medication of adults.
Insomnia in old age.—The highest physical perfection is reached before the fortieth year of life. Between this age and the forty-fifth year man’s vigor begins to decline. The power of accommodation diminishes, necessitating the use of spectacles; adipose tissues begin to load the body; the hair grows thin, and begins to bleach. The processes of nutrition and of disassimilation become more sluggish ”

“ Medicines to control restlessness and sleeplessness should be avoided if possible. Hydrate of chloral, opium, bromides, valerian, sometimes increase the difficulty, and the objections to their prolonged use are obvious, and yet they must sometimes be used for a time. The bromides, with cannabis indica, valerianate of zinc, camphor, and hyoscyamus, may serve an excellent purpose for a time. Opium and its preparations, where they agree, act like magic in producing mental calm and sleep. ”

“ The suppression of nervous irritability is the principal indication for treatment. This may be temporarily accomplished by the use of the bromides. But these must be reinforced by an ample dietary, with stimulant nervines and anti-spasmodics. Good wine, camphor, valerian, hyoscyamus, cannabis indica, and occasional doses of opium, will generally suffice to induce the needful repose. If confinement in bed precludes muscular movement for any length of time, passive exercise must be secured through the aid of massage. ”

“ From one-fourth to one-half of a grain of good extract of cannabis, repeated in two hours if it has not produced sleep, is an excellent remedy in migraine of the young. It is very important, in this disease, that the habit of long neuralgic paroxysms should not be set up; and if the first two or three attacks are promptly stopped, by the induction of sound, non-narcotic sleep, we may get time so to modify the constitution, by tonics and general regimen and diet, as to eradicate the neuralgic disposition, or at least reduce it to a minimum. ”

“ A nervous tonic may at the same time be a sedative to nervous irritability. I gradually increase the dose as the symptoms are wont to increase, during three or four days, and the drugs thus given seem to have a better effect.
If the nervous irritability is extreme, especially if there are hysterical symptoms or twitching of muscles, or spasm of the rectal or vesical sphincter, I add lobelia and stramonium, which, besides relieving these symptoms, are excellent in allaying the nausea and vomiting.
Cannabis indica is an excellent agent to cause tranquillity and destroy hallucinations. ”

“ Research focused on the relationship between cannabis and mental health is thus important especially considering that psychiatric illnesses are complex disorders with multiple factors contributing to vulnerability and eventual expression of the illness. ”

“ The emerging evidence strongly suggests that cannabis exposure during adolescence increases an adult’s individual vulnerability to drug addiction and schizophrenia and may also produce long-lasting effects on anxiety and mood disorders. ”

“ Based on the current evidence available from human and animal models, it is evident that cannabis use during adolescent development increases risk of psychiatric diseases such as drug addiction and schizoaffective disorders with genetic interactions. No convincing data exist to support one “common cause” that exclusively predicts which individuals using cannabis as teens will progress to addiction and psychiatric disorders later in life versus those who do not. ”

“ Caspi, A & Moffitt, TE (2002) , Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study, vol. 325, pp. 1212–3, 10.1136/bmj.325.7374.121212446537, pmid:12446537, DOI 10.1136/bmj.325.7374.1212 ↑ Casadio, P; Fernandes, C; Murray, RM & Di Forti, M (2011) , Cannabis use in young people: the risk for schizophrenia, vol. ”

“ Although a small fraction of teens that use cannabis develop schizoaffective disorders, a number of epidemiological studies repeatedly demonstrate elevated risk to develop these psychiatric disorders in association with early-life cannabis use. ”

“ Numerous human studies, including prospective longitudinal studies, demonstrate that early cannabis use is associated with major depressive disorder and drug addiction. A strong association between schizophrenia and cannabis use is also apparent, especially when considering genetic factors that interact with this environmental exposure. These human studies set a foundation for carefully controlled animal studies which demonstrate similar patterns following early cannabinoid exposure. ”

“ These effects usually last for 2 to 4 hours. However, the effects of cannabis on cognition might last much longer, ranging from 5 to 12 hours. Those who consume cannabis orally might not experience such significant symptoms as the bioavailability is significantly reduced. Individuals who have consumed high doses might be acutely confused, and they might have other clinical symptoms such as hypotension and hypothermia as well as psychiatric manifestations such as psychosis. ”

“ Motivation and cognition may be altered, making the acquisition of new information difficult. Marijuana can also produce paranoia and psychosis.
Because users often inhale the unfiltered smoke deeply and then hold it in their lungs as long as possible, marijuana is damaging to the lungs and pulmonary system. Marijuana smoke contains more cancer-causing agents than tobacco.
Long-term users of cannabis may develop psychological dependence and require more of the drug to get the same effect. The drug can become the center of their lives. ”

“ The most common method used to consume cannabis is via smoking the product, but it might also be consumed orally in various food products [5] .
2. Pharmacology of Cannabis Understanding the pharmacology of cannabis is essential as it helps to understand the side effects associated with cannabis and its proposed medical benefits. The main constituent that is responsible for the psychoactive properties is tetrahydrocannabinol [6] . In the central nervous system, there are 2 main subtypes of the cannabinoid receptors. These receptors are commonly known as cannabinoid-1 and cannabinoid-2 [7] . ”

“ Abstract Cannabis use is increasingly pervasive among adolescents today, even more common than cigarette smoking. The evolving policy surrounding the legalization of cannabis reaffirms the need to understand the relationship between cannabis exposure early in life and psychiatric illnesses. cannabis contains psychoactive components, notably Δ9-tetrahydrocannabinol (THC) , that interfere with the brain’s endogenous endocannabinoid system, which is critically involved in both pre- and post-natal neurodevelopment. ”

“ The psychoactive effects of cannabis, principally mediated by THC, occur via its interaction with the endocannabinoid system, which regulates numerous biological processes involved in development and neuroplasticity. ”

“ III of the National Longitudinal Study for Adolescent Health recapitulate this pattern of wide spread yet occasional use in adolescents. While the majority of teens have infrequent use, still a significant percentage, 6.6%, report daily use. Determining the long-term impact of occasional and heavy cannabis use during active periods of brain development, such as adolescence, is of critical importance. ”

“ Consequently, THC and related compounds could potentially usurp normal adolescent neurodevelopment, shifting the brain’s developmental trajectory toward a disease-vulnerable state, predisposing early cannabis users to motivational, affective, and psychotic disorders. ”

“ Were we able to procure a thoroughly reliable extract of hemp in this country, and did physicians use it as freely, as carelessly, and in as large doses, as they are using opium, morphine and chloral, hashisch takers would be more common.
Known in English-speaking countries as Indian Hemp or Cannabis Indica, it is called Hashisch by the Arabians, Gunjah and Churrus by the inhabitants of India, Bust or Sheera by the Egyptians, Dagga or Dacha by the Hottentots, El Mogen by the Moors. This is the solid extract. Bangue, Bang or Bendji is the spirituous extract. ”

“ In the former malady, for instance, the hypodermic injection of morphia always produces striking palliative, and very often curative effects. In alcoholic pains this remedy either affords only trifling relief, or more commonly aggravates the malady by increasing the general nervous excitement; and the only true treatment is at once to suspend all use of stimulants, to administer quinine, and to insist upon a copious nutrition. If any hypnotic must be employed, let it be chloral, or bromide of potassium with cannabis Indica. ”

“ The pure alkaloid, cannabin, has been recently introduced as a soporific, in doses of three-quarters of a grain to a grain and a half. According to Stillé and Maisch, the wakefulness caused by the itching of eczema may be relieved by the use of cannabis indica. The uneasy sleep attendant upon ungratified sexual appetite may also be relieved in the same way, since the drug is decidedly anti-aphrodisiac. ”

“ The temptation to use drugs is, like the fascination of being pitied and petted, very great, as alcohol, chloral, or opium often acts like magic for the time being, and there is generally a craving for one or all of them. But they are utterly demoralizing in the end. The habitual use of stimulants and narcotics in such cases only increases the evil. The fact must be recognized that the hysterical insane are often least responsible where they seem most so, and that they must be treated with unending patience, kindness, gentle firmness, and a wise ignoring of most of the symptoms. ”

“ Abstract Cannabis, also known as marijuana, has 9-tetrahydrocannabinol as the main constituent. There has been strict legislation governing the utilization of cannabis locally and worldwide. However, there has been an increasing push to make cannabis legalized, in view of its potential medical and therapeutic effects, for various medical disorders ranging from development disorders to cancer treatment, and being an adjunctive medication for various neurological conditions. ”

“ Hence, the CB1 receptor has a consequential mediating effect on memory, cognition, and movement [1] . Both the CB1 and CB2 receptors are coupled to inhibitory G protein complexes, which via activation would cause an inhibition of adenylate cyclase. This in turn results in a decreased concentration of cAMP in the cell. Thus, activation would in turn result in the inhibition of neurotransmission [6] .
Thus, when cannabis is consumed, the main ingredient which is tetrahydrocannabinol would bind to the CB1 receptors and this results in an activation of the G protein complexes. ”

“ Given the vulnerable nature of adolescent neurodevelopment and the persistent changes that follow early cannabis exposure, the experimental findings outlined should be carefully considered by policymakers. In order to fully address the growing issues of psychiatric illnesses and to ensure a healthy future, measures should be taken to reduce cannabis use among teens. ”

“ All forms of cannabis have negative physical and mental effects. Several regularly observed physical effects of cannabis are a substantial increase in the heart rate, bloodshot eyes, a dry mouth and throat, and increased appetite.
Use of cannabis may impair or reduce short-term memory and comprehension, alter sense of time, and reduce ability to perform tasks requiring concentration and coordination, such as driving a car. Research also shows that students do not retain knowledge when they are "high." ”

“ However, there are ethnic and genetic variants. It should be noted that individuals who are homozygous for the VAL/VAL alleles in the catechol-O-methyltransferase (COMT) genotype tend to be at enhanced risk. Those individuals who are homozygous for the MET/MET alleles in the COMT genotype tend to be not at enhanced risk. [1] In addition, the usage of cannabis has been linked with an earlier age of onset of psychosis [16] . Previous meta-analysis has reported that the average age of onset of psychosis for cannabis users was 2.70 years younger as compared to normal controls [16] . ”

“ Risks Associated with Usage of Cannabis 4.1. Psychiatric Manifestations Arising from the Usage of Cannabis There are various psychiatric manifestations that might arise from the usage of cannabis. Anxiety disorders have been reported to be associated with cannabis usage. A recent meta-analysis [8] that looked at 31 studies involving 112,000 individuals has found a positive association between anxiety disorder and cannabis usage. It is postulated that individuals with underlying anxiety disorders might have used cannabis as a form of self-medication to help them cope [9] . ”

“ Whilst there has been much research and evidence examining the association between cannabis usage and major mental disorders, a recent meta-analysis has found an association between cannabis use and personality traits [18] . It has been demonstrated that on-going cannabis usage is associated with much higher scores of global, positive, and disorganized schizotypal personality traits [18] . Of importance, current research has reported that cannabis usage is associated with an elevated risk of suicide in those with and without psychosis [19] . ”

“ Twin-studies, which control for potential confounds such as genetics and shared environmental influences, have also confirmed that early adolescent onset of cannabis use increases the likelihood of developing drug dependence later in life ( [22] ) . ”

“ Cannabis use is associated with progression to use other illicit substances in humans. Twin-studies illustrate that cannabis users have an increased risk of developing substance abuse disorder compared to their discordant twin. ”

“ Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. However, most of the excess risk appears to be mediated by substance abuse comorbidity. The risk in these patients with comorbidity is similar to that for substance abuse without psychosis. Public health strategies for violence reduction could consider focusing on the primary and secondary prevention of substance abuse. ”

“ A potential implication of this finding is that violence reduction strategies that focus on preventing substance abuse among both the general population and among people with psychoses might be more successful than strategies that solely target people with mental illnesses. However, the quality of the individual studies included in this meta-analysis limits the strength of its conclusions and more research into the association between schizophrenia, substance abuse, and violence would assist in clarifying how and if strategies for violence reduction are changed. ”

“ Our findings suggest that individuals with substance use disorders may be more dangerous than individuals with schizophrenia and other psychoses, and that the psychoses comorbid with substance abuse may confer no additional risk over and above the risk associated with the substance abuse. ”

“ The high prevalence of cannabis use among teens and the increasing number of states in the USA that legalize cannabis for both medicinal and recreational purposes are concerning given the surprisingly limited information known about the impact of cannabis on the developing brain and individual susceptibility. ”

“ According to a report released by the U.S. National Institutes of Health in August 2022, 43 percent of young Americans have smoked marijuana in a year, 8 percent have used hallucinogens, and 11 percent have smoked marijuana every day, the highest level in record. According to a study released by the Manhattan Institute for Policy Studies on August 4, 2022, the number of Americans dying from drugs and drug abuse has increased dramatically in recent years, by more than 100,000 per year. ”