Ignorance and mental health issues - Tod Mikuriya

[palmspringsbum]

Ignorance and mental health issues.

Tod Mikuriya
June 11, 2006

One of the most problematic areas of medicinal cannabis is the bias and denial regarding mental health issues. As a psychiatrist with an ear to the mental and emotional aspects of cannabis as a psychotherapeutic I am painfully aware of physicians from other disciplines that suffer from specific deafness as they listen to the patients describe their issues of anxiety or depression. There is an unconscious or rationalized process to connect with an anatomical or physical problem and ignore or feel uneasy about dealing with emotional or mental illness. In this area moralism and antipathy is expressed by disparaging characterizations of young and seemingly healthy patients getting access to cannabis.

Breaking the stereotype is Tom O'Connell, a thoracic surgeon with the power to listen, who has discovered through in-depth interviews, psychotherapeutic uses for a variety of disorders. Within the medical marijuana activists community, including physicians willing to risk sanctions, there is a strong and virulent disease of moralism and hubris. This morphs into the political realities of the "short list" states. Oregon, is the unfortunate example of what happens when mental disorders (with the exception of Alzheimer's rage reactions) are denied access.

Antipathy toward psychiatric conditions is firmly embedded in the consciousness of England and America. In 1873 and 1893 the British government in India was concerned about the allegation that insane asylums were populated by cannabis caused mental illness.

http://www.ccrmg.org/journal/03sum/preihdc.html

Exhaustive and extensive discussion resulted in the official finding that moderate used did not have adverse psychiatric effects. Notwithstanding, this myth has persisted. In 1956 Benabud et al. in the International Journal of the Addictions claimed that the Berrechid Mental Hospital near Casablanca, Morocco had significant numbers of cannabis users. This motivated my visit to that facility in 1966 that led to the conclusion that this was another ignorance-based study. The gross inadequacy of diagnostic capabilities and protocol precluded confirmation but added to the pile of bad science. This flawed work can be found on an internet search.

http://www.mikuriya.com/ce_berrechid.html

This urban legend continues to reappear in the context of political perturbation in England where one might come away with the impression that young Brits were more vulnerable to cannabis than their California counterparts. The fantasies of the institutionally anointed English paint a far more dire picture of cannabis abusing youth.

The psychiatric community maintains denial of the psychotherapeutic properties of cannabis. Contrary to 19th century medical literature citations that described significant psychotherapeutic applications and variable results in neurological and mental conditions, the contemporary consensus in psychiatric literature depicts cannabis use as dysfunction or pathologic. Jerry Mandel reviewed all entries in the psychiatric literature and found no therapeutic applications. The reefer madness consensus of forgetfulness continues today, defended by a policy of denial and censorship. Shortly after 911, I wrote a letter to the APA Journal describing cannabis therapy for the treatment of PTSD symptoms. Not published.

I recently terminated my membership in the American and California Societies of Addiction Medicine for their continuing refusal to acknowledge or discuss cannabis substitution for harm reduction treatment of alcohol and other drug dependencies. Notwithstanding my efforts over the years, they stonewall considering this method I have noted to be a clinically effective alternative. But they rigidly continued to refuse my entreaties over the past thiry years.

http://www.mikuriya.com/cw_alcsub.pdf

This amazing phenomenon of forgetfulness and ignoring historical medical intelligence significantly degrades and attenuates the quality of medicine and science.

Tod H. Mikuriya, M.D.

[palmspringsbum]

Weekend Edition
July 8 / 9, 2006

Why Judges Shouldn't Have Control Over Everything

Cannabis is a First-Line Treatment for Childhood Mental Disorders

CounterPunch
By Dr. TOD MIKURIYA

In 1996, California legalized cannabis as a treatment for "any... condition for which marijuana brings relief." Although the law does not constrain physicians from approving the use of cannabis by children and adolescents, the state medical board has investigated physicians for doing so, exerting a profoundly inhibiting effect.

Even doctors associated with the Society of Cannabis Clinicians have been reluctant to approve cannabis use by patients under 16 years of age, and have done so only in cases in which prescribable pharmaceuticals had been tried unsuccessfully. The case of Alex P. suggests that the practice of employing pharmaceutical drugs as first-line treatment exposes children gratuitously to harmful side effects.

Alex P., accompanied by his mother, first visited my office in February 2005 at age 15 years, 6 months. At that time he had been prescribed and was taking Fioricet with codeine (30 mg, 3x/day); Klonopin (1 mg, 2x/day); Ativan (1 mg, 2x/day); and Dilaudid "as needed" to treat migraine headaches (346.1), insomnia (307.42), and outbursts of aggression to which various diagnoses -including bipolar with schizophrenic tendencies- had been attached by doctors in the Kaiser Healthcare system.

Alex had previously been prescribed Ritalin, Prozac, Paxil, Maxalt, Immitrex, Depacote, Phenergan, Inderal, Thorazine, Amitriptaline, Buspar, Vicodin, Seroquel, Risperdal, Zyprexa, Clozaril, Norco, and Oxycodone.

A history taken from Alex and a separate interview with his mother, Barbara P., were in full accordance. The mother described Alex as a healthy baby who was "never a good sleeper." She had "a rocky relationship" with Alex's father, who had three children from a previous marriage. Alex, their second son, "always saw himself as the peacemaker when there was arguing... I think that's why, when it was time for him to go to school, he never wanted to go. He just didn't like to leave the house."

Although Alex showed facility communicating verbally, his reading and writing skills disappointed his teachers and prior to going to middle school he was evaluated for an Individual Educational Plan.

According to his mother, "They didn't say he was dyslexic, they said he 'had trouble processing things.' He wasn't acting wild in school. He was always well behaved. But they said he had ADD because he couldn't concentrate and process things." At age 11, Alex was prescribed Ritalin for attention deficit disorder.

In middle school Alex befriended some 13- and 14-year-olds, with whom he was caught stealing a car (and with whom he had shared his stimulant medication, and who introduced him to marijuana). Thus began a four-year sojourn through institutions of the Central Valley juvenile justice system and Kaiser-affiliated hospitals and clinics.

In this period, according to Barbara P., "They put him on all these medications and not only couldn't he sleep at night, but he started having rampages, hitting -mainly me. He fought with his brother and his dad, too. He beat up the truck. He couldn't remember afterwards what he actually did. He seemed like a completely different person. I don't think that's because of who he is. I think it was because of the medications he was taking." Barbara P. expresses remorse that she obeyed court orders to force Alex to take his prescribed medications.

At age 13 Alex made a serious attempt at suicide by hanging himself from a tree outside his house. He was rescued by his brother returning home unexpectedly. He reports making other attempts to overdose on pills.

Alex had known since age 11, when he first smoked cannabis with his older friends, that it had a calming effect. Many of his encounters with the juvenile justice system were for marijuana possession. His mother says, "He was aware that it helped him not feel stressed out and not have headaches. It helped him concentrate. It helped him sleep. All the things he needed. But I wasn't for smoking it." She reports feeling social pressure from her Central Valley community and pressure from her husband to oppose Alex's attempts to obtain and use marijuana.

"Alex went through three rehabs--two inpatient and one outpatient, all court-ordered, all for marijuana. He could not do inpatient and I told them that. It's not that Alex wanted to be out there doing drugs, he wanted to be home! He had a thing where he didn't want to be put in an institution where he didn't know anybody. That would drive him more crazy. He ended up running from one rehab house and getting kicked out of another."

Perceiving that Alex's mental state was worsening, and in response to his repeated requests to be allowed to smoke marijuana, Barbara did research on the internet that alerted her to similarities between cannabis and Marinol (dronabinol), a legally prescribable drug. Her request that a Kaiser physician prescribe Marinol for Alex was rejected.

Through the internet she identified the author as a specialist in cannabinoid therapeutics and arranged an appointment for Alex.

A prescription was written in February 2005 for Marinol (10 mg), along with a recommendation to use cannabis by means of a vaporizer. Alex has consistently maintained he prefers smoking cannabis to ingestion by other means, due to rapidity of onset and ability to titrate dosage. ("It works great and you can use just as much as you need," he says.)

When a drug test ordered by the Probation department turned up positive for cannabinoids, Alex had a hearing at which a Superior Court judge declared that because Marinol use could mask marijuana use, he would not allow it. He explicitly refused to recognize the validity of a specialist in the field of cannabis therapeutics and ordered Alex to take only drugs prescribed by Kaiser.

Barbara P. says: "I guess judges have authority over anything. He thought Alex had a drug problem with marijuana because he had smoked it before." At a subsequent hearing another judge rescinded the order. When Alex's Probation ended in May, 2005, he began medicating exclusively with smoked cannabis.

Dramatic improvement

Alex and Barbara P. were seen by the author at a follow-up visit in February 2006. Alex reported dramatically improved mood and functionality with only one migraine attack in the past year, not severe enough to require a trip to the hospital for a Dilaudid injection. He is in an independent study program at a small public school and getting straight As and Bs. "They love me at school," Alex asserts. His teacher is aware that he medicates with cannabis with a physician's approval. He smokes approximately one ounce per week and would use 50% more if it were cheaper to obtain. He does not vaporize because a vaporizer is "too expensive" (although he has taken up the guitar and purchased several models). He summarizes his status thus: "I use(d) to use a lot of medication like Klonopin and other pain medication but I haven't had to since the use of cannabis."

His mother reports: "We knew after about three months on Marinol that he was going to be okay. He started doing a lot better. He sleeps well, he's not on any of the other medications, I haven't had to take him to the emergency room for migraine since he first went on Marinol. He's been totally fine. He walks the dog, cleans up his room, does chores for the family. And I know that he's going to be okay. Before, I never knew what was going to happen. I couldn't picture him getting a job." Alex's father has relented in his disapproval of Alex's cannabis use, having seen its effects on the household.

The case of Alex P. is one of iatrogenic illness in which drug-oriented school counselors and administrators played a harmful role. In a previous era, psychologists would have put more emphasis on examining the family constellation. An adequate work-up would have identified Alex's insomnia as the likely cause of his poor scholastic performance. Failing an adequate work-up, the quasi-diagnosis "inability to process" led to a prescription of methylphenidate, a stimulant, for an 11-year-old with persistent insomnia. The resulting disinhibition led in turn to trouble with law enforcement, a cycle of extreme anxiety and distress, and the prescription of more drugs, irrationally chosen to counteract drug-induced symptoms.

As a result of the federal prohibition, there exist no official guidelines governing when and how cannabis should be used by patients suffering from a given condition. The Institute of Medicine Report of 1999 acknowledges the feasibility of cannabis being used to treat certain conditions when all pharmaceutical options have failed. The case of Alex P. suggests that employing pharmaceutical stimulants, antidepressants and anti-psychotics exposes children gratuitously to harmful side effects in violation of Hippocratic principles. The first-line treatment for any condition, efficacy being equal, would be the drug or procedure least likely to cause harm. Given the benign side-effect profile of cannabis, it should be the first-line of treatment in a wide range of childhood mental disorders, including persistent insomnia.

Physicians and parents both face stigma and take risks in authorizing cannabis use by children, but the risks are legal and social rather than medical. The case of Alex P. exemplifies this reality.

[palmspringsbum]

This article is an example of the yellow journalism attendant upon the debate in Great Britain over reclassification of cannabis.

<span class=postbold>See Also:</span> Cannabis Chronicles - The Reasons Behind Gordon Browns Marijuana Madness and subsequent articles in that thread.

Cannabis: hidden risks to mental health

March 19, 2008

(Media-Newswire.com) - Community Mental Health Teams ( CMHTs ) across East Sussex are working with a number of teenagers and young adults who’ve developed mental health problems as a result of smoking cannabis.

For some people using cannabis can cause unusual experiences, some of which doctors refer to as psychotic symptoms. These include hallucinations, strange ideas, confused thinking and acute mood swings. Although these effects tend to pass in a few hours, scientists believe that heavy use of cannabis, especially in teenagers and young adults, increases the risk of developing a continuing psychosis, like schizophrenia.

Oliver Beatson, member of the East Sussex Youth Cabinet explained,

“I think that using cannabis starts off as a social recreation. People try it for a new experience either unaware of the risks, or prepared to pay the consequences, thinking what’s the chance of it going wrong for me?

This risk is admittedly fairly low – but it rises considerably if stronger forms of cannabis, such as skunk, are used. In East Sussex, skunk has become the ‘cannabis of choice’ for many people, as opposed to less concentrated forms. There are many different strengths and variations, such as resin and herbal options, and it’s easy to under or overestimate their effects.

Councillor Bill Bentley, Lead Member for Adult Social Care, explains:<blockquote><i>“The chemical in cannabis which makes people feel ‘high’ or ‘stoned’ is called tetra-hydro-cannabinol ( THC ). Skunk has a much higher level of THC – and as a result is far more dangerous to your mental health. In young adults and teenagers, when the brain is still developing, the risk is that this class C drug will have serious long-term effects on your mental health, requiring medical treatment and possibly even admission to hospital. We need to get the message out there that for some young people heavy use of skunk can mess up your life.”</i></blockquote>It’s not always obvious when people are developing a psychosis. Some of the warning signs may be losing contact with friends, not wanting to go out or do anything, being suspicious of people, having panic attacks, saying strange things or getting distracted easily.

Nick Yeo, Chief Executive of East Sussex Downs & Weald and Hastings & Rother Primary Care Trusts, says:

“If you think you, your son or daughter, friend or partner may be developing mental health problems, it’s important to get help early on, to stop things becoming more serious. This means talking to your doctor for advice. Then, if a serious mental illness is diagnosed, your doctor will call in one of the community mental health teams – made up of nurses, social workers, psychiatrists, doctors, occupational therapists and psychologists. These professionals work with the patient to find the best route back to recovery.”

Families also play a strong role in recovery. With a family’s support behind them, a person is more likely to continue with their treatment. Nevertheless, before this happen, the family has to come to terms with the person’s illness.

Community Mental Health Teams understand this, and part of their role is to involve the family; to help them understand the situation and their role within it. In this way, they can offer vital support and stop the deterioration of family relationships which are so important to a person’s long-term recovery.

<span class=postbigbold>Notes to editors</span>

Cannabis is the most widely used illegal drug in Britain.

The use of super-strength 'skunk' cannabis has soared five-fold over the past six years, a Home Office study has found. The powerful strain of cannabis now accounts for 80 per cent of all street seizures of the drug by police.

A growing body of evidence suggests cannabis may be a causal factor in the development of psychosis. Zammit et al ( 2002 ) looked at 50,000 Swedish conscripts from 1970 to 1996. Teenage cannabis users doubled their chance of developing schizophrenia. Those who had used cannabis more than 50 times had 6 times the usual risk of developing schizophrenia. The authors estimated that 13% of schizophrenia could be averted if all cannabis use were prevented.

Further Dutch, German and New Zealand studies have all found a relationship between regular cannabis use and psychosis, with cannabis users doubling or tripling their risk of psychosis, even after controlling for confounding variables.

<span class=postbigbold>Dual diagnosis</span>

It is generally accepted that between 30–50% of people with a serious mental illness also have problems with substances.

There is a general consensus that cannabis use worsens psychotic symptoms among people with schizophrenia and people with bipolar affective disorder ( manic depression ) who experience psychotic symptoms.

<span class=postbigbold>Slang</span>

Street names for drugs vary around the country. Bhang, black, blast, blow, blunts, Bob Hope, bush, dope, draw, ganja, gear, grass, hash, hashish, hemp, herb, marijuana, pot, puff, Northern Lights, resin, sensi, sinsemilla, shit, skunk, smoke, soap, spliff, wacky backy, weed, zero. Some names are based on where it comes from… Afghan, homegrown, Moroccan etc.