CANNABIS CULTURE – For a plant that has caused no deaths via overdose when used on its own, cannabis has certainly faced more than its unfair share of demonization.
Yet, it wasn’t until the 1940s that cannabis was taken out of all the medical and pharmacotherapy textbooks. Until relatively recently, cannabis was considered to have significant medical value by many people and cultures throughout the world. This started to change around the early 1900s, when cannabis started to become associated with brown-skinned laborers of Indian or Latin origin, black jazz musicians and anyone thought of as “non-conformist” (i.e. beatniks and hippies, although this was more in the post-WWII period).
In this time, there’s been a lot of myth-making surrounding cannabis. Many of these myths were and are based on propaganda rather than science, or over-extrapolate/jump to conclusions based upon a small grain of truth. We shall go over the most common ones, in no particular order of importance …
- “Cannabis causes cancer”
This is a very confusing issue for many people. How can something be both a treatment and a cause of cancer? One of the most common reasons cited is the smoking of cannabis. Whilst this makes sense intuitively – inhaling burning matter is not ideal, and there are many issues regarding how well grown the cannabis is (i.e. how many chemicals the plant had sprayed on it) – the evidence so far suggests that cannabis and tobacco smoke are not equally carcinogenic. However, in many countries, it is common to mix cannabis and tobacco, so the dangers of tobacco are not entirely mitigated.
Yet, interestingly enough, a study into the association between cannabis and tobacco smoking on the incidence of bladder cancer shows that cannabis use may be “inversely associated with bladder cancer”. This means that those who used cannabis only were less likely to get bladder cancer than those who didn’t smoke anything at all! Those who used both cannabis and tobacco had a slightly increased incidence of bladder cancer, whilst those who used tobacco only had a much higher rate of bladder cancer incidence. This may be because those who use tobacco only may smoke far more, whilst those who mixed cannabis and tobacco may use far less tobacco and may be more likely to not smoke everyday. Those who avoid tobacco altogether may also tend to live healthier lifestyles in other areas, such as diet and exercise.
Of course, just because cannabis may protect against some kinds of cancer, doesn’t mean that it may not be a factor in the development of other kinds of cancer. Surely smoking cannabis may cause or at least be a factor in the development of lung cancer? Well, there seems to be little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers. As for the cannabinoids themselves potentially causing cancer, we simply do not have enough data to say whether this is for certain, and there is a not-insignificant amount of evidence to suggest that cannabinoids may be used to treat certain cancers. Indeed, we have even talked to cancer biologist Dr. Michael-Masterman-Smith about this. To quote:
“We studied more than 30,000 compounds over the course of about 5 years. We reduced those 30,000 compounds to about 11 compounds that could be therapeutically active in cancer stem cells. About half of those compounds were cannabinoid receptor agonists – called CB1 and CB2 receptor agonists – that told us that cannabinoid compounds could be potentially effective in killing these deadly cells.”
Yet, we must also be careful with cannabinoid treatment for cancer. Treatment must match classification, meaning that the cannabinoid-terpenoid profile being used for treatment must be attuned to the specific type of cancer. Using the wrong type may cause certain types of tumors to grow, due to cannabinoids’ effect on hormones such as estrogen and progesterone. Overall, though, there does seem to be a significant amount of data on utilizing cannabinoids to beat cancer. Most of the dangers seem to be associated with smoking cannabis, where there may be other issues such as chronic obstructive pulmonary disease (COPD) and respiratory problems. Regarding cancer, to quote The National Academies of Sciences, Engineering & Medicine (NASEM):
“Regarding the link between marijuana and cancer, the committee found evidence that suggests smoking cannabis does not increase the risk for cancers often associated with tobacco use – such as lung and head and neck cancers. The committee also found limited evidence that cannabis use is associated with one sub-type of testicular cancer and insufficient evidence that cannabis use by a mother or father during pregnancy leads to a greater risk of cancers in the child.”
2. “Cannabis causes mental illness”
For those who have schizophrenia or whose families have a history of it, cannabis is best avoided. However, as not everyone has the same abnormalities in their genes (particularly chromosome 22q11), this is not a risk for everyone. As for anxiety, depression and bipolar disorder, we shall quote NASEM again:
“The evidence reviewed by the committee suggests that cannabis use is likely to increase the risk of developing schizophrenia, other psychoses, and social anxiety disorders, and to a lesser extent depression. Alternatively, in individuals with schizophrenia and other psychoses, a history of cannabis use may be linked to better performance on learning and memory tasks. Heavy cannabis users are more likely to report thoughts of suicide than non-users, and in individuals with bipolar disorder, near-daily cannabis users show increased symptoms of the disorder than non-users.”
The Royal College of Psychiatrists in the UK come to some similar conclusions about cannabis’ impact upon mental health.
Whilst the research by NASEM is a meta-analysis of 10,000 studies, there does seem to be a lot of debate over cannabis’ effect upon mental health. Yes, there could very well be some issues regarding cannabis and mental health, but cannabinoids may be used to treat depression, anxiety and bipolar disorder as well. CBD also has potential as an antipsychotic, and could prove useful for schizophrenia. So, what’s going on here?
One thing that could be going on here is that we’re getting the cart before the horse. Some people may be using cannabis because they’re depressed and/or anxious, and are using cannabis as a form of self-medication. As some studies control for this factor, I will posit two pertinent – and perhaps more interesting – factors that could be at play: age and dosage. The brain during childhood and adolescence may be more sensitive to cannabinoids, and therefore disrupt its natural development in some way. Cannabinoid dosing is also key, as microdosing small amounts of THC may have anxiolytic and antidepressant-like properties, whilst higher doses of THC may cause anxiety.
CB1 receptors seem to be key in the development of anxiety and depression, and learning how to modulate it may give us some novel new therapies. As for bipolar disorder, it may also depend upon at which stage of the cycle cannabinoids, as well as which type, are taken. Just as SSRIs may exacerbate rapid cycling, cannabinoids may have similar effects. However, some animal models and anecdotal reports suggest therapeutic potential for cannabinoids in bipolar disorder as well. To quote ‘Cannabinoids in bipolar affective disorder …’, which recounts some of Dr. Lester Grinspoon’s patient stories:
“The literature search revealed no systematic studies of the therapeutic use of cannabis or cannabinoids in BAD, although there are several anecdotal reports. Grinspoon and Bakalar (1998) described five cases in which cannabis appeared to alleviate mania. For example, one woman with BAD quoted in their report chose cannabis over alcohol to control her manic behaviour: ‘A few puffs of this herb and I can be calm … this drug seems harmless compared to other drugs I have tried, including tranquillisers and lithium’. A husband, describing his wife with BAD said: ‘My wife functions much better when she uses marijuana. When she is hypomanic, it relaxes her, helps her sleep, and slows her speech down. When she is depressed and would otherwise lie in bed all day, the marijuana makes her more active … Lithium is also effective, but it doesn’t always keep her in control’.”
Depression in particular is a very difficult thing to measure, as there are many causes and the symptoms are varied. Treating it can be very difficult, and we must always ask, “Why is this person feeling depressed?” Those who are depressed due to chronic pain may require a different mode of treatment from someone who is depressed because someone close to them died, or if they have a persistent neurotransmitter imbalance. The “treatment must match classification” applies as much to mental health as it does to cancer or any other condition. Remember: endocannabinoids play a fundamental role in homeostasis. This makes it very powerful, and just as with any other medication, there’s both promise and pitfall. To reiterate a common refrain, more research is needed. A plant as chemically diverse and with such a low lethal dose deserves it.
3. “Cannabis is addictive”
Whilst around 9% of people who use cannabis regularly can become “dependent”, the withdrawal is not dangerous, as it can be with alcohol and opioids. Consistent users may become more irritable, suffer from appetite loss, insomnia and “rebound dreams” when they stop using cannabis, and may in some instances feel abdominal pain, sweat more profusely, get the “chills”, headaches and even slight fevers. A particularly negative experience may also leave a person reeling, emotionally speaking. Most withdrawal symptoms begin within the first three days, and can last up to two weeks, with restlessness and difficulty in sleeping for up to 30 days after cessation. Whilst cannabis is not physically “addictive” in the traditional sense, it doesn’t mean that it doesn’t have its issues regarding mental dependency. This is why so many prefer to call cannabis addiction “cannabis use disorder” – it may identify problematic use, but not be an actual physical dependency.
Yet, many people who use cannabis regularly tend to stop using it without any major issues, and there are certainly many who used it throughout their college years and early 20s, only to stop using it when they get a job, start a family etc. Whilst many people do get some sort of withdrawal, for many it seems to be short-lived and more a minor inconvenience than something that requires medical supervision. Even regular users tend not to put themselves in too much danger in order to use or get a hold of cannabis, and many function quite well without it (and even with it). Also, the “cravings” associated with drugs such as cocaine and alcohol, which can begin even with casual use, are not usually as strong with cannabis.
Plus, there’s the fact that it’s almost impossible to have a deadly overdose on cannabis. How “addictive” cannabis is seems to depend very much upon each individual’s personal and mental “makeup”, as well as the reasons why they use it and how regularly. A person who uses cannabinoid-based medications regularly is not necessarily “addicted” to cannabis if they are using it as intended and to relieve their symptoms. And who knows – there may even be a genetic component to addiction, as well as environmental. Indeed, cannabis may even help people overcome addiction to other substances.
4. Cannabis can cure everything!
No, it cannot. Although the endocannabinoid system (ECS) is implicated in the development of many conditions (theoretically, anyway), this doesn’t mean cannabis is a panacea. Yes, it may be useful for helping treat many diseases, illnesses and injuries, whether palliatively or curatively, it doesn’t mean it’s for everyone. Some people may find it has a positive effect, some negative, and some neutral. This is the same with many medications. Learning who and for which conditions cannabis could be useful for, as well as at what dosage, will allow us to utilize this amazing herb more effectively.
5. “Cannabis kills brain cells”
Whilst there are some studies out there that suggest an association between cannabis use and differences in the volume and size of the brain, when controlling for other factors such as age, sex, alcohol use and other variables, “there is no association between marijuana use and standard volumetric or shape measurements of subcortical structures.” Even long-term and heavy use don’t seem to do too much damage when it comes to the amount of grey matter a person has, and it seems that none of the studies that show a reduction in brain size and/or volume have seen their results replicated. Instead, cannabinoids may even promote hippocampal neurogenesis in adults.
Whilst there are definitely some issues with cannabis, we should not throw the baby out with the bathwater. There’s still a lot of research that needs to be done, especially with regards to long-term effects as well as what health benefits and problems that can arise from occasional use. Also, there are many non-psychoactive cannabinoids, and some of these cannabinoids (as well as terpenes) may be used to “buffer” some of the negative effects of THC to some extent. Moreover, psychoactive amounts of THC needn’t always be used, so there may well be ways of mitigating some of the potential health issues surrounding cannabis by careful dosing. There’s a lot of research to be done before we can say anything for definite regarding the harms of cannabis.