Easily the coolest college professor you could ever hope to have.

Every Wednesday on NORML SHOW LIVE, Dr. Mitch Earleywine joins us to discuss the latest research in cannabis and to take live calls and chat questions from listeners on marijuana culture, history, medicine, and science.  He is a member of the NORML Advisory Board and his research has been published in over fifty scientific journals on drugs and addiction.  He is the author of Understanding Marijuana, Pot Politics, and Parents’ Guide to Marijuana, and a professor of psychology at SUNY Albany.  We asked Dr. Mitch his opinions of the latest meta-analysis on cannabis and schizophrenia.

Download audio file (Dr. Mitch Earleywine – Latest Cannabis Psychoses Bunk.mp3)

NORML SHOW LIVE: The headlines are out there – CNN, WebMD, NPR, every little bit of alphabet soup out there on the cable channels and the news – is trumpeting this headline, this study – Matthew Large, I believe, is the lead researcher on this – from Prince of Wales Hospital in New South Wales Australia says quote:

“It is increasingly clear that marijuana is a cause of schizophrenia and that schizophrenia caused by cannabis starts earlier than schizophrenia with other causes.”

DR. MITCH EARLEYWINE:  Alas, no.  There are no new data – I want to emphasize that – this is a meta-analysis, which means it takes the studies that were already out there and tries to combine them mathematically to make sense of it all.  What you’re not hearing in the media is that in fact, this is probably early-onset folks self-medicating.

You can imagine somebody who is experiencing some symptoms of psychosis, particularly folks with less access to medical care, or folks who are already a little bit paranoid because of the disorder and they’re unwilling to go to a physician.  They hear their friends are using cannabis and enjoying it.  They do it, too, they notice some mild improvements in their symptoms, they turn to it later when they have a psychotic break.   What a surprise, [the researchers] say, “they smoked cannabis first, that’s the big issue.”

What burns my ass is that this same journal a month before had another article failing to replicate this data where we find folks with a special genetic risk and if they’re heavily involved with cannabis early in life they’re more likely to develop schizophrenia.  So all this malarkey about, “oh, if you’re a genetic risk then you’re really gonna get it” isn’t showing up in other data sets.  The media isn’t covering that in the least.

The other finding in this big meta-analysis is that early onset of psychosis showed up for folks who were using drugs more generally – not just cannabis – and this makes much more sense pharmacologically.  When you think about cocaine, amphetamine, and other drugs that work directly in the dopamine system, that’s the system that schizophrenia is all about.  And what a surprise, these folks are more likely to have an early onset.

I’m concerned that the cannabis-related studies are really spurious and they’re compounded by  use of amphetamines, Ritalin, Adderall, all these other stimulant drugs that people were – particularly in Australia – unwilling to fess up to, but more than willing to say they used cannabis.  We’ve got a big problem here.

As we’ve seen time and again none of us want children to have access to cannabis. And the way to get that access limited is, of course, not an underground market that never cards anybody, but a taxed and regulated one, where folks that are too young to be experimenting with this and folks who have psychosis in the family can be markedly more advised and essentially educated before they even purchase the plant.

NSL: Matthew Large, this researcher here, even addressed what we just discussed about the self-medication; he said, quote:

“There is not so much evidence for the widely-held view those patients self-medicate with marijuana.  Marijuana smoking almost always comes before psychosis and few patients with psychosis start smoking marijuana for the first time.”

Is this a case then where they’re just defining psychosis as their starting point of looking at these people rather than the onset of symptoms that would pre-date or pre-sage the psychosis that’s about to come?

DR. MITCH: That’s it exactly, Russ, and as we’ve mentioned in the past what often happens is they find a big record of people who’ve had psychotic breaks and then go back and see if they’ve reported cannabis earlier.  But we have very poor assessments of these potential psychotic symptoms before these people used cannabis and the few studies that do do that, the measures are slightly biased against cannabis users.

I’ve pointed out in the past one of the big questionnaires for this – a schizotypal personality questionnaire – has an item that says “I use words in strange and unusual ways.” Well, sure, schizophrenics certainly do that.  They make words up; that’s part of the way that you manifest the diagnosis.  But we also have a whole subculture here where people are “kickin’ back with the chronic at 420.”  Well, what a surprise, people who do that may say “I use words in a strange and unusual ways.”  In my dataset when you drop that item out, suddenly the link between schizotypy and cannabis use disappears. I’m concerned there are comparable problems in these other datasets.

NSL: One of the things we’ve always said in these pieces with you and I talking about this is how worldwide the rates of schizophrenia and psychosis seemed to stay stable at about 1% of the population, even if that population starts smoking a whole lot of weed – if a lot of them start smoking or if they start smoking a lot of it – doesn’t matter is still stays the same.

But one of the hypotheses they have here is that, “Yeah, sure, there’s a certain 1% that are gonna get psychosis but these 1% are gonna get it earlier and then they’d have these extra two or three years of psychosis-free functioning that they would be losing out of because of their use of marijuana.”

My first thought on that is if this were the case, wouldn’t we see a lowering of the median age of psychosis onset when we have higher use of cannabis in a society?

DR. MITCH: In fact, Wayne Hall in Australia has made this same suggestion and they have yet to detect this change in the median age of first onset. But he’s suggesting that some new data are going to reveal that in the current younger cohort, this is the case.  I haven’t seen those data yet and I’m a little concerned.  In part we go to so much effort now to try to identify psychosis earlier that it seems like if that is the case, it may be simply that we are better at identifying psychotic disorders than we were 20 years ago, so we have this other potential confound.  And as Paul [Armentano] has emphasized time and again, we do have a subset of folks who really respond well to cannabis-based medicines in controlling psychotic episodes, and I think it may be a cannabidiol issue where Project CBD may be able to help us isolate who might be helped and who might not from this.

And then, of course, that fits that self-medication hypothesis better.  I feel like the critique of that self-medication that they offer in this meta-analysis is premature, in part because of how poorly we assess psychotic symptoms prior to anyone’s cannabis use.

NSL: What is the actual risk to people who have a history of mental illness or who feel they may have a certain mental illness and how they should entertain the notion of using cannabis to treat themselves?

DR. MITCH: In fact, cannabis is rarely my first choice for any of the more common mental illnesses. So we’ve talked before about depression, anxiety, and PTSD.  With depression, cannabis may help a subset of folks.  A number of my friends who’re in clinical practice say that the people who are using it are having more troubles in their practice.  But that may be a different subset.

But my first line of defense – it really sounds corny – but kind of a bibliotherapy.  Educate yourself about depression. If you have a mental health center that you appreciate, 12 weeks of good hard work, of taking a look at your own faults, how you behave during the day, the way you frame the events in your life; that can last a lifetime in the treatment of depression.  And then cannabis is just to enjoy, not something you have to lean on in order to make sure you have a happy day.

With anxiety, I’ve done this both on Facebook to some of our friends and repeatedly in emails and my published work.  Anxiety is one of the psychological disorders that psychology really has mastered. If folks again are willing to go see a therapist for a good couple of months and really put some effort in, you can literally tame this kind of thing and make it so anxiety is no longer debilitating, and then suddenly your cannabis again is just for fun.  The idea that cannabis is actually going to help anxiety is very dose-dependent, very strain-dependent, and not the most efficient way to get at this.

PTSD, I just got those new data on that.  A ton of people think that cannabis helps some of the symptoms of PTSD.  I completely believe them.  But compared to these exposure-based treatments – which I know are a drag – [cannabis] is not going to last a lifetime the way that that kind of treatment can, and then again cannabis is just for fun.  It doesn’t have to be for medication and you’re less likely to have these lingering symptoms of the emotional numbing, the distancing from your family, or these kind of freaking-out experiences when you’re in a big crowd.  And then, what a surprise, you basically worked hard for three months and kicked this disorder rather than felt like “I have to lean on cannabis for the rest of my life.”

A new article on MedPage today claims that we still don’t fully understand the health risks of cannabis use:

Overall, “the public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs,” Australian researchers reported in the Oct. 17 issue of The Lancet.

Wayne Hall, PhD, of the University of Queensland in Herston, Australia, and Louisa Degenhardt, PhD, of the University of New South Wales in Sydney, reviewed nearly 100 studies covering acute as well as chronic effects of marijuana, including reports of the prevalence of marijuana use around the world.

Globally, they wrote, about 3.9% of the world’s population used marijuana in 2006, according to United Nations statistics.

Well it opens nicely by noting that cannabis is safer and that almost 1 out of 25 people worldwide use cannabis. It gets a bit dicey from there:

They spent more time detailing the psychomotor impairments associated with the marijuana high. “Some experimental studies have shown diminished driving performance in response to emergency situations,” Hall and Degenhardt said, findings also corroborated in epidemiological studies.

For example, one study of car crash victims found that they were more likely to have tetrahydrocannabinol (THC), the main psychoactive component of marijuana, in their blood compared with age- and sex-matched controls.

Another study determined that motorists killed in wrecks were 2.5 times as likely to have been responsible for the accident when they had THC in their blood.

These are meaningless points when you recognize that:

1. Marijuana is the third-most used drug after alcohol and tobacco, so it is not surprising you’d find it in car crash victims;
2. Marijuana is detectable in the blood long after most other drugs, including alcohol, are not; and
3. Recent studies show that people can test positive for THC in the blood up to a week after ceasing their use of cannabis.

Few somatic effects of chronic use have been documented, Hall and Degenhardt found, except for several case-control studies suggesting promotion of lung cancer. Also, THC increases heart rate in a dose-dependent way, perhaps increasing risks for people with preexisting cardiovascular disease.

Yet when we look at populations of chronic cannabis users, we don’t find any link to lung cancer or heart attacks. In fact, we’re finding that cannabis may be a key to preventing and curing cancer!

Cognitive effects while high are, of course, well recognized, but their persistence is less clear, Hall and Degenhardt said. Some studies say cognitive impairment remains in chronic heavy users even after they quit, but others indicate that recovery of function is the rule.

I’d say we just find some old dudes who’ve smoked pot for fifty or more years and put them in a Jeopardy tournament with old dudes who’ve been drinking for fifty or more years and let’s settle this once and for all!

Similar uncertainty clouds the research on whether marijuana fosters use of other, arguably more dangerous, drugs such as cocaine and heroin, the researchers said. People who use marijuana are more likely to use other illicit drugs as well, but causality has been difficult to prove.

How about “impossible to prove”? The Institute of Medicine in 1999 and every other study since has concluded that there is no “gateway effect”. The only gateway in marijuana is to the dealer of illegal drugs. You know why they don’t call tequila a gateway drug? Because you can’t buy cocaine, heroin, or meth on the shelf next to it.

Marijuana use has also been linked to increased risk of psychiatric disorders including schizophrenia and, less consistently, depression.

Except that, worldwide and nationally, the rates of schizophrenia and psychosis remain virtually static even as cannabis use and potency rises and falls. A recent ten-year analysis of data from the UK found no increase in schizophrenia and psychosis even as rates of cannabis use exploded.

Overall, they concluded that marijuana is clearly associated with negative health and psychosocial consequences, but these are not as major as for some other drugs, and the causal relations remain unproven.

“The focus of epidemiological and clinical research should be on clarifying the causative role of cannabis for these adverse health effects,” the authors said.

Really? You looked and looked and found that lots of people use cannabis and you couldn’t prove that it did much harm to them, so the the focus going forward should be to prove that cannabis did harm them? How about accepting that as drugs go, cannabis is probably the safest one out there, the most beneficial to the most people and the least harmful to society?

They also cited a recent study estimating that marijuana accounted for about 0.2% of the total disease burden in Australia, a nation with one of the world’s highest rates of cannabis use. Its health impact was one-tenth that of alcohol and one-fortieth that of tobacco, the study found.

That makes for a nice sound bite: Cannabis – ten times less damaging to society than alcohol, forty times less damaging to society than tobacco, and yet still illegal.

State to allow farmers to grow hemp | NEWS.com.au
NEW laws will allow New South Wales farmers to grow cannabis crops for industrial use, the state government says.

But the hemp plants will not be varieties containing any significant amount of the active substance in illicit cannabis.

The Hemp Industry Bill will allow farmers to grow hemp (cannabis sativa) for use in skin care products, paint, load-bearing masonry, insulation and as an additive to wool, Primary Industries Minister Ian Macdonald said.

Such production is already permitted in Victoria, Tasmania, Queensland, the [Australian Capital Territory], Victoria and Western Australia.

The NSW Department of Primary Industries would work with farmers to make sure crops were only grown under a licence by applicants of good repute, Mr Macdonald said.

The licensing system would stop industrial hemp being used as a camouflage for the marijuana variety of hemp, which contains a high concentration of the illicit cannabis drug THC, he said.

The legislation would pave the way for a potentially lucrative industrial hemp industry, providing farmers with the additional option of another fast-growing summer crop, Mr Macdonald said.

Yet another sensible government allowing its people to grow non-drug cannabis.  Yet another place overseas for our American dollars to flow to fulfill the domestic demand for hemp products that our struggling family farmers aren’t allowed to grow.  And, interestingly, yet another scenario where ignorant politicians don’t realize you can’t use industrial hemp to camouflage consumer cannabis, because hemp will cross-pollinate the cannabis and ruin its potency, and cannabis will cross-pollinate hemp and ruin its fiber potential.