Dr. Sachin Gandotra
DPM, MD (Psychiatry)
Consultant Psychiatrist, Mental Health Foundation
Cannabis remains one of the most commonly used illicit drugs, and its effects have traditionally been seen as less harmful than the outcomes with highly prevalent use of alcohol or other illicit drugs. Globally its use appears to be increasing with an estimated 162 million (4%) of the worlds' adults using it in 2004, a 10% increase on use in the mid 1990s (UNDOC, 2006). Most people begin cannabis use during early adolescence, and peak use usually occurs during late adolescence and young adulthood. It has been estimated that 1 in 11 cannabis users will become dependent.
Cannabis sativa, from which cannabis is derived, is one of the earliest cultivated plants and the first evidence of its use was in China for fibres in 4000 BC. It was here that its psychoactive use was also recognized. Subsequently in India, its use became prevalent for medicinal and recreational purposes as mentioned in a collection of sacred texts called Atharveda dating 1000 BC. Persians knew about the initial euphoric and later dysphoric effects of cannabis before the Christian era. Cannabis was introduced in western medicine around the 19th century by the works of William B O'Shaughnessy, an Irish physician, and by a French psychiatrist Jacques Joseph Mareau's book. In 1964, the chemical structure delta 9 tetrahydrocannibinol (THC) was identified and sparked series of researches in its use. The various forms of cannabis have varied concentrations of the active ingredient THC as, marijuana & Bhang (1-3%); Ganja, cultivated (6-20%); Hashish (Charas) (10-20%); and Hash oil (15-30%). Many synthetic preparations like Nabilone, synthetic THC, Levantradol are available and are much more potent.
The purpose of this writing is to sensitize the general masses about the effects of cannabis beyond the known recreational effects of euphoria, relaxation, intensification of sensory experiences and time distortion. Research over the years has focused on the association between cannabis use and occurrence of psychoses in such individuals and knowledge about this should bring about a consideration of where to draw a line. Cannabis consumption in first time users can lead to a condition called "toxic psychosis" characterized by disorientation, confusion, impaired attention, hallucinations, and paranoid symptoms lasting about a week. Evidence for this comes from studies by Talbot and Teague in 12 Vietnam soldiers, and subsequent studies in India in more than 200 patients who were observed to report such symptoms.
Cannabis use in higher quantities can precipitate "acute functional psychosis" characterized by frank delusions, hallucinations and emotional turmoil. This is evidenced by multiple single case studies and unsystematic series. Perhaps the bulk of research points to the link between cannabis use and schizophrenia. Multiple well designed studies with huge sample sizes and prospective in methodology point to some worth considering associations. Schizophrenia patients using cannabis have been seen to have an earlier age of onset of illness, more psychotic symptoms, worse prognosis because of poor treatment adherence, increased symptom severity and higher relapse rates. The relative risk of schizophrenia in cannabis users is 2.4 times more than in non users, and its use as an independent risk factor for psychosis is a finding in many studies.
Till date in literature, the overall hypotheses proposed are that common independent factors explain the co occurrence, cannabis causes psychosis that would not have occurred in the absence of cannabis use, cannabis precipitates psychosis in persons with genetic vulnerability to schizophrenia, cannabis initiates an early onset of already predetermined psychosis and worsens or prolongs its course, and individuals with psychosis proneness are more likely to become regular or problematic cannabis users than those without these traits. Certainly, there is also literature that refutes or is neutral in its findings, but what is important to understand is that cannabis use beyond moderation is likely to have serious mental health consequences. The moderation is a subjective concept and the associations mentioned above should serve as a rough guideline to judge the recreational use of cannabis versus pathological use versus no use at all.
Since less attention has been focused on developing and evaluating treatment interventions in this area, therefore programmes for adolescent substance abuse treatment in times to come require analysis to incorporate strategies like 12 steps, cognitive behaviour therapy, motivational enhancement, family interventions, gender and cultural competence and continuing care of our children.
