Scale in relation to changes in marijuana use at 3 and 6 months after the baseline assessment. The purpose of the study was to examine reduction in marijuana use and its impact on depression symptoms. After controlling for alcohol, investigators found a significant relationship between reductions in marijuana use and reductions in depression symptoms among young women who reported at least some mild depression symptoms (Moitra et al., 2016). Recently, the European Mania in Bipolar Longitudinal Evaluation of Medication study analyzed a sample of 1,922 adults who had experienced a manic/mixed episode of bipolar disorder. Participants’ data were organized into three groups: current use of marijuana (between 12-week and 24-month visits), no Schizophrenia and other psychoses One of the primary concerns cited in the controversy over decriminalization and legalization of marijuana is its causal relationship with psychosis. Debate is ongoing concerning whether ingesting or smoking marijuana increases the risk for psychosis or, conversely, whether marijuana use contributes to the alleviation of symptoms associated with schizophrenia. Marijuana, while not seeming to cause any basic structural changes in the brain, does appear to make changes in areas of the brain responsible for memory and emotion. Whether these changes are transitory or permanent and whether they contribute to the pathophysiology of schizophrenia are unknown. Many studies now show a robust and consistent association between marijuana consumption and the development of psychosis, but this may not be the case for schizophrenia specifically. Two primary kinds of data inform this issue: studies done with people with schizophrenia and studies of first-episode psychosis. Evidence suggests that the use of marijuana does not in itself cause a psychotic disorder. Rather, the evidence suggests that both early and heavy use of marijuana are more likely in individuals with a vulnerability to psychosis (Ksir & Hart, 2016). Longitudinal studies show a consistent association between adolescent initiation of marijuana use, in a dose-dependent fashion, and the emergence of psychotic symptoms and their severity, along with functional impairment and worse outcomes (Bagot et al., 2015). A study of 64 participants who were followed for five years demonstrated that continued marijuana use with subclinical depression symptoms is associated with poorer clinical outcome, and may be a predictor of negative outcomes in persons experiencing their first episode of psychosis (González-Ortega et al., 2015). Another study found a dose-dependent association between change in marijuana use (from intermittent to continual use) and relapse of psychosis that Multiple sclerosis and spasticity Data from more than 40 clinical trials of marijuana and cannabinoids have been published. Beyond the two indications for which dronabinol and nabilone are already approved by the FDA, the strongest evidence exists for the use of marijuana and cannabinoids as phytotherapies for chronic pain, neuropathic pain, and spasticity associated with multiple sclerosis. In 2014, the American Academy of Neurology published evidence- based guidelines that recommended an oral marijuana extract containing both THC and CBD (not yet available in the United States as an FDA-approved medication) as having the highest level of empirical support as a treatment for spasticity and pain associated with multiple sclerosis. Synthetic oral THC Cancer and pain management Cannabinoids have known antineoplastic and antitumor effects (Ramer & Hinz, 2008, as cited in Kendall & Alexander, 2017; Velasco et al., 2016; Yasmin-Karim et al., 2018). Beyond this hopeful and promising fact, marijuana use is not a new subject for healthcare professionals who care for people being treated for cancer and the discomfort related to the disease and
current but previous use (during the first 12 weeks), and never use marijuana. The study found that people with bipolar disorder who stopped using marijuana during their manic/mixed episode had clinical and functional outcomes similar to those who had never used marijuana. People who continued to use marijuana had a higher risk of recurrence and poorer functioning, such as work impairment and not living with a partner. Investigators surmised that the clinical implications of the findings were that a holistic management plan for bipolar patients should include psychoeducation and other treatments or interventions that focus on stopping use of marijuana, alcohol, and other drugs, as well as on improving adherence and preventing relapses (Zorrilla et al., 2015). is not thought to be the result of self-medication or genetic or environmental variables (Schoeler et al., 2016). According to a Cochrane review (McLoughlin et al., 2014), the evidence from research is unclear concerning a possible relationship between marijuana and schizophrenia. For some people with schizophrenia, positive symptoms (e.g., hallucinations, delusions, thought disorders) are worse when they use marijuana. “For many, however, using marijuana seems only to have the expected mild soporific effects that probably compound negative symptoms” (McLoughlin et al., 2014, p. 41) such as blunted affect, anhedonia, and asociality. Upon reinspection with lead investigators of the studies covered in the Cochrane review on marijuana and schizophrenia, researchers concluded that there was as yet no evidence to demonstrate that one type of adjunct psychological therapy or one type of drug therapy was more effective than another and that there was also insufficient evidence to show that CBD had an antipsychotic effect (Pushpa-Rajah et al., 2015). Alcohol use is known to confound data in studies on psychosis risk related to marijuana use (Auther et al., 2015), as could any other substances, such as stimulants. Research also differentiates the amount of marijuana use in self-care as a factor in research outcomes. For example, “heavy” marijuana consumption (defined as smoking more than three marijuana cigarettes per day) seems to impair verbal memory in first-psychotic-episode patients. Heavy users also perform worse than medium users in other neurocognitive tasks. Medium users (one to three “joints,” or marijuana cigarettes, per day) did not show any greater risk than nonusers. Based on these results, investigators inferred the existence of a dose-related effect of marijuana consumption (Núñez et al., 2016). More recently, a review and meta-analysis conducted by Vaucher and colleagues (2018) led to the conclusion that use of cannabis was likely to increase the risk of schizophrenia. and Sativex© (THC and CBD) oromucosal spray followed with “effective” ratings (Yadav et al., 2014). One systematic review of the literature suggests a clear role for marijuana preparations in symptom management of movement disorders that are known to worsen in people who are anxious. The review found that marijuana in various formulations is effective in reducing symptoms, especially hyperkinetic symptoms, or the anxiety that aggravates symptoms in some conditions (Koppel, 2015). An Italian multicenter study found that patients treated with Sativex responded even better when physiotherapy for their spasticity was added to the regimen (Grimaldi et al., 2019). treatments. Nor is it new to those who care for people being treated for chronic and intractable non-cancer pain. According to Donald Abrams (2016, p. 404), who has been an oncologist for four decades and has advised patients about the use of marijuana for some time, “We recommend a self-titrated dosing regimen for the patient as the safest option, rather than attempting to prescribe an actual dose.” Dr. Abrams expresses
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