Cannabis, Mental Health and Context: The Case For Regulation
by Paul Armentano

Armed with sound-bites reminiscent of the 1936 propaganda film "Reefer Madness," the US government recently kicked off yet another smear campaign on the supposed dangers of marijuana. The Feds' latest charge: Pot causes mental illness.

"A growing body of evidence now demonstrates that smoking marijuana can increase the risk of serious mental health problems," US Drug Czar John Walters announced at a press conference1 hyping the White House's latest anti-pot campaign. "New research being conducted here and abroad illustrates that marijuana use, particularly during teen years, can lead to depression, thoughts of suicide, and schizophrenia."

Predictably, those looking for the science behind the White House's alarm would be hard pressed to find any. Absent from their campaign was any mention of a recent clinical study published in the April 2005 issue of the journal Psychiatry Research refuting a causal link between cannabis use and behavior suggestive of schizophrenia. "The current study ... suggest[s] a temporal precedence of schizotypal traits before cannabis use in most cases," its authors concluded. "These findings do not support a causal link between cannabis use and schizotypal traits."2

Survey data published in the journal Addictive Behavior also puts a damper on the White House's "pot leads to depression" claims. After analyzing survey results from 4,400 adults who had completed The Center for Epidemiologic Studies Depression scale (a numerical, self-report scale designed to assess symptoms of depression in the general population), researchers at the University of Southern California found: "Despite comparable ranges of scores on all depression subscales, those who used once per week or less had less depressed mood, more positive affect, and fewer somatic (physical) complaints than non-users. ... Daily users [also] reported less depressed mood and more positive affect than non-users." 3

Lastly, there are the results of a recent meta-analysis published in the journal Current Opinion in Pharmacology. The study's verdict? Those who use cannabis in moderation, even long-term "will not suffer any lasting physical or mental harm. ... Overall, by comparison with other drugs used mainly for 'recreational' purposes, cannabis could be rated to be a relatively safe drug."4

Cannabis In Context

The phrase "relatively safe" is appropriate in any discussion regarding cannabis and mental health. No substance is harmless and in many cases, the relative dangers of a drug may be increased or decreased depending on set and setting. Cannabis is no different.

To date, there is a limited body of data noting an association – albeit a minor one5 -- between early use of cannabis and increased symptoms of depression, psychotic symptoms, and/or schizophrenia based on a handful of longitudinal studies.6 However, interpretation of this data is troublesome and much of it is not well understood.7 Identified as well as unidentified confounding factors (such as poverty, family history, polydrug use, etc.) make it difficult, if not impossible, for researchers to adequately determine whether any cause-and-effect relationship exists between cannabis use and mental illness. Also, many experts point out that much of this association may be due to patients' self-medicating with cannabis, as survey data and anecdotal reports of individuals finding therapeutic relief from both clinical depression and schizotypal behavior are common within medical lore, and clinical testing on the use of cannabinoids to treat certain symptoms of mental illness has been recommended.8

Nevertheless, until this association is better understood, there may be some merit in the government's caution that adolescents (particularly pre and early teens) and/or adults with pre-existing symptoms of mental illness refrain from using marijuana (and/or other psychoactive substances), particularly in large quantities. This statement, however, is hardly an indictment of marijuana's relative safety when used in moderation by adults or an endorsement of the federal government's efforts to criminally prohibit its use for all Americans. If anything, just the opposite is true.

Health Risks Call For Regulation, Not Prohibition

Health risks connected with drug use -- when scientifically documented -- should not be seen as legitimate reasons for criminal prohibition, but instead, as reasons for legal regulation. Specific to cannabis, if, as the Drug Czar alleges, studies demonstrate that those "who first used marijuana before age 12 [are] twice as likely as adults who first used marijuana at age 18 or older to be classified as having serious mental illness,"9 then this is an argument in favor of legally regulating cannabis in a manner similar to alcohol, so that better safeguards may be enacted restricting adolescents from legal access to it.10 Walters' concerns, however, do not support criminally prohibiting the responsible use of the cannabis by adults any more than fears regarding the abuse of alcohol by a minority of teenagers support a blanket prohibition on the use of beer by adults.

In addition, if, as the Drug Czar questionably suggests, "as many as one in four people may have a genetic profile that makes marijuana five times more likely to trigger psychotic disorders,"11 this claim is yet another argument in favor of regulation. If there does exist a minority population of citizens who may be genetically prone to potential harms from cannabis (such as, possibly, those predisposed to schizophrenia), then a regulated system would best identify and educate this sub-population to pot's potential risks, so that they may refrain from its use, if they so choose.

To draw a real world comparison, millions of Americans safely use ibuprofen as an effective pain reliever. However, among a minority of the population who suffer from liver and kidney problems, ibuprofen presents a legitimate and substantial health risk. However, this fact no more calls for the criminalization of ibuprofen among adults than do the Drug Czar's half-baked claims, even if true, call for the current prohibition of cannabis.

Finally, there lies the fact that cannabis prohibition has forever undermined the federal government's ability to educate its citizens, particularly young people, to the potential risks of marijuana when and where they present themselves. Ending prohibition and enacting a legal, regulated cannabis market would likely restore this lost credibility, as evidenced by the fact that science-based, federal education campaigns regarding the health risks of tobacco and drunk driving have greatly reduced smoking and driving under the influence among teenagers, while similar, rhetorically-based campaigns regarding teen pot use have been largely met by their target audience with groans and snickers.

As concluded by the Netherlands Drug Policy Foundation some years ago, cannabis' "health risks are remarkably limited, but cannabis is not completely harmless." As a result, the Foundation determined: "There ought to be a special legal regulatory system for cannabis because its use definitely does entail health risks. If cannabis was completely harmless, the same rules could be applied as to tea. Cannabis should not be made freely available, but the rules on cannabis can be very general and lenient." Placed in this context, the administration's latest anti-pot campaign does little to advance the government's position in favor of tightening prohibition, and provides ample ammunition to wage for its repeal.

Endnotes>

Comments
From: ?? (02/09/06 10:43:41)

i do pot and i'm just fine!!! it helps me with my depressed ways!!! i'm sick of everyone saying its bad for you... and ohh its that gateway drug... f*** that, you have a choice .... drugs can't change you... you change you!!!!!!!!!!!!....
---------------------------------------
From: Jerry (02/09/06 08:18:33)

It is amazing that this debate over marijuana is still going on in the US. I've been smoking pot on and off most of my adult life (30 years) and I can attest that it is Much less additive than either alcohol or tobacco! I consider myself a responsible, tax paying adult, who is a contributing member of society, yet, I can't enjoy pot without fear of our government.
---------------------------------------
From: cornball (02/09/06 06:54:28)

marijuana basically kept me from committing suicide. i used to suffer from depression and after i started smoking about 6 years ago i felt like a new person. i've quit since then (haven't smoked since october 2005, thats a long time for me!) but i am still an avid supporter of legalization and norml. one day we will win. i just hope that day comes soon. till then, in the words of Bob Marley "Get up stand up, stand up for your rights!"
-Cornelia from houston, tx
---------------------------------------
From: Jasper (02/09/06 02:00:40)

It seems to me that this ridiculous prohibition cannot last forever. I'm 22, soon enough it's going to be my generation who are making the decisions. Maybe it's because of where I'm from, I don't know, but certainly I don't seem to meet many people of my generation who think that marijuana is bad; even among people who don't smoke, it seems to be generally accepted. We just have to wait until these people in power now retire or die. Maybe this is too optimistic, but it sounds sensible.
---------------------------------------
From: anonymous (02/09/06 01:56:35)

quite to the contray, my husband is manic/depressive, and has run the gambit of prescription drugs to treat it, nothing worked without serious side effects, or actually making the DEPRESSION worse. the only thing that has helped regulate it is MARIJUANA! Without the sexual side effects, and general zombiesque feeling that other LEGAL drugs leave in their wake, marijuana leaves him able to function and contribute to society, with out any NEGATIVE side effects.
---------------------------------------
From: anonymous (02/09/06 01:29:48)

send a letter to your state reps for medical use of marijuana and they send you a letter stating there are better synthetic drugs with less side effects on the market. What is wrong with these people? Our gov. is creating a country of legal junkies all because they would not be able to tax marijuana. AND OF COURSE IT IS ALL ABOUT MONEY.
---------------------------------------
From: anonymous (02/09/06 01:18:55)

WHAT HAPPENED TO DEMOCRACY?
We need a study to determine how all of the pain meds. and anxiety meds. are affecting mental health.
I read a article stating the no.1 drug of choice for teenagers is prescription meds. because they are easy to obtain.
I have never heard of any one dying from marijuana but how many people have died from legal drugs and alcohol.
---------------------------------------
From: Skater (02/09/06 11:58:24)

I been smokin since 1966, as a Viet Nam Veteran, we had to cope and coping to me was smokin a joint... but when it came time to "throw down" I was there if you know what I mean. People who drank alchohol I wasn't too close to because when it came time to "throw down" you couldn't depend on them, their reaction time was way off.
---------------------------------------
From: PozSkydiver (02/09/06 10:56:21)

As an AIDS patient mj has done wonders to help me maintain weight and mood level when I am able to get mj. I have not smoked in 4 months and it shows. Yet, I have never gone psycho due to mj. In my opinion it is the Feds who have gone psycho. What are they smoking?
---------------------------------------
From: Olwen Moondancer (02/09/06 09:53:47)

Marijuana has many health benefits, but legalising it would render the pharma cartel obsolete. For many reasons, this issue being one, I thank Goddess that I live in Canada.
---------------------------------------
From: "springtime voodoo princess" (02/09/06 09:46:08)

The common misconception that marijuana users are uneducated and lazy isn't unreasonable - some of the comments here are offensive and embarrassing to those of us who are responsible activists trying to create a positive awareness about the benefits of adult recreational marijuana use.
---------------------------------------
From: anonymous (02/09/06 09:39:04)

Fight Meth not Marijuana
---------------------------------------
From: CME (02/09/06 08:50:32)

I am a student, an honors student, at a University of Louisville, I smoke regularly and do not have any problems because of it. It helps me to cope with day to day stressors, and just be a more relaxed, patient person. As a reader mentioned above, Cannabinoids are present in our bodies without smoking pot, we actually have a receptor specifically designed to match up with cannabinoids, so how can it be so bad if our body actually has a place for it. LEGALIZE IT!
---------------------------------------
From: Dr-AH (02/09/06 01:45:25)

If every member of congress, and all elected officials were required by law to smoke 2 joints a day, wouldn't we have a better run country?
---------------------------------------
From: A (02/09/06 01:35:28)

I was diagnosed 12 years ago as bipolar. I have taken almost every kind of antidepressant, mood stabilizer, etc.--from Aplraxolam to Xyprexa, and nearly a drug for every letter in between. Nothing helped me like MJ. Also, I am mildly anorexic; but I do not exhibit the symptoms as long as I smoke once in awhile. I am a recovering alcoholic; and, as such, can attest to the fact that one of the most legal, accessible drugs in this country is by far more dangerous to one's mental health than MJ!
---------------------------------------
From: hilltoptoker (02/08/06 11:47:07)

I appreciate the useful properties of cannabis. For 37 years it has been daily part of my life. Cannabis is a Universal gift that can be worn, eaten, vaporized, smoked, and accepted by the body and soul for healing. I have never felt suicidal or depressed but recently developed concern when my lawyer commented to me that he was sorry for his behavior as he was out of prozac. Our government needs a mandatory uninalysis to show where their heads are at. THANKS AND BLESSINGS TO ALL!
---------------------------------------
From: whhaOOOA (02/08/06 09:40:19)

hey man, i wake and bake like everyday w/ my friend and my grades are improving so......and i was like sick once and i smoked and got better.....it was pretty sweet
---------------------------------------
From: zombywoof (02/08/06 08:55:50)

thanks norml, but why so long to email me this info?
a letter to the editor of my local newspaper with the TRUTH is in the works tonight!
again many thank you's
---------------------------------------
From: Corey (02/08/06 08:53:16)

NORML NEEDS COMMERCIALS TO EDUCATE THE POPULATION ABOUT THIS MASSIVE PROBLEM, i have been smoking for well over a year, i recently moved, thus haven't smoked in over 2 weeks, and with no side effects from stopping. i belive there is no addictve properties to marijuana, i will keep smoking until i die, and i will keep promoting norml.org to everyone i know. p.s. cannabinoids are natrually found in the human body, thus proving some extra just makes you feel good
---------------------------------------
From: B Ebe (02/08/06 08:48:21)

I have HIV/AIDS and a bad back. And no pain killers out there help me cope with my life like a couple hits of some good green every 3 hours. And I don't here voices and never killed anyone. If anything I feel more energy to be able to cope with all the issues I live with!! It Makes my life that much easier to cope with.
---------------------------------------
From: AJS (02/08/06 02:43:30)

IM SICK AND TIRED OF THIS BS number 1, "bud creates paranoia" well yes that is true, because we gotta turn our freakin heads every five seconds looking for cops, who are paid to arrest us. its time for a change, when is this going to end? how is this even going on? is this situation we americans are going through even real? WHAT THE HELL IS WRONG WITH 'OUR' government? i thought this was a democracy, AREN'T the PEOPLE suppose to RULE? god help us all!!
---------------------------------------
From: ricky (02/08/06 10:16:43)

we will overcome.

to quote the blue oyster cult:
i'm burning for you
---------------------------------------
From: Stevie T. (02/08/06 02:46:30)

the only thing that causes people to go crazy over marijuana is all the constant pressure and paranoia that authorities put on marijuana users
---------------------------------------
From: bord butterfly (02/07/06 09:09:12)

Well I suppose that if you help do somthing about it like have people sign a petition it could help make it legal. then they would probably worry about wide use.
---------------------------------------
From: anonymous (02/07/06 08:48:10)

In my opinion, the government is outlawing marijuana because it cannot tax it. If marijuana was legal, it could be grown in your backyard. So, the government would have no way of regulating it. The government makes more money by employing police to regulate the drug. Go figure....
---------------------------------------
From: space monkey (02/07/06 07:01:57)

i have never known a depressed "pot-head". Most of my friends smoke all the time and they have no signs of depression, they don't seem dumber, most of them are some of the smartest people i've known
---------------------------------------
From: ender (02/07/06 06:31:48)

The sad thing is the white house doesn't need the science to back it up because the majority of american society today is either too stupid to ask questions or too brainwashed by the american stereotype. And as for it causing depression that's bs, it sure the hell makes me happy! I have seen no reason for "MARIJUANA" to be illegal other than the stupid stereotype behind it.
---------------------------------------
From: unknow (02/07/06 04:55:35)

what pissed me off is that other countries have weed to use with out being treated like killers
and everybody who lives in America are from these other countries. so what the f*** and don't give me bulls*** give me results.
---------------------------------------
From: anonymous (02/07/06 03:34:13)

HARD-WORKING INDIVIDUALS USED TO USE CANNABIS AFTER A LONG DAY OF WORK. WHAT FOR? TO EASE THE PAIN YOU DARN FOOLS!!
---------------------------------------
From: Frannie (02/07/06 09:42:29)

Very interesting paper. I'm glad NORML publishes info other than just legal information.

Thanks very much for all the work of NORML's chapters and members (my sister and I joined a few weeks ago and when I wore my NORML shirt out, a neighbor who has never said boo to me struck up a nice conversation).

-Frannie from Framingham, MA
---------------------------------------
From: dude (02/07/06 01:54:28)

wtf? marijuana use is like a mother f***n anti depressant, i just read it in high times magazine and no one that smokes it gets depressed, if anything it is helping them. Marijuana use is much more relaxed than alcohol, the government just wants to go through with it, it's all bulls*** to me. Plus I also read that with the increased use of marijuana, more brain cells may form.
---------------------------------------
From: anonymous (02/06/06 04:38:05)

I've had 3 back surgeries, drugs pushed at me by Dr's, like lori and oxy. These are AT LEAST HIGHLY ADDICTIVE. I must be mentally and physically functional! Surgeries have not helped. Cannabis has. Yet in my state you can't use it W/out serious reprisal. The real crimes are against this country, by our oppressive and often hypocritic Gov. allowing drug co.'s to push dangerous and addictive drugs. While prohibiting safe non-addicting alternatives.
---------------------------------------
From: CUZ-O (02/06/06 12:50:06)

OK THAT'S JUST STUPID. IF PEOPLE WANNA SMOKE WEED LET THEM..BECAUSE IT REALLY DOES CALM YOUR NERVES AND NO ONE EVER KILLED SOMEONE WHEN THEY WERE HIGH, OK. IT SHOULD BE LEGALIZED OR I'M MOVING TO AMSTERDAM!
---------------------------------------
From: chipper (02/06/06 12:08:31)

cannabis is keeping me alive-
it is helping me mentally and physically- my blood work is proof that cannabis is a healer in all forms of health- thank you
---------------------------------------
From: anonymous (02/06/06 10:09:00)

VOTE!!!!!!
---------------------------------------
From: AJ (02/06/06 09:49:18)

i just dont get it. every day hundreds of people die because of the misuse of alcohol or even prescribed government drugs. in the entire history of cannabis how many people has it killed? the answer 0. so whats the deal here? if alcohol kills people and drugs that the government gives to us kills people, and those are legal, but pot the safer alternative is illegal. how can we depend on a government who can't even follow simple logic like that?
---------------------------------------
From: anonymous (02/06/06 07:02:04)

Maybe the real reason pot prohibition hasn't ended is the alcohol lobby. I read that they are the biggest contributor to "anti-drug" organizations. Also, I feel that the medical marijuana movement has done little for recreational users. Here in Fla. it's a first-class misdemeanor to have more than 20 grams (up to a yr. in jail.) We could use decrim. first, then medical pot can take care of itself.
---------------------------------------
From: anonymous (02/05/06 11:59:20)

Pot and mainstream culture do not mix: pot is expansive, relaxing, reflective, unambitious. Mainstream culture is secure, air-tight, straight, problem-solving, upright, ambitious. But the wise and beautiful know which one to choose ; )
---------------------------------------
From: anonymous (02/05/06 01:48:06)

I use vaporized marijuana daily as an integral part of treatment for bipolar II disorder. The fed's sweeping generalizations and pseudoscience are extremely insulting to myself and the thousands of other bipolar patients who report substantial anxiety relief with proper, controlled doses of cannabis. Sometimes, the information that the feds EXCLUDE is the most revealing... many psychiatrists, including my own, "recommend" (formal prescription is illegal) marijuana for their patients.
---------------------------------------
From: Stickygreen (02/04/06 01:46:10)

What about the dangers of CRACK!!!
---------------------------------------
From: jen (02/04/06 12:18:06)

my ADHD does not affect me as much with the aid of marijuana (my concentration is much better). i would rather take something natural compared to synthetic government made chemicals.
---------------------------------------
From: JDZ (02/04/06 11:13:14)

Pharmaceutical companies could be strong lobbyists in favor of criminalizing pot. If anyone could grow pot in their back yard and partake, there would be many less pharmaceutical meds sold. Many regular pot smokers are considered "slackers" and the drug -- and its proponents -- have a tendency to help you see through the bulls*** of the corporate/military mindset of our current economic/political landscape.
---------------------------------------
From: anonymous (02/03/06 08:44:43)

I don't know why it's so hard for the gov. to tell the truth
---------------------------------------
From: Anonymous (02/03/06 01:03:11)

The only reason hemp is illegal is because the government doesn't wanna have to admit they were wrong. If it were legal they could say how much of what goes in it, tax the hell out of it, and take away the drug lord's business.
---------------------------------------
From: Brittany (02/03/06 09:51:37)

Marijuana use hasn't made anybody in my school depressed. so i have no idea what they're trying to prove. I think it's becoming more and more normal and common, and that the laws are going to be able to change, especially if they think of no better excuse than this.
---------------------------------------
From: Emily Joy (02/02/06 03:26:30)

The link between the two is simply a correlation, which means there is no way of telling cause and effect. Plus, the data may just be a coincidence, I mean, there's a correlation between ice cream intake and drowning for God's sake. Maybe we should ban ice cream.

I think the whole idea of schizophrenics and depression patients being more likely to go to marijuana is a good one. Cause and effect, my friends, none of these correlations can really prove the cause and effect.
---------------------------------------
From: Emily Joy (02/02/06 03:26:11)

Psychologists can never really prove whether or not marijuana does actually 'cause' schizophrenia. To do so, they would have to create an actual experiment, which, if it did create these alleged 'mental problems', would be unethical.
---------------------------------------
From: SL (02/01/06 08:18:32)

Tea is completely harmless? I'll wager I could harm myself with tea if I tried hard enough.....
---------------------------------------
From: Oh jeez (02/01/06 12:24:42)

the feds never fail to be moronic. keep spreading the truth not the lies!
---------------------------------------
From: KR (02/01/06 04:54:00)

Like B said, i too get an occassional bout of acid reflux, but that's if i'm smoking joints of lower quality stuff. On the other hand, i've never had the reflux problem with really good nugs smoked in a water pipe.
---------------------------------------
From: anonymous (02/01/06 12:49:51)

I really do not understand the government. They try too hard, marijuana has so many positive and yet they ignore that. I have been smoking since I was thirteen and I never come across anything bad. What is wrong with people?!!
---------------------------------------
From: dr marinowsky (02/01/06 12:43:29)

The cannabis plant constituents, the phytocannabinoids, are coming near the definition of nutrients.
Agonism at the receptor for cannabinoids number one, CB1, is neuroprotective. Presumably it would diminish the risk for suffering neurodegenerative diseases, such as cerebral tumors or Alzheimer (cerbral beta-amiloidosis).
---------------------------------------
From: Jeb (01/31/06 09:39:33)

This changes every thing! HA, HA, HA Sure it does.
"Marihuana is an evil, soul destroying drug that is rapidly corrupting the youth of America."
"Reefer Madness"
There are far worse drugs on the market that create worse psychological problems than marijuana. Legalization is all a control issue, if the US could figure out how to tax it appropriately it becomes legal. Speak out against the laws. You control the government. speak out, if you want any change.
---------------------------------------
From: matt huhta (01/31/06 02:54:49)

if that's the best they can come up with against marijuana then all out legalization isn't far off
---------------------------------------
From: B. (01/31/06 12:09:11)

I occasionally get acid reflux... there's nothing that I'm aware of that works as effectively at relieving the symptoms of acid reflux for me than a little vaporized cannabis.
---------------------------------------
From: Aly (01/30/06 10:53:48)

If I have only smoked bout 4 times, how does that affect my reaction time and perception (for distance)? Any good sites or info...?
---------------------------------------
From: anonymous (01/30/06 09:26:08)

Thanks for a balanced and science-based response to the latest fear mongering from Washington. As a social worker and parent of teenagers, your informed and sensible stand on the pot prohibition issue has long been welcome, even more so now that the doublespeaking neo-fascists have taken over the country.
---------------------------------------
From: anonymous (01/30/06 04:10:23)

cannabis is great for mental health maybe a possible cure for depression. Indians and Eygytians used it. why can't we? B.P
---------------------------------------