Today, we are going to look at 2 articles that crossed my path recently on the subject of cannabis. One examines the results of a new cannabis study, the other YET AGAIN rehashes the same old prohibition talking points that brought us to where we are in the first place. But this one has a slightly different flavour since it is out of the UK.
We will start with the cannabis study, which has been widely reported using a similar baity headline to mine. The following was published on a platform called Medical Xpress and written by someone at the American Heart Association.
Marijuana users’ risk of deadly complication doubles after rare type of bleeding stroke
Among people with an aneurysmal subarachnoid hemorrhage (aSAH) stroke, a type of bleeding stroke, recent marijuana users were more than twice as likely to develop a dangerous complication that can result in death or greater disability, according to new research published today in Stroke, a peer-reviewed journal of the American Stroke Association, a division of the American Heart Association.
The study is the largest to examine the impact of THC or Tetrahydrocannabinol, the psychoactive component (change of a person’s mental state) of marijuana on complications after an aneurysmal subarachnoid hemorrhage (a rare but severe form of stroke).
In an aneurysmal subarachnoid hemorrhage, a weakened and bulging part of a blood vessel bursts on the surface of the brain (called a ruptured aneurysm), resulting in bleeding in the space between the brain and the tissue that covers it. This type of stroke can be devastating, resulting in neurological disability in about 66% of people and death (during the follow up period) in about 40%. The immediate treatment of an aneurysmal subarachnoid hemorrhage focuses on stopping and preventing further bleeding. However, despite treatment, in the 14 days following an aneurysmal subarachnoid hemorrhage, many patients may develop worsening symptoms (such as speech problems or difficulty moving). This is caused by blood from the initial stroke irritating blood vessels, causing them to constrict enough to cut off the blood supply to a portion of the brain (called a vasospasm), resulting in more brain damage. This complication, called delayed cerebral ischemia, is a leading cause of death and disability after an aSAH stroke.
“We’re all vulnerable to a bleeding stroke or a ruptured aneurysm, however, if you’re a routine marijuana user, you may be predisposed to a worse outcome from a stroke after the rupture of that aneurysm,” said Michael T. Lawton, M.D., senior author of the study and president and CEO of Barrow Neurological Institute in Phoenix, Arizona.
There is no doubt about it, that is a scary finding on its face. But many conclusions can be scary without proper context.
Researchers analyzed data on more than 1,000 patients who had been treated for aneurysmal subarachnoid hemorrhage at Barrow Neurological Institute between January 1, 2007 to July 31, 2019. All patients had been treated to stop the bleeding either via 1) open surgery to clip off the base of the aneurysm, or, 2) noninvasively, by threading a slim tube through a blood vessel to the base of the aneurysm and releasing coils that fold to fill in the space and provide a barrier to further bleeding.
Urine toxicology screening was performed on all patients admitted with ruptured aneurysms. The study compared the occurrence of delayed cerebral ischemia in 46 people (average age of 47 years; 41% female) who tested positive for THC (the component of cannabis, also known as marijuana, that induces a high) and 968 people (average age 56 years, 71% female) who tested negative for THC. A positive urine screen for THC reflects cannabis exposure within three days for a single use to within approximately 30 days for frequent heavy use.
The recent cannabis users did not have significantly larger aneurysms or worse stroke symptoms when admitted to the hospital, and they were not more likely to have high blood pressure or other cardiovascular risk factors than patients who screened negative for THC. However, recent cannabis users were significantly more likely to have also tested positive for other substances, including cocaine, methamphetamines and tobacco, compared to the patients who screened negative for THC.
Among all participants, 36% developed delayed cerebral ischemia; 50% were left with moderate to severe disability; and 13.5% died.
After adjusting for several patient characteristics as well as recent exposure to other illicit substances, patients who tested positive for THC at last follow up were found to be:
- 2.7 times more likely to develop delayed cerebral ischemia;
- 2.8 times more likely to have long-term moderate to severe physical disability; and
- 2.2 times more likely to die.
And, there is our context. Along with the information that makes the headline of this article incredibly misleading. It would seem that this isn’t just a story about marijuana and THC, this is also a story about many illicit drugs. But I’m guessing that “Study Shows Risk Of Deadly Bleeding Stroke Complication Doubled In Illicit Drug Users” doesn’t have the same bite as using a term that is highly algorithmically favourable. As the new saying goes, if it clicks, it sticks.
“When people come in with ruptured aneurysms, and they have a history of cannabis use or are positive on a toxicology screen, it should raise a red flag to the treating team that they are at higher risk of vasospasm and ischemic complication,” Lawton said. “Of all the substances detected in the toxicology screen, only cannabis raised the risk of delayed cerebral ischemia. Cocaine and meth are hypertensive drugs, so they are likely related to the actual rupture but not expected to have an impact on vasospasm.”
The study does not specifically address how cannabis raises the risk of vasospasm and delayed cerebral ischemia. Lawton noted, “Cannabis may impair oxygen metabolization and energy production within cells. When stressed by a ruptured aneurysm, the cells are much more vulnerable to changes that affect the delivery of oxygen and the flow of blood to the brain.”
The study’s limitations include being conducted retrospectively at a single institution and not being a head-to-head analysis of people who use marijuana and those who don’t.
The researchers are currently conducting follow-up in the laboratory to better understand THC-related risks that may impact aneurysm formation and rupture. They also urge further research to study the impact of various doses of THC on stroke complications
Here, we finally learn the vector in which cannabis plays in this medical condition, at least allegedly. We also finally learn the limitations of the study, and the steps being taken in attempting to replicate the results in a scientific manner. Though I question how many people made it this far into the article before clicking off and potentially sharing it to everyone in their reach.
As is often the case, the author of the study urge caution when it comes to showcasing the results of their work. But care is futile in the face of creating attention-grabbing headlines.
“The current study is not at the level of science of a randomized controlled trial, but it is a rigorous statistical analysis involving more than 1,000 patients, so the results are important and add to what we already know about possible adverse effects of marijuana use,” said Robert L. Page II, Pharm.D., M.S.P.H., FAHA, chair of the writing group for the American Heart Association’s 2020 cannabis statement and professor in the department of clinical pharmacy and the department of physical medicine/rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, Colorado.
In conclusion, as with many things, more research has to be conducted to properly confirm this finding. When that happens, hopefully, the media will be just as eager to report that result as they were to run with this headline.
I won’t hold my breath.
* * *
In 2 words . . . oh boy.
Liberal parents who let their children smoke cannabis are warned that the drug is causing up to a THIRD of psychosis cases in London and strong ‘skunk’ can cause schizophrenia-like symptoms
- Sir Robin Murray has sounded the alarm over the use of highly-potent ‘skunk’
- Expert said drug is behind 30 per cent of his psychosis patients in south London
- King’s College London professor runs clinic dedicated to psychosis caused by cannabis
Highly-potent cannabis is not being taken seriously enough by some liberal-minded parents, who would rather see their teens smoke pot than drink alcohol, a top psychologist has warned.
Sir Robin Murray, 77, a professor of Psychiatric Research at the Institute of Psychiatry (IoP), King’s College London, said around a third of the psychosis patents he sees at his practice in south London are caused by use of high-strength skunk.
The expert said the cases mostly involve young people, who often suffer from debilitating paranoia and hallucinations.
Gotta love a population that is seemingly fine with a publication publicly shaming parents for making a parenting choice. And of course, this is aimed specifically at liberal parents.
Makes me wonder what would happen if a psychologist similarly came out and publicly shamed conservative parents for indoctrinating religious dogmas into children before they are at an age to question things for themselves. If it got covered at all, something tells me that the tone would be VERY different than this.
Political biases aside, however, the medical issue is indeed important. Though the solution as proposed is really, REALLY stupid. But, more on that later.
It comes as London is set to relax drug laws by no longer prosecuting young people caught in possession of cannabis – offering them educational courses on the drug’s dangers instead.
But results from European neighbours offer an insight into the potential pitfalls of such a policy – with Portugal seeing a huge surge in cannabis-induced psychosis after it decriminalised the drug in 2001.
According to research in the International Journal of Methods in Psychiatric Research, the number of hospital admissions in the country with a primary diagnosis of psychotic disorders and schizophrenia stemming from cannabis use soared by nearly 30-fold, from 20 a year in 2010 to nearly 590 in 2015 – and almost 90 per cent of these patients were men, whose average age was 30.
It is in fact true that the number of cannabis-induced psychiatric conditions did in fact take an exponential uptick following decriminalization. That is certainly a statistic not to be taken lightly. However, Portugal is now not the only cannabis-neutral nation-state for which we can draw data. Canada has been legalized since 2018, which should make it another source of good data.
This brings me to the very big difference between Canadian drug policy and Pourtagise drug policy. Legalization vs decriminalization.
In Canada, though the bureaucratic hoops that one has to jump through are rigid to the point of being ridiculous, the sale of regulated marijuana to 19-year-olds and older is completely legal. Since it is regulated, the THC and CBD content is closely monitored so the issue of newcomers using exclusively extremely potent drugs has become less of an issue. Childhood cannabis poisonings are indeed up from that they used to be, but frankly . . . obviously. There is far more cannabis (in particular, cannabis edibles) around then there has ever been previously. And not all parents or caregivers are going to know to keep their stash safe. Though that is indeed extremely irresponsible, how many people got into their parent’s liquor cabinets without them knowing?
Though care is certainly urged in regards to pharmaceuticals and cannabis, alcohol deserves the same treatment (if this is the approach we are to take). If telling alhocol consumers to Drink Responsibly is considered a reasonable policy, why not consume cannabis responsibly?
This is all in contrast to decriminalization, which leaves the cultivation of cannabis in the hands of the same underground producers, but eliminates the legal risk to the actual drug users themselves. Or to put it another way, it leaves highly potent cannabis (the type that a market made up of primarily high tolerance regular users) as pretty much the only cannabis option available. Meaning that even novice users end up essentially jumping off the deep end without experience should they ever do what is human and get curious about this plant that everyone is talking about.
Also worth remembering is access to this cannabis is governed strictly by the moral compass of the dealer selling it. If they have no issue with selling to a minor, then scoring weed can be just as easy as buying a candy bar. While it is far from impossible for minors to access regulated substances like alcohol or tobacco, there are still more barriers to clear than just handing a criminal some cash and walking away with a stash.
Earlier, I had mentioned that Canada may be a good source when it comes to tracking cannabis-induced psychiatric episodes being we were the trailblazer when it came to opening up the industry on a federal level. Back in the days before legalization, I even recall an episode of marketplace exploring just this topic. Given that 3 years have passed, it feels like a good time to check and see if the fears were justified.
The following article (published on January 2ed, 2019) certainly is attempting to sound the alarm.
Right off the bat, there was a rise in cannabis-related behavioural and mental health-related hospitalizations between 2006 and 2015.
- Between 2006 and 2015, the rate of hospitalizations for cannabis-related mental or behavioural disorders in Canada rose from 2.11 to 5.18 per 100 000.
- Males consistently accounted for over two-thirds of all hospitalizations for cannabis-related mental or behavioural disorders.
- Young people aged 15 to 24 years represented the greatest proportion of hospitalizations (between 49% and 58%) of any age group.
- Over the entire study period, psychotic disorder was the most common clinical condition among hospitalizations for cannabis-related mental or behavioural disorders, and accounted for 48.0% of cannabis-related hospitalizations in 2015.
- Between 2006 and 2015, the rate of hospitalizations due to cannabis-related psychotic disorder tripled, from 0.80 to 2.49 per 100,000
These findings make perfect sense since this was the timeframe in which cannabis (more, cannabis legalization) was slowly entering the public psyche and changing long-held attitudes towards the drug. At the same time, the debut of shows like Weeds and Breaking Bad helped bring the often gritty underworld of drug prohibition into the forefront of popular culture. Moreso Breaking Bad of course (while I still enjoy Weeds, it was primarily a comedy at heart).
As for the data I seek, sources at the moment seem rather scarce. This isn’t really surprising since it has only been around 3 years (notice that the last dataset was taken from a period spanning a decade). Though I also can’t help but wonder if part of the reason I’ve not come across more hair on fire articles is the ready availability of less potent strains in the pot shops. Though all cannabis was largely the same to me when I was viewing it as an outsider, the differences became more apparent once I started actually participating in the legal market. In fact, some people I know have even commented that they avoid much of the legal market since it demonstrates the opposite problem that the illicit market does . . . it’s aimed primarily at the novice and lite recreational user. Most of the offerings are far too weak for their raised tolerance levels.
While a big part of this stems from the profit motive (appealing to new and lite recreational users), regulations also play a role in this. While I am not sure offhand what the limits are for flower, I know the THC maximum for edibles and drinkables is 10mg. A level that is perfectly fine to send someone like me on a journey (as I found out last year), but a level that may well not work for others. Though you can of course increase the dose by buying more (up to 30 grams per transaction), this can get costly VERY quickly.
While I was and still am of the opinion that the legal market will eventually drive out the illicit market (I’m sure hooch peddlers didn’t go away overnight after the lifting of prohibition), work still needs to be done to get the paranoid and uninformed regulators out of the way. Though I understand that the heavy-handed approach is owing to the lack of research available on cannabis (and people’s overall lack of knowledge of the substance), these roadblocks will continue to prop up the illicit market so long as they exist.
Considering that this is a hindrance that isn’t shared by other substances (such as alcohol or tobacco), what of it federal regulators?
Sir Robin suggested the high number of cases in his practice are now impacting the facility’s ability to care for patients.
He told the Times: ‘I think we’re now 100 per cent sure that cannabis is one of the causes of a schizophrenia-like psychosis.
‘If we could abolish the consumption of skunk we would have 30 per cent less patients [in south London] and we might make a better job of looking after the patients we have.’
We have tried that. According to your very own findings, it didn’t work. How many more patients do you have to get inundated with before this flaw in your logic becomes apparent?
You are not helping the cause by this way of thinking. YOU ARE MAKING IT WORSE!
Sir Robin works at the first NHS clinic in England to specifically treat cannabis smokers suffering from psychosis.
Running from Maudsley Hospital in Camberwell, south London, patients are typically seen for a minimum of 15 weeks, with treatment including one-on-one sessions with specialist therapists.
The aim of the clinic is to first help cannabis users wean themselves off the drug before helping them to manage without it – helped by weekly group therapy sessions with fellow patients and experts.
Sir Robin has praised the clinic, reporting it to be a success, even when services moved online due to the Covid pandemic.
It comes after he was part of the first team of researchers who proved a link between cannabis and mental illness among teenagers in the early 2000s – with many papers backing up his findings ever since.
Only two years ago, a study found that south London had the highest incidence of psychosis in Europe – and cannabis was said to be the largest contributing factor.
The investigation, overseen by Sir Robin and published in The Lancet Psychiatry, found that those who smoked high-potency skunk were five times more likely to develop psychosis than those who did not smoke it.
According to the findings, rates of psychosis in London could be slashed by 30 per cent if skunk was taken off the streets.
You can tell someone’s seriousness in tackling a given issue by the seriousness in the solutions they propose. If skunk were abolished from the streets, hurray . . . PROBLEM SOLVED!
Get serious. Clearly, that has not worked because THERE IS NO ABOLISHING SKUNK. It is already abolished. And yet the problem still persists. Hence, it’s time to go back to the drawing board and consider what has worked. Since the decriminalization model has problems (according to your own argument), how about the legalization model?
Though the dataset is indeed young for this model, it is still there.
While it has been noted that higher instances of cannabis use associated with legalization will likely result in more instances of cannabis-induced mental or behavioural disorders, this isn’t as much of an “AAAAHHHHH!” observation as it is a “DUH!” observation.
The more people who get licences and own vehicles, the more instances of drunk driving and speeding there will be. The more people that purchase alcohol, the more instances of alcohol poisoning there will be. While I am not discounting the need for research to close the gaps in knowledge that persist in cannabis research, bad outcomes are still far from the norm when it comes to the average cannabis experience. Therefore if we are not prohibiting alcohol and vehicles based on the small but very visible percentage that catches the headlines, the same should apply for cannabis.
Particularly when it is entirely possible to adjust some of the variables that are totally uncontrollable in both illegal and decriminalized frameworks. For example, age restrictions of legalized cannabis will help to keep skunk out of the hands of most children and teens. And regulation of potency and (most importantly) education in terms of the effects of this potency will go a long way towards keeping the very powerful stuff out of the hands of those unprepared for it.
THERE is your solution. As opposed to more standing aside and pissing into the wind and wondering why our knickers keep getting wet.
Despite its potentially harmful effects, Sir Robin welcomed London’s plans to end prosecution of young people found in possession of cannabis.
The policy, set to be adopted by the Metropolitan Police, would see carriers of the drug offered educational courses on its dangers.
But Sir Robin wants more clarification over the scheme.
He said: ‘My questions will be: where will they get the counsellors who know anything about risks of cannabis?
‘What will happen if they don’t accept the counselling or go back to cannabis use?
‘And will it be accompanied by any education regarding the risks of cannabis — this is by far the most important thing.’
He added: ‘Because Lewisham is one of the proposed boroughs [where the scheme could first be introduced] we will be able to track the effects on psychiatric problems secondary to cannabis use — addiction, suicide attempts and psychosis.
‘But we need also to track road traffic accidents, street violence and visits to A&E departments for cannabis problems.’
Sir Robin said policy changes in other countries provided potential warnings for Britain.
In the state of Colorado in the US, there are now cannabis products available which contain more than 70 per cent THC – or tetrahydrocannabinol – the compound which gives users a high.
For comparison, traditional weed from the 1960s contained around 3 per cent or less THC, while the average in Europe and North America today is 10 to 15 per cent, according to an article by Sir Robin in JAMA Psychiatry.
It is amazing how attached these boomers are to out-of-date and overly destructive ideas of the past that just don’t work. While the support of decriminalization is a step in the right direction, education of the dangers of cannabis IS NOT!
Assuming that the Canadian education system is not all that different from the British system, we were made well aware of the dangers of drugs all through the process. So much so that the reality of the situation (at least when it came to cannabis) ended up casting doubt on almost everything I learned through the years from the curriculum. A big danger when it comes to people moving on to far more risky drugs than cannabis.
While it is good to make young people aware of the risks posed by drugs (including cannabis), fear-mongering doesn’t work. Scaring young people is not a solution, it is an old tactic that has proven futile. If you truly want to tackle this problem, start supporting cannabis legalization schemes and get some of the market variables back under regulated control.
Meanwhile, a study in Denmark found that alongside a rise in THC potency, cannabis-associated schizophrenia has increased by up to 400 per cent over the past two decades, reported the Times.
Sir Robin’s study in 2019 warned that 94 per cent of all cannabis available on the streets of London was in the form of skunk.
Researchers from King’s College London studied 2,100 people in 11 cities in Europe and South America in the biggest study of its kind.
They found that the link with psychotic disorders such as schizophrenia and paranoid delusion was strongest in London and Amsterdam – the two cities where high-potency cannabis is most commonly available.
Sir Robin said at the time: ‘If you are going to legalise, unless you want to pay for a lot more psychiatric beds and a lot more psychiatrists then you need to devise a system in a way that will not increase the consumption and will not increase the potency. Because that is what has happened in the US states where there has been legalisation for recreational use.
1.) Prohibition is the reason why all of these problems are happening. Since these boomer types insist on playing hands-off as to their part in all of this, let’s make it crystal clear.
2.) While I am unsure of whether or not Colorado had a spike in cannabis-related psychiatric episodes post-legalization (and certainly post super-strong edibles availability), there is no way to not have the amount of cannabis use not rise post-legalization. It’s an incredibly stupid requirement to begin with since the key to arresting the problem is education and potency controls. While it is true that I don’t believe that potency limits are helpful, education of consumers IS helpful.
‘The critical question is whether medicinal use remains medicinal. The problem in California and Canada was that medicinal use became a synonym for recreational use.
‘You could go on the internet and tell a doctor, “I have headaches, I have back pain, I feel better if I have cannabis”. The main reason they legalised it was to try to control the amount of so-called medicinal use there, hoping that there would be a decrease in the use.’
The research, published in the Lancet Psychiatry journal, found that skunk – with a THC level of more than 10 per cent – increased the odds of psychosis 4.8-fold in a person who smoked every day compared with someone who never used the drug.
Using it more than once a week was less dangerous, but still increased the risk 1.6-fold.
Actually, the real goal of the Canadian government’s cannabis legalization was limiting youth access and reducing criminal involvement in the trade, according to this article. A goal that makes perfect sense since eliminating fake medicinal use by way of legalization is just stupid. How is easing access to cannabis going to drive usage rates down?
That is just stupid. Coming from a so-called doctor . . . Jesus Christ, stick to psychiatry.
Though my bias and education in this area tends to make fossil attitudes on the subject like these quite caustic to my well-being, not all cannabis critiques are this devoid of critical thought. The following post covers an analysis that I rather liked in both its informativeness and its honesty. Fear was never used, only information.
The sooner everyone begins to approach cannabis legislation and research with more emphasis on honesty and reality, the sooner it will become less of a vector for creating unwitting casualties. Until then, the chaos left in its unregulated wake is just as much on the heads of the academic proponents of the status quo (such as Sir Robin Murray!) as it is on the growers and dealers themselves.
Consider yourselves warned and informed.