Steamboat Springs therapist sees rise in marijuana addiction
How safe is cannabis?
January 26, 2019
STEAMBOAT SPRINGS — Gary Gurney, a licensed counselor and certified addictions therapist, has been treating patients with substance use problems at Yampa Valley Psychotherapists for more than 20 years.
In the last year, he has seen a new kind of patient: people misusing a substance that some don't even consider addictive — cannabis. The phenomenon has shocked him.
"In all my years, I've never seen this," he said.
The rate of marijuana use in the U.S. has more than doubled in the past decade. While it remains federally illegal, a growing number of states have passed legislation to lessen that prohibition.
A green revolution
Thirty-three states and Washington D.C. have legalized cannabis in some form. Ten of those states have legalized recreational cannabis for adults 21 and older.
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Most of those states allow the sale and use of cannabis for medicinal purposes.
Whether or not cannabis can actually solve the health problems that people use it for — nausea from chemotherapy, anxiety, epilepsy and dementia, among others — has not been confirmed.
Cannabis remains a Schedule I drug under federal law, meaning that its effects, beneficial or otherwise, cannot be adequately studied by American researchers.
A 2017 report from the National Academy of Medicine, written by a panel of 16 leading medical experts, concluded "very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States."
One of the only unequivocal conclusions about cannabis in the entire 468-page report is this: "Cannabis use is likely to increase the risk of developing schizophrenia and other psychoses."
At a time when cannabis has become more common and more potent than ever, mental health professionals, like Gurney, worry about its effects on mental health.
When Colorado legalized medical marijuana in 2000, Gurney was optimistic about its potential benefits. He saw it as a healthier, safer alternative to more addictive prescription medications such as painkillers or antidepressants.
"All of a sudden, they were using marijuana and able to stop those medications," he said of his patients.
But during the past year, people have come to him complaining that they can't wean themselves off of cannabis. When they tried to stop using, they became agitated, even depressed.
This has made Gurney question the medical efficacy of marijuana, at least in unchecked dosages.
"In the short term, we've seen real benefits," he said. "But in the long term, we just don't know."
While Gurney has not yet seen a correlation between marijuana use and psychotic breaks, he does worry about the potential effects of the drug on adolescents.
He explained that the human brain is not fully developed until people are 21 or 22 years old.
"There is big concern of how marijuana affects adolescents when their brains are still forming," he said.
A statewide youth survey published Tuesday by the nonprofit Rise Above Colorado showed that one in four children age 12 to 17 said they had six or more difficult mental health days in the previous month. "These teens are significantly more likely to have tried alcohol, marijuana and prescription pain relievers," the survey said.
Links to psychosis
Dr. Erik Messamore is a psychiatrist who specializes in psychotic disorders. He has more than 20 years of experience treating patients with schizophrenia, the most common psychotic disorder. While working at the Oregon State Hospital, he noticed a startling correlation among his patients.
He estimates that he treated more than 1,000 people with schizophrenia each year at the state hospital. They all had one thing in common.
"One-hundred percent of them were adolescent-onset, regular cannabis users," Messamore said.
Correlation does not imply causation, and Messamore was quick to say that he does not believe that everyone who smokes cannabis will become psychotic. These are people who heavily used marijuana during their adolescent years when their brains were still developing.
He, like Gurney, has witnessed marijuana addiction among his younger patients that are already causing them mental health issues.
"I can't convince these young cannabis users who are developing psychosis to stop smoking," Messamore said.
Some argue that people who already suffer from a mental illness are the ones most likely to use drugs. They make the case cannabis is a way to cope with psychosis, not the cause of it.
While Messamore said that more research needs to be done about a possible link between marijuana use and schizophrenia, the fact that all of his schizophrenic patients had a history of marijuana use is striking.
"No serious, open-minded person can dismiss this evidence," Messamore said.
As far as how marijuana leads to psychotic breaks, Messamore theorizes that THC, the psychoactive ingredient in marijuana, floods the brain with dopamine.
"Dopamine flooding is a well-established pathway to psychosis," he said.
Psychosis in the U.S. is on the rise. Emergency rooms across the country have seen a 54.2 percent increase in patients coming in with schizophrenia and other psychotic disorders from 2006 to 2014, according to the Healthcare Cost and Utilization Project.
The National Alliance on Mental Illness characterizes psychosis as "disruptions to a person's thoughts and perceptions that make it difficult for them to recognize what is real and what isn't."
When he moved to Ohio in 2014 and began work at a residential treatment center, Messamore started seeing these symptoms in a particular type of patient: middle-aged professionals who worked in intellectually demanding careers like law and medicine.
They came to him with warning signs of psychosis — symptoms like delusions and hallucinations — but they were otherwise perfectly healthy.
"There was not any hint around how they organized their thoughts that they were a candidate for psychosis," he said.
The only link among most of those patients was that they used cannabis as an adolescent, as well as to cope with the rigors of their undergraduate and graduate studies.
Like Gurney, Messamore supports marijuana legalization. He sees particular promise in the use of CBD, a nonpsychoactive cannabinoid in marijuana that does not get people high.
What he rejects is the idea that marijuana is harmless, an idea that he saw touted among marijuana activists in Oregon.
"Anything that is truly medicinal cannot be safe across the entire population," he said.
To reach Derek Maiolo, call 970-871-4247, email dmaiolo@SteamboatPilot.com or follow him on Twitter @derek_maiolo.