Pubdate: Wed, 05 May 2010
Source: Ottawa Citizen (CN ON)
Copyright: 2010 The Ottawa Citizen
Contact: http://www.canada.com/ottawacitizen/letters.html
Website: http://www.canada.com/ottawacitizen/
Details: http://www.mapinc.org/media/326
Author: Kelly Egan
Bookmark: http://www.mapinc.org/find?252 (Cannabis - Psychosis)

'REEFER MADNESS' CLOSE TO TRUTH WORLDWIDE EVIDENCE SUGGESTS

Bummer news. Marijuana, it turns out, doesn't just get you high -- it 
can contribute to serious psychosis.

This potentially explosive topic will be explored Thursday during a 
public lecture at the Royal Ottawa Mental Health Centre, entitled 
Cannabis and Psychosis: the Untold Story.

Dr. Robert Milin, a psychiatrist and substance-abuse expert, will 
provide an outline of the theory that has gained much credence in the 
last decade -- that marijuana use increases by two-or three-fold the 
risk of a "psychotic outcome," such as schizophrenia.

"I laugh," Dr. Milin said in a light aside this week, "that Reefer 
Madness thing that you heard about is not that far off."

The physician was careful to warn about jumping to conclusions. So 
far, the relationship between smoking weed and developing a psychotic 
disorder is not, as scientists like to caution, a "causal" one. 
Evidence from studies around the world, however, points to a link or 
an association, possibly after a single use.

Dr. Milin compared it to the link between cholesterol and heart 
disease. Alone, high cholesterol does not "cause" heart disease, but 
is widely considered a contributing factor, like smoking or obesity.

It is more than guesswork. One study in Australia was based on 
interviews with 3,800 young people. Other literature reviews have 
traced the evidence to the 1850s.

Dr. Milin is co-authoring a chapter on the issue for an American 
academic publication and says a great deal more knowledge has been 
gathered only in the past couple of years.

There is also evidence that a heavy intake of marijuana further 
magnifies the risk of a psychotic disorder or brings out, for those 
pre-disposed, an earlier onset of mental illness.

Adolescence seems a particularly vulnerable age, said Dr. Milin, 
because the brain is still changing. This is also the age when the 
first onset of schizophrenia, for example, will often occur.

Taken together, these pieces of information mean marijuana use is 
often suspected when young people appear at hospitals suffering their 
first psychotic episode.

"The evidence now tells us we should be following these patients to 
see how they progress."

Some recover with no other ill effects, others don't -- but the 
episode stands as a red flag.

"The trick is, how do we identify that vulnerable patient?"

A young man named Matt, now 22, is one of them.

Well-spoken, musical, a good student from a good family, he began 
smoking pot regularly when he was 15, mostly after school.

By the time he began his first year of university, he was smoking 
daily. His friends could see he was changing. His mind, for lack of a 
scientific description, was racing. He began, for instance, to attach 
great meaning to mundane things. He was parsing his every word.

He slept and ate at odd times. He was having feelings of 
"grandiosity" with regard to his place in the world. He berated his 
friends over trivial things, like what they wore and ate. He had a 
vague notion of himself as some kind of prophet.

At the end of his first university year, at age 19, he went to see a 
doctor who noticed he would not answer a simple direct question. He 
admitted to having a vision of himself as a moviemaker, putting to 
film his deep, philosophical thoughts.

He needed help.

He was sent to an Ottawa Hospital clinic that determined he was 
suffering from drug-induced psychosis. Medication was prescribed and 
it soon began to help.

Now off marijuana for more than three years, he believes the drug is 
linked to his mental crisis.

"If there were environmental stresses that brought me to the edge of 
that cliff, then weed pushed me over."

He also thinks marijuana is a "far greater hazard" than many people perceive.

Matt was asked about whether he has advice for parents with teenagers.

"You know, a lot of parents I knew were really vigilant and I don't 
think that helped very much," he said Tuesday. "I think it produced 
an atmosphere of shame. Just as I don't think people should be 
ashamed of being psychotic or taking medication, I don't think they 
should be ashamed of the choices they've made."

Embarrassed, yes, but not ashamed, he explained.

Keep the lines of communication open with your children, he urged. 
"An atmosphere of shame only begets more insecurity."

He speaks frequently to high school students. His message is that 
drug-induced psychosis is treatable and support is available. "I'm 
not there to preach, but be careful. You just don't know how damaging 
it can be."

The lecture begins at 7 p.m. in the Associates in Psychiatry 
Auditorium at the Royal Ottawa Mental Health Centre on Carling 
Avenue. Doors open at 6:30 p.m.
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MAP posted-by: Jay Bergstrom