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Letter to the Editor

The Risk of Cannabis

doi: 10.1097/01.EEM.0000586512.26514.00
Letter to the Editor

Editor:

In response to the article by Sherry Yafai, MD (“Don't Dismiss Patients Who Use Cannabis,” EMN. 2019;41[7B]; http://bit.ly/2lklagQ), I wanted to say I work in a psychiatric emergency department, and it seems that almost all of my homicidal, suicidal, and psychotic patients have used or are currently using Cannabis.

I recognize this is one man's opinion, but it seems to me there's a significant risk. I would hate to underestimate that risk given the current popularity of Cannabis.

Neal Mack, MD

Largo, FL

Dr. Yafai responds: Like all medications, Cannabis has negative side effects, specifically high-dose THC. A recent article showed a higher likelihood of acute psychosis with higher concentrations of THC. (Lancet Psychiatry. 2019;6[5]:427; http://bit.ly/2ZmS0vB.) That said, Cannabis is more than just one isolated nonlethal side effect, especially when used correctly by physicians with the right dose and the right indication. CBD, THCA, CBDA, CBG, CBN, and more than 500 other chemicals in this plant have no correlation or association with psychosis. In fact, a recent article showed that using high-dose CBD was beneficial for treating schizophrenia. (Am J Psychiatry. 2018;175[3]:225; http://bit.ly/31ZFd4a.)

Saying Cannabis is only going to cause psychosis would be akin to saying all narcotics only lead to death or that there is no indication for Percocet after orthopedic surgery, Robitussin AC for cough, or Dilaudid for cancer patients because all narcotics cause death. Our role as physicians is to be the diagnostician, interpreter, and prescriber of medications, not to leave this to the uneducated patient to experiment on his own. We know that some patients use, rather than abuse, multiple medications and drugs outside the treatment plan and that THC is only one of a multitude of medications being misused. How about the Xanax and Klonopin that patients overdose on? Should we throw those medications out too? This medication is not any different.

Please keep reading my column every month (http://bit.ly/CaseforCannabis) or come to our Oct. 5 conference for more information on the actual indications, dosages, and modes of administration from a medical perspective and, more importantly, how to discuss your patients' use or misuse to improve their care. (http://www.thereleafinstitute.com/conferences.) I would also encourage you to ask friends and family if they have tried Cannabis products. I am sure you will be pleasantly surprised to learn that many people have, and they have not ended up in the psych ED.

Let's keep up the conversation; that is the pathway toward education. To quote Sonia Batra, MD, a host of “The Doctors,” “Let's replace stigma with science.”

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