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Keeping Our Balance

OLDHAM, JOHN M. MD

Journal of Psychiatric Practice: November 2019 - Volume 25 - Issue 6 - p 417
doi: 10.1097/PRA.0000000000000432
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Editor

November, 2019. In a recent open access review article titled “The effects of cannabinoids on executive functions: Evidence from cannabis and synthetic cannabinoids—A systematic review,” Cohen and Weinstein contend that cannabis is the “most popular illicit drug of the 21st century.”1 As we know, the legalization of recreational marijuana is growing in this country, although this transition is not without substantial controversy. As a general principle, we’ve been here before—for example, as the country moved from prohibition to legalization of alcohol use. More recently, we might consider a reverse process: the increasing alarm about the health hazards of smoking—still legal to smoke, yes, but now widely prohibited in designated areas. Though I’m tempted, I won’t even get into gun safety, but it’s a huge social concern with potential life-and-death consequences. To keep our balance is challenging in the realm of our constitutionally protected freedoms, while respecting a wide range of opinion, and while, as objectively as possible, paying attention to new scientific findings. But one bottom line is that what is good for some of us may not be good for others of us. And what may be good or at least benign for healthy adults may not be so for youth with still developing brains, or for the elderly.

In a recent NY Times article, Carey2 wrote an interesting and informative piece about a Center for Psychedelic and Consciousness Research recently opened at Johns Hopkins, to re-examine whether compounds such as LSD or psilocybin, if administered and studied carefully, might be of benefit for a number of serious psychiatric illnesses. There are, after all, many examples of “repurposing” drugs that have been on the shelf for a long time, or of remaining alert to see if FDA-approved drugs might have unexpected benefit for other conditions beyond those for which they are approved. Ketamine, for example, is a welcome boon to some individuals with serious and refractory depression, an application beyond its FDA-approved use as an anesthetic.

In this issue of the Journal, Vinnikova and Skryabin provide a report from Moscow that reflects the worldwide growing concern about the risks of synthetic cannabinoid use. In this pilot study, the authors focused on the emergence of psychosis in users of synthetic cannabinoids, presenting descriptions of 4 types of psychosis identified in these individuals when they were followed longitudinally. Also in this issue, Blevins and colleagues present a study of “emerging adults” (18 to 26 y of age) participating in a partial hospital program, to examine the level of regular use of cannabis and/or alcohol by the participants and to consider their motivations for substance use, as well as to look for correlations of patterns of use with patterns and severity of psychiatric symptomatology. These researchers found that high levels of cannabis and alcohol use, although not the reason for admission to the partial hospital program, were associated with greater intensity of depression, anxiety, and other symptoms. They also concluded that, while the use of the substances often reflected efforts to reduce states of distress (a coping method), any such effects were short-lived and led instead to a rebound heightened intensity of symptoms.

We are all in a blazing biopsychosocial environment these days, where enormous change is underway. The “bio” of biopsychosocial reflects the fast-moving field that is helping us unravel the neurobiological etiology of psychiatric illnesses and other brain disorders. The “psycho” of biopsychosocial involves the psychological and emotional manifestations of these disorders that must be recognized and minimized whenever possible. And, finally, the “social” of biopsychosocial becomes more pressing every day, given issues ranging from climate control, to exploding social media and the ever-widening technological frontier, to political headwinds that make it hard to stay level-headed enough to make our world safer. Most of the time, there are many sides to every question, but we must continue to seek advances in treatment, to revisit older ideas in new lights, and to minimize risk.

JOHN M. OLDHAM, MD

Editor

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REFERENCES

1. Cohen K, Weinstein A. The effects of cannabinoids on executive functions: evidence from cannabis and synthetic cannabinoids—a systematic review. Brain Sci. 2018;8:40. Available at: www.mdpi.com/2076-3425/8/3/40. Accessed September 16, 2019.
2. Carey B. Johns Hopkins opens new center for psychedelic research. New York, NY: New York Times; 2019. Available at: www.nytimes.com/2019/09/04/science/psychedelic-drugs-hopkins-depression.html?searchResultPosition=1. Accessed September 16, 2019.
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