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In the upcoming 2022 Psych Congress, psychiatrists from around the world will be tackling everything impacting the field of psychopharmacology, including the use of cannabis. Dr. Timothy E. Wilens, Chief of the Division of Child and Adolescent Psychiatry at Massachusetts General Hospital and Harvard Medical School will be exploring this topic in a session titled, “Marijuana and Young People: A Combustible Combination.”

Let’s take a look at what Dr. Wilens might explore at this year’s congress.

A Look at the Neurobiology of Marijuana

Marijuana is made up of two primary ingredients: delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). These ingredients bind to the cannabinoid receptors in the body, Specifically CB₁ and CB₂.

• CB₁ receptors Are found in the brain and central nervous system, including the vascular system muscles a gastrointestinal tract
• CB₂ receptors Are mostly in the peripheral organs especially S sociated with the immune system,  such as the spleen, bones, and skin

Now medical marijuana has been FDA approved for the treatment of several conditions. For example, several studies have been conducted to explore the use of medical marijuana to treat pediatric epilepsy, and found that it had reduced both seizures and convulsive seizures in these patients.

Dr. Wilkens then explained the differences in the role of THC as compared to CBD, and explain the following:

• THC is typically used to treat pain, nausea and vomiting, spasticity, glaucoma, insomnia, and improved appetite
• CBD, on the other hand, is more often used to manage seizures, pain, migraines, anxiety, depression, and inflammatory diseases such as inflammatory bowel disease

Prevention of Marijuana Misuse

While the use of medical marijuana has significantly risen over the past few years, Dr. Wilkens believes it's still critical to manage, if not prevent, the use of marijuana in our younger patients as it can lead to cannabis substance misuse. He recommends clinicians encourage parents to monitor marijuana use in their kids and encourage nonjudgmental discussion around marijuana. Parental use of marijuana could strongly impact their children’s use of marijuana, so keeping that in mind is very important as well.

Now looking beyond conversations with parents, clinicians should advocate for sensible public laws around marijuana. legalization issues and zero tolerance policies may be leading to more misuse. And Dr. Wilkens encourages clinicians to get to the root of the issue rather than jump to marijuana use.

Getting to Know the Impacts

Dr. Wilkins then went further into the benefits and risks of marijuana use, and general considerations clinicians should keep in mind. Some of these issues include:

• Lung-based risks, including the risk of wheezing exacerbation and COPD and asthma. However, marijuana can cause less irritation compared to cigarettes
• Marijuana use hasn’t been shown to increase the risk of lung or other cancers. In fact, a recent study showed that marijuana use decreased the risk of prostate cancer
• In adolescents and adults, there has been a twofold increased risk of motor vehicle accidents while intoxicated with marijuana. this risk increased in states where medical marijuana was legal

For adolescents, in particular, a study titled “Temporal dynamics of the relationship between change and depressive symptoms and cannabis use in adolescents receiving psychosocial treatment for cannabis use disorder,” studied depressive symptoms in younger patients with cannabis use disorder to see if it interfered with treatment. The study found that Depressive symptoms in adolescent patients didn't interfere with the benefits that came with their cannabis use. it also found that a reduction in cannabis wasn't necessary to reduce depressive symptoms in these patients.

To summarize, Dr. Wilkens stress that marijuana has substantial addiction potential, and for patients under 16 years of age, it can lead to potential structural brain changes and lasting neurocognitive dysfunction. So it's important to encourage patients to really consider the benefits and risks that come with cannabis use to decide whether or not it's right for them.

Resources:

https://mghcme.org/app/uploads/2021/02/Wilens-Cannabis-MGH-SUD-2021-on-template.pdf