Mental Health Counseling and Cannabis: Are You Part of the Problem or Part of the Solution?
As Illinois becomes an adult use state with the Cannabis Use and Tax Act, mental health professionals need to update their understanding of this substance. Counselors can no longer utilize the ‘tried and true’ teachings that: cannabis causes psychosis, schizophrenia and addiction. Clinicians who are not factually informed or maintain a negative bias will jeopardize trust and efficacy within the counseling relationship. It is imperative that patients are provided with factual and accurate information regarding cannabis use, just as a provider would provide information about safe sex. There is no place for personal opinions and urban legends. Providing outdated, biased information is unethical and will have patients seeking other sources for their questions. The medical and adult use cannabis industry already provides this information. Treatment professionals, trained to assess, diagnose, educate, and guide, are missing a great opportunity to be meaningful in this option in health care.
I began my career within the court system, working with high risk DUI cases. As a seasoned CADC, the majority of my career was spent as a supporter of the War on Drugs. Decades were spent supporting intervention, prevention, DARE, Snowball and Snowflake. I watched with interest as Colorado legalized first medical cannabis, then adult use cannabis. Expecting a wave of negative effects I began searching for information. I was surprised by what I found. Yes, ER visits for edibles and misuse, but no dramatic upsurge in arrests or addiction. I went to CO and visited a dispensary – clean, educational and well run. Interesting.
When medical cannabis became legal in Illinois, I attended an information session for the IL Medical Cannabis Pilot Program. There I learned two things that changed the course of my career. First, fitting a long missing puzzle piece, was HOW cannabis worked in the body. I learned that all mammals have an Endocannabinoid System, which balances all other systems within the body. This is an endogenous system that can be supported through nutrition, holistic therapies and natural remedies. Since all hemp and cannabis was prohibited in 1937, after centuries of ingestion and farming, it’s not a leap to hypothesize that the Endocannabinoid systems (ECS) of most became deficient. Trauma or deficiency in the ECS can lead to a variety of systemic conditions presenting as pain, autoimmune, mental illness and other chronic conditions. Cannabinoid receptor sites are present throughout the body and brain, often in the same areas as opiate receptor sites. They are not present, however, in the part of the brain that controls respirations, removing risk of death by cannabis overdose. The benefits of cannabinoids have been found to be natural: analgesics, antioxidants, anti-inflammatories, anxiolytics and anti-spasmodics. They have also been found to be neuroprotectant and neurogenerative. CBD and THC are the most known cannabinoids, but we also know of THCA, CBDA, CBN, CBG with more on the horizon.
The second thing I learned was that there is a patent held on cannabinoids as being neuroprotectant and antioxidant. Patent 663057 was applied for in 1999 by the National Institutes of Health, aka, the US Government. It is set to expire this year and the general consensus is that holding on to the patent while making products illegal, pave the way for pharmaceutical companies to create products for which the NIH can gain a profit. I sat on this information for a hot minute before becoming angry. How could ‘the government’ list something as neuroprotectant and antioxidant while at the same time keeping it at Schedule 1?? Granted, the focus is on cannabidiol and not THC. Even so, the evidence of health benefits of tetrahydrocannabidiol continue to mount , with the benefits exceeding the risks. I really began my search for more information.
I then came across a TED Talk on little Charlotte Figi called Charlotte’s Web. After giving a brief history and overview of cannabis prohibition, (a whole different story for another day!) the speaker began to share information on the non-psychoactive component of cannabis called Cannabindiol or commonly known as CBD. The child was being treated with a form of cannabis they initially called ‘The Hippie’s Disappointment’, now known as Charlotte’s Web. It still had a very small amount of THC, but not enough to cause a psychoactive (high) response. Charlotte had a severe form of epilepsy, causing so many seizures that she began to miss developmental milestones. The use of this product so dramatically reduced the number of seizures that she resumed normal developmental achievements. I became inspired by the possibility of this ‘healing plant’ helping so many as opposed to viewing it only as a substance of abuse.
The last helpful piece of information is the COMT gene variation. This genetic variation may cause rapid metabolization of THC, while at the same time absorbing 30% more of the substance. It is proposed that this variation or the misuse of the substance, lead to the mental health concerns in some individuals. Those with the gene variation, adolescents in particular, may need intensive interventions in order to heal the brain from the high levels of THC. Ironically, use of CBD can often help in that process. With regard to Substance Misuse, micro-dosing is the most efficient way to use cannabis therapeutically, without concern for adverse effects. Patients who over use, particularly concentrates (also known as ‘dabs’), flood the receptors to the point where the Endocannabinoid system will reduce the number of receptor sites in order to maintain homeostasis. Almost every substance put into the body with few to no receptors sites, will be viewed as a toxin causing negative effects such as headaches, depression, anxiety, a-motivational syndrome and nausea. Unlike a lot of drugs of misuse, a tolerance break of 4 – 6 weeks allows the system to reset.
Another consideration for working with mental health patients and cannabis, is that different types of cannabis can benefit or exacerbate a person’s condition. Knowledge on terpenes becomes important, especially when patients have PTSD, CPTSD and anxiety. Generally, Sativa strains and high THC levels can make theses conditions worse, while Indica strains can be more calming. However, one cannot rely solely on these designations as these are used to simplify a more botanically complex system of plant identification. Individual response is another unknown factor in that a patient can have the opposite effect that most others experience. It’s both empowering and overwhelming to be in charge of your own ‘medicine’ and health care. Having an informed health care provider to discuss responses and products can really help a people find what works for them. It can also smooth over concerns of family and other misinformed providers. Hopefully, with all products being legal for the 21 and over crowd, we will see a reduction in severe negative reactions. In time I think treatment programs who offer guided use of CBD and cannabis could really benefit those who want to come off of other substances. We all know our health care system, and treatment system in particular, needs some restructuring. Medically Assisted Treatment is already being provided. Cannabinoids can be very useful tools.
In closing, there is so much MORE to learn! This is just the beginning of all we can learn about cannabinoids and nuanced use for improved health outcomes. In light of all the cringe worthy experiences patients have had with their mental health providers, I sincerely hope health care providers will become more educated. Is your mental health provider on board? Let us know!