Pot, teenagers, and the psych ward

MunoRN, RN · Jun 18, 2015

I would agree that in general we should avoid any 'altering' medications in teens, although the benefits sometimes would appear to outweigh the risks, such as for kids with seizures not controlled by other treatments. It shouldn't be available to teens for recreational purposes and I don't know of anywhere that it is.

Marijuana and schizophrenia have an interesting relationship because marijuana contains components that can both "unmask" schizophrenia as well as treat the symptoms of schizophrenia.

The myth that marijuana can cause schizophrenia in teenagers has so far been shown to be false, including studies such as this Harvard: Marijuana doesn't cause schizophrenia The confusion comes from the potential for one if it's components, THC, to "unmask" already existing schizophrenia in an adolescent or young adult. Typically schizophrenia doesn't become evident until a person is in their teens or even 20's, what marijuana appears to do is speed up the inevitable emergence of symptoms in people who already have schizophrenia rather than causes schizophrenia.

Yet not all eventual schizophrenics have their symptoms unmasked by marijuana and many even self-medicate with marijuana, which may be due to another component of marijuana which counteracts the pro-psychotic effects of THC. That component, cannabidiol, has been found in some studies to actually be comparable to other commonly used antipsychotics in treating schizophrenia. The ratio of the "unmasking" component and the therapeutic component vary depending on strain which might explain why it can opposing effects.

toomuchbaloney · Jun 18, 2015

Whether the use of cannabis triggers the onset of schizophrenia or depression in otherwise vulnerable people or whether it actually causes these conditions in non-predisposed people is not yet resolved. Further, it cannot be assumed that mechanisms are the same for both conditions (cannabinoids have effects on a variety of neurotransmitter systems) or at different developmental stages. For example, although evidence shows that mental disorder leads to the use of cannabis among adolescents, the reverse seems true in early adulthood.

McGee R, Williams S, Poulton R, Moffitt T. A longitudinal study of cannabis use and mental health from adolescence to early adulthood. Addiction. 2000;95:491â€“503.

Although most young people use cannabis in adolescence without harm, a vulnerable minority experience harmful outcomes. A tenth of the cannabis users by age 15 in our sample (3/29) developed schizophreniform disorder by age 26 compared with 3% of the remaining cohort (22/730). Our findings suggest that cannabis use among psychologically vulnerable adolescents should be strongly discouraged by parents, teachers, and health practitioners. Policy makers and law makers should concentrate on delaying onset of cannabis use.

Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study

nursingaround1 · Jun 18, 2015

There's a lot of studies out there, and the latest that I've seen say it's bad for teens and adults - but yes, certain components do have medical uses.

But there's the whole culture of pot smoking that the studies don't often talk about. The surfer, skateboarder, unmotivated dropout sort of culture. Some of the kids at school here openly admit that as as soon as they graduate and move back to California they'll get their medical pot license - so it's a total joke.

There's so many negative outcomes of pot users, especially in growing minds, yet we focus on the professor of maths at university who smokes it every day and who turned out fine. But so many more don't turn out fine.

Miss Rayanne · Jun 18, 2015

I spent two years in a psych ward - and not as an inpatient. Due to the ward being in small city in New Zealand, we had it all - mildly unwell, dangerously unwell, old, young, and even some children, although the oldest I ever looked after was 14yrs. We also didn't have very many men working there, and I was one of 3 guys working there. It was because of this reason, they often gave me the teenage males to look after.
Johnno (not his real name) wouldn't speak to me for my first month, because he didn't trust me. He didn't trust anyone, but how can you trust anything when you hear hairy legs patter across the hardwood floor, and see thousands of spiders crawling towards your bed, and then feel them biting you. He was only 16yrs old, and this was his life.
After a year working with Johnno, he trusted me, and talked to me, although 'talking' doesn't really explain it. His bursts of laughter would often be interrupted by bouts of laughter. I used to ask him what he was laughing at, but I was told not to do this, as asking about his hallucinations apparently reinforced his belief in them. Which makes it kinda tricky, because sometimes having a little glimpse of what's going on in his head does give you some idea of how bizarre his world is.
'There's a black demon with red eyes and he says you're a C...' The first time he told me this, I resisted the urge to look over my shoulder, but I couldn't stop the goosebumps or chill down my spine.
Poor Johnno started smoking Pot at the age of 14, and was first admitted to the unit at the age of 15. In 3yrs time, he'd never been free of his hallucinations, and probably never will be. All we'll do is give him more drugs to relax him, so the demons don't bother him so much, and then given more drugs to counter the extra-pyramidal side effects of such strong anti-psychotics.
I looked after a worrying number of teenagers there because of Pot. They say growing minds are vulnerable, and it makes sense. What worries me now is that scientist now say the brain doesn't finish developing until people are 25yrs old.
Yet it's legal for teenagers to smoke pot in some places.
They believe it's harmless.
I regularly talk to the students at my schools, and many do believe it's harmless as well.
What scary is the growing number of adults who believe it's harmless.
Another patient I looked after turned out to be my friend, Pete. I'd known Pete through high school, and he was always the calm guy who didn't drink, so we often used him as our sober driver. It's only now, as an inpatient, I realize we had a stoned driver instead. I realize now why he drove so carefully, so slowly.
I'd lost contact with Pete in the last couple of years, but he'd gotten a job killing chickens, so I'm not surprised he fired up a spliff several times a day with a job like that. He had started to believe the TV and Radio were beaming instructions into his head, and eventually convinced himself he was the Messiah. Fortunately he came right, but he can never smoke again, and will not risk drinking.
It might have helped that he stopped killing chickens for a living.
Anyway, not sure what my point is, just thought I'd share some experiences from the psych ward, but before I go, I can't help leave with one last, controversial statement:
Pot is an insidious, creeping poison that destroys youth, but society chooses to be blind to it, because 'what I do in my own house, doesn't hurt anybody else, so don't tell me what to do.'

Where is it legal for minors to smoke marijuana? I come from Colorado, one of the American states that has very liberal marijuana laws, and you can't smoke it until you are twenty-one. I think you are over stating the dangers. The vast majority of the people who use this drug, do not end up in an inpatient psych ward. I think your two examples might have been mentally ill prior to starting marijuana.

emtb2rn, BSN, RN, EMT-B · Jun 18, 2015

Alcohol is way worse than pot. I'd anecdotally estimate that we see 100 etoh patients to every smoked too much dope patients.

MunoRN, RN · Jun 18, 2015

There's a lot of studies out there, and the latest that I've seen say it's bad for teens and adults - but yes, certain components do have medical uses.
But there's the whole culture of pot smoking that the studies don't often talk about. The surfer, skateboarder, unmotivated dropout sort of culture. Some of the kids at school here openly admit that as as soon as they graduate and move back to California they'll get their medical pot license - so it's a total joke.
There's so many negative outcomes of pot users, especially in growing minds, yet we focus on the professor of maths at university who smokes it every day and who turned out fine. But so many more don't turn out fine.

I'm not sure it's necessarily true that surfers and skateboarders are generally people who didn't "turn out fine", but more importantly it raises the question; does marijuana use cause people to surf and skateboard? Or are people who are drawn to surfing and skateboarding also the people who are more likely to try marijuana.

GuEsT78 · Jun 18, 2015

I believe it was a PBS (U.S.) documentary I saw that suggested that any drug that shapes how our minds work could be risky when used on children and teens. It may have been this one or one the related reports at the bottom of the webpage.

The Medicated Child | FRONTLINE | PBS

In recent years, there's been a dramatic increase in the number of children being diagnosed with serious psychiatric disorders and prescribed medications that are just beginning to be tested in children. The drugs can cause serious side effects, and virtually nothing is known about their long-term impact. "It's really to some extent an experiment, trying medications in these children of this age," child psychiatrist Dr. Patrick Bacon tells FRONTLINE. "It's a gamble. And I tell parents there's no way to know what's going to work."

Their reasoning made sense. Adult minds have finished their shaping process. Anything that alters how they work is likely to go away if the drug is discontinued. Not so for children and teens. Drugs that alter their minds form and may leave their minds in a bad state for life.

Think of an oak tree. When it's small, it takes little effort to change the shape of its branches and twigs. That's how drugs can alter a child's minds in ways that may not be good. When that tree become older, that bending those now-thick limbs become impossible. So it is with our minds and drugs. The bad thing is that we are what we are. The good is that we're unlikely to become substantially worse.

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What bothers me about drug legalization, particularly for pot, is that we're not doing so for the right reasons, meaning that we've discovered that they do little or no harm. We're simply doing it, in the U.S. at least, simply because we've grown tired of the drug war.

I tend to deal with people who want to legalize drugs by asking them a series of followup questions from, "how about teens" and "how about middle-school kids" to "should it be legal to pass out these drugs for free in front of an elementary school?" Eventually, there's a point where they say, "Yes, that should be illegal." But having done that, the quibble then becomes out when not if. And don't forget that what all 22-year-olds can get is what some 6-year-olds can get.

Years ago, I was the director of a halfway house that was mostly populated with drug addicts and alcoholics trying to avoid prison time. But occasionally we had someone with mental issues. One was a guy somewhat like the one you discuss. He was in his early twenties and once told me that his father was the god Zeus, who'd hurl lightning bolts at me if I didn't treat him properly. (Later, he did hurl a log through a picture window.) He attempted to self-medicate with pot and that tended to trigger his paranoia.

On the other hand, it is hard to separate cause and effect. Was he crazy, in part, because of po?. Or was pot how he tried to make his craziness go away? You can't randomize people like rats and drug or not drug them to see what happens.

I don't know. I do know that, when he became more than we could handle he agreed to a voluntary commitment to a state institution that, by completely controlling his environment and given him standard medications for his problem, did get his situation under control. Whether he could manage on the outside is another matter. One of our major social follies in the 1970s was getting rid of institutional environments that may be the only way to keep the lives of some manageable.

I do know that, were I in state politics, I'd not only be opposing legalization, I'd be creating incentives for drug users to move to states where their drug of choice is legal. It's not the nicest of responses, but it is one that, if the consequences of legalization turn out to be bad, will at least limit their geographic extent. The early adopters will become the later regretters.

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One more thing. When I lived in Seattle, I knew most of the so-called "homeless" guys in my neighborhood. The usual bromides about them and how their lifestyles could be fixed didn't really apply. They didn't want to be fixed. Some were clearly mentally ill, but where being kept in line by their peers. Others simply had issues with drinking or drugs such as pot that meant they couldn't hold down a regular job. Their solution was to catch odd jobs, sleep in the bushes when the weather was fine, and in general try to avoid both commitment in life and legal trouble (which could lead to prison). At their current numbers, they weren't really a problem. But make pot easier to get and their numbers might grow enough they would become a serious problem.

Thanks for raising this issue. It needs more serious discussion than it is getting.

--Michael W. Perry

nursingaround1 · Jun 18, 2015

Two points:

1. Marijuana is harmful to young people - I think we agree on that at least. And this is because the brain is developing. Neuroscientists have pretty clearly shown the brain doesn't fully mature until 25yrs of age, so perhaps the legal age should be 25?

2. Have you seen the massive street parties in Colorado, where masses of people are in the streets smoking, where many of them are teenagers? I've seen the videos.

nursingaround1 · Jun 18, 2015

So we've shown that we can't handle alcohol, so let's throw another drug, another depressant, into the mix. What logical thinking.

heron, ASN, RN · Jun 18, 2015

The laws against partaking don't work ... so let's keep arguing for restrictions .... that's logical?

Miss Rayanne · Jun 18, 2015

So we've shown that we can't handle alcohol, so let's throw another drug, another depressant, into the mix. What logical thinking.

So let me ask you, would you rather threw people who smoke marijuana but otherwise cause no other problems, in jail? Remember that it cost over $25,000 a year to house and feed an inmate. The state has limited funds, so I would rather we use our corrections department to keep people who are truly dangerous away from society. We regulate marijuana in my state, and we're doing just fine.