MHM Magazine

The storm around COVID-19 settles gently and matters more mundane rear their not so ugly heads again. And so, to revisit the clouds and confusion around cannabis. Google, AI and social media has created a host of experts and along the way fact and fiction have become blurred. The entry of those with vested commercial interests into the debate has further muddied the waters. The confusion relating to the legalisation of recreational cannabis use and decriminalisation persists. The cognitively challenged presume that decriminalisation means safe. And CBD shops have mushroomed everywhere… History The tale is not new. Cannabis has been used in its different forms by various groups of people from antiquity. The ancient Egyptians used ‘oil from hempseed’ to treat vaginal inflammation, the Hindu god Shiva is said to have been given cannabis as an antidote after he was poisoned. Hindu scriptures refer to cannabis as a ‘source of happiness’. Followers of the Sufi sect in Islam felt that cannabis helped them gain spiritual insight by the arousal of ecstatic states. The Rastafarians believe that cannabis helps penetrate the truth and brings them closer to God. THC vs CBD The cannabis plant (leaves, stems, flowers and buds) contains over 120 active ingredients, cannabinoids. The 2 most abundant are delta-9- tetrahydrocannabinol (THC) and cannabidiol (CBD). THC binds to CB-1 receptors (found in the central nervous system, heart, testes, and immune system) and modulates the release of the neurotransmitters serotonin, noradrenaline, acetylcholine, glutamate, GABA, dopamine, and the opioid systems. All these transmitters are relevant to psychiatry. Receptor stimulation modulates mood, cognition and appetite and brings a sense of well-being and relaxation. Impaired motor coordination, delayed reaction times and cognitive deficits may also ensue. THC is psychoactive and genetic modification, and the development of hybrid strains has seen the concentration of THC increase from 1 to 5% in the 1980’s to 27 to 29% in some strains currently. The effect of THC on the individual depends on a variety of factors – the manner of ingestion (whether it is smoked, vaped or consumed as edible gummies and brownies), the amount used, the environment in which it is used and its use in combination with other drugs. Individual patient factors (weight, metabolism) also play a role. CBD should have no more than 0.3 % THC. It does not cause euphoria and is not psychoactive. It may help relieve pain and inflammation but can also cause diarrhoea, fatigue, and weight loss. The peripheral effects of CBD – bronchodilation and decreased intraocular pressure suggest its use in the treatment of asthma and glaucoma. Addiction Cannabis is the most used illicit drug in the United States – in 2021 35.4% of young adults (aged 18 to 25) reported its use in the last year. 9% of those who experiment and 25% to 50% of those who use it daily will become addicted. Short term effects on health include: • Intoxication - disturbances in level of consciousness, cognition, and behaviour • Problems with motor coordination leading to increased risk of injury • Anxiety, panic attacks, hallucinations • Acute cardiovascular effects – increased heart rate and blood pressure, myocardial infarction and strokes Long term use causes dependence which increases health risks. Magnetic resonance imaging (MRI) studies report structural changes in Dr Hemant Nowbath Psychiatrist Durban CANNABIS…SINNER OR SAVIOUR? Issue 5 | 2023 | MENTAL HEALTH MATTERS | 17 MHM