If you do a quick internet search about cannabis and schizophrenia, you will find competing positions in every other search result. Some argue that cannabis can treat the psychological condition while others claim that it can cause it. As in all things true, the answer is not as black and white as most would make it seem.
An Overview of Schizophrenia
According to the American Psychiatric Association, schizophrenia is a “chronic brain disorder that affects about one percent of the population” demonstrating symptoms such as “delusions, hallucinations, trouble with thinking and concentration, and lack of motivation” when the illness is active.
Somewhere along the way, unknowing people started confusing schizophrenia with multiple personality disorder and associating it with violent outbursts, societal degeneration, and homelessness. Schizophrenia is not the same as a personality disorder, and most schizophrenics live relatively normal lives with their families, in group homes, or on their own. Violent episodes are extremely rare, as are the other stereotypical beliefs about people who live with schizophrenia.
Active schizophrenia can make it difficult for a patient to differentiate reality from their hallucinations. Symptoms include audible and/or visual hallucinations, extreme paranoia, decreased motivation, decreased communication, confused thinking, unusual movements and behavior, and impaired cognition. Symptoms usually become apparent during young adulthood, between ages 20 and 30. The cause of schizophrenia is unknown, but scientists believe that adverse life experiences and environmental conditions may be contributing factors.
Disease Without a Cure
Schizophrenia does not have a cure; however, many patients are able to live highly rewarding lives if they follow a regimented treatment plan. Treatment options include the use of antipsychotic drugs coupled with therapy and rehabilitation. As patients age, the severity of their psychotic episodes decreases.
Cannabis Might be a Trigger
The American Psychiatric Association attributes illicit drug use as an exacerbating factor when it comes to the onset of schizophrenia as well as the severity of psychotic episodes. Cannabis, a substance with psychoactive effects due to the presence of THC, is the most pervasively used “illicit substance” in the world.
Those who blame cannabis for the onset of psychosis are not totally off-base. There is a plethora of research demonstrating a relationship between cannabis use and schizophrenia. A small 2014 study made the behavioral connection between cannabis use and schizophrenia, finding that cannabis use “occurs in up to 42% of patients with schizophrenia and substantially worsens disease progression.” A recent Israeli study has suggested that cannabis use in adolescence, specifically if the users have a genetic predisposition for the brain disorder, may trigger schizophrenia.
Cannabis Might also be a Treatment
The major hole in each of the aforementioned studies is that none of them definitively prove causation. This is a really important distinction. While it is possible that cannabis contributes to the onset of psychosis, the research seems to lean in a different direction—that cannabis use in schizophrenic patients is more symptomatic of the disorder than responsible for it.
Schizophrenia is a mysterious disorder, but researchers have discovered a fascinating connection it has to the endocannabinoid system (ECS), the system named after cannabis. The ECS is comprised of cannabinoids and their receptors, which are located throughout the body. The discovery of this system is the most significant milestone in neuroscience. The ECS is responsible for a sweeping range of bodily functions including temperature regulation, sleep, the immune system, mood regulation, and reward and pleasure systems. Matthijs Bossong, Ph.D., of the Rudolf Magnus Institute of Neuroscience at the University Medical Center Utrecht in the Netherlands explained the relationship between the endocannabinoid system and schizophrenia in an interview with Psychiatry Advisor.
“It has been shown that patients with schizophrenia have enhanced levels of endogenous cannabinoids as measured both in their blood and cerebrospinal fluid,” Bossong explained, adding that increased levels of cannabinoid receptors have been identified through neuroimaging and post-mortem examinations of patients’ brains.
“For many brain functions, such as memory, executive function, and emotional processing, we found striking similarities between cannabis-intoxicated healthy volunteers and non-intoxicated schizophrenia patients,” Bosson continued.
What that means is that sober schizophrenic patients’ brains look similar to the stoned brains that are not disordered by schizophrenia. The apparent connection between schizophrenia and the endocannabinoid system has led researchers to look for a way to use cannabis to treat the disorder.
THC Isn’t the Only Cannabinoid
It’s true that THC may exacerbate psychotic symptoms given its psychoactive effect, but cannabis is so much more than THC. The plant harbors around 100 other cannabinoids, none of which demonstrates psychoactive attributes, and many of which seem highly therapeutic.
One cannabinoid, in particular, cannabidiol (CBD), seems especially promising for schizophrenic patients.
In a 2012 study, researchers found that CBD showed exceptional promise as an antipsychotic treatment. In a previous study, the scientists discovered that the lower the level of the endocannabinoid anandamide, the more likely patients were to experience psychotic symptoms. Unlike THC, CBD does not stimulate cannabinoid receptors but influences the endocannabinoid system through different molecular pathways. One of the ways that it regulates the ECS is by inhibiting the degradation of anandamide. CBD allows anandamide levels to remain elevated, thereby decreasing psychotic episodes in schizophrenic patients. CBD performed just as well as amisulpride, a powerful antipsychotic drug, but with significantly fewer side effects.
Continued Research is Critical
Here’s the thing. No matter how much you love or hate cannabis, it’s hard to determine the certainty of any finding given the paucity of research on this specific topic. Truthfully, there have been countless studies on the plant’s medicinal attributes as well as its risks—certainly enough evidence to justify the countless number of people turning to the plant for treatment of an array of conditions. But the legal hurdles scientists face in order to conduct their research compromises their ability to execute large-scale, long-term studies without unreasonable government interference.
As a Schedule I substance, cannabis is federally regarded as a drug with a high potential for abuse and no accepted medical use. This contraband designation makes cannabis extremely difficult for researchers to access. Paradoxically, the Drug Enforcement Administration says that the only way that cannabis will be rescheduled is if clinical trials can prove the plant’s medical efficacy. It’s a double bind that hurts all aspects of our society: cannabis prohibition is steeped in bigotry, economically stifling, and an unnecessary blockade to health. Until cannabis is rescheduled, cannabis research conducted in the United States will continue at a trickle’s pace while a legal commercial market explodes from state to state. It’s time for prohibitionists to find out if their beliefs still hold water in an age where the entire world is changing its mind.