Cannabis abuse and mental health
International Day against Drug Abuse and Illicit Trafficking 2021 observation by IPS, Manipur State branch

Dr. Mona Nongmeikapam *

"My room-mate is trying to kill me. They are Government agents who are in disguise, they don't have good intentions........ I need to get out of here. I feel that my life is under threat."

"I no longer have the need for further education. I am in direct line with the supreme power and we have some big plans. We can directly talk through our heads. Only good is going to happen to me."

A youngster with or without significant psychiatric family history having grandiose plans and delusional ideas, being a little off, not in touch with reality, or neglect in self-care, no sense of time or urgency, or major panic attacks, not turning up for classes, interviews, exams or social events, ...... Cannabis could be your culprit.

With supporters vouching for Cannabis for its "medicinal values" and acknowledging cannabis use as a "rite of passage", let us learn more about cannabis also popularly known as ganja or marijuana in keeping with the theme of International Day Against Drug Abuse and Illicit Trafficking 2021: "Share Facts On Drugs, Save Lives". The aim is at combating misinformation and sharing the facts on drugs.

What is Cannabis ?

Cannabis refers to a group of three plants with psychoactive properties, known as Cannabis sativa, Cannabis indica, and Cannabis ruderalis. It is known by multiple names : weed, pot, marijuana. Locally, we know it as Ganja, Bhang, Charas, etc.

How does it work ?

Cannabis is made up of more than 120 components, which are known as cannabinoids. Of these, there are two main components: 1) Cannabidiol /CBD. This is a psychoactive cannabinoid, yet it is non-intoxicating and non-euphoric. 2) Tetrahydrocannabinol/THC. This is the main psychoactive compound in cannabis. THC is responsible for the "high" that most people associate with cannabis.

What does it do to the mind ?

1. Cannabis intoxication: After recent use, impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment or social withdrawal.

2. Cannabis use disorder : A problematic pattern of use manifested by at least 2 of the following within 12 months- taking in larger amounts or longer period than intended, failed efforts to cut down or control, great deal of time is spent in activities related to cannabis use, craving, neglecting work, school, or home, use despite having persistent or recurrent social or interpersonal problems, salience, despite knowledge of having a persistent or recurrent physical or psychological problem, tolerance or withdrawal.

3. Cannabis withdrawal : Three or more of the following signs and symptoms develop within approximately 1 week after cessation of heavy, prolonged use: Irritability, anger or aggression; Nervousness or anxiety; Sleep difficulty; Decreased appetite or weight loss; Restlessness; Depressed mood. With at least one of the following physical symptoms- abdominal pain, tremors, sweating, fever, chills, or headache.

4. Cannabis intoxication delirium : Disturbed attention and cognition (memory deficit, disorientation, language, visuo spatial ability, or perception)
5. Cannabis-induced psychotic disorder : Presence of delusions or hallucinations
6. Cannabis-induced anxiety disorder : May present as panic attacks or social anxiety.
7. Cannabis-induced sleep disorder : Severe disturbance in sleep.

Physical Manifestations: At least 2 of the following signs may develop within 2 hours of cannabis use : Conjunctival injection, increased appetite, dry mouth or increased heart rate.

There is also reported increased sweating, headaches, restlessness, forgetfulness, visual distortions, etc.

Effects form long-term use :

o A motivational syndrome : A gradual detachment, decreased emotion and drives, concentration and memory issues, disinterest, passivity, apathy, and a general lack of motivation.
o Depersonalization-Derealization Phenomenon: Described as feeling like an observer with respect to one's own thoughts, body, and sensations;and feeling of unreality and detachment from one's surroundings
o Running Amok: Violent psychotic episodes
o Chronic cough and respiratory problems or exacerbation of pre-existing ones
o Weakened immune system
o Potential carcinogenic
o Faster heart rate by 20–50 beats per minute
o Red eyes from the increase in blood flow
o Interference with fetal development during pregnancy
o Reduced fertility and sex drive
o Mood swings, social problems, poor school or work performance
o Family and relationship problems
o Legal repercussions and financial problems.

In adolescents, there could be impairment in the ability of young people to learn and develop social skills, difficulties with concentration, memory and learning.

Does cannabis trigger mental illness ?

o Cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.The chances of developing psychosis reportedly increases by five times compared to people who have never used marijuana.
o Dual diagnosis : Individuals with a mental health disorder using marijuana.
o Regular cannabis use may be linked to greater symptoms than non users amongst Bipolar patients.
o Heavy cannabis users is associated with suicidality.
o Regular cannabis use increases the risk of social anxiety disorder.
o Gateway drug : Cannabis is said to serve as a stepping-stone for more dangerous substance addictions.

Prevention ? "Say No To drugs" campaign starting from educational institutes and at grass-root levels and with a wide outreach approach and under proper Governmental and expert supervision is the way forward. The casual attitude towards Cannabis abuse as "a rite of passage" should be changed.

The "medicinal properties" of Cannabis should not be an excuse for the ill-informed to abuse the drug. It would help to bear in mind that many of the drugs of abuse like morphine, alcohol, etc. also have medicinal indications but they are given under strict guidance and monitoring. The pharmacological benefit of any substance does not validate misuse.

The psychoactive property of cannabis and the widespread negative impact not only upon the individual abusing it but their family, society, economic, law and order issues mandates absolute abstinence.

Cure ?

Cannabis abuse is definitely treatable given the right approach, motivation and attitude of the individual and family support. But especially during this pandemic, it is unfair and totally unnecessary that so many of one's closest people should have to bear the brunt of what started as a very avoidable bad habit, maybe out of curiosity, peer pressure or plain boredom.

Be smart, don't start.