Medical Marijuana for Bipolar? Getting High is NOT the Object
On January 1, laws making legal the use of recreational marijuana went into effect in Colorado and the state of Washington. Fifty-six percent of Americans now favor legalization and regulation of marijuana.
In the meantime, there are 20 states plus Washington DC where medical marijuana is legal, and four states with pending legislation.
"Medical marijuana" is something of a misnomer. A physician does not write a prescription for a specific compound at a specific dosage that a patient fills at a pharmacy. Indeed, the physician’s only involvement may be in issuing the requisite medical marijuana card.
The card allows users to shop at marijuana dispensaries. It also amounts to a "get out of jail free" card
Having said that, medical marijuana has been a godsend to many, offering relief across a wide range of conditions. One can also make a case for medical marijuana to treat bipolar, albeit one with a host of major provisos. At the very least, the issue bears examination. Let’s get started …
The case for medical marijuana
Anyone who has endured for just one minute the sheer terror of the brain in a state of siege is justified in checking out any form of relief. Like most other psychiatric meds, marijuana slows down the brain. Depending on the user, this may translate to relieving anxiety, reducing stress, regulating sleep, easing mania and agitated depressions, and even improving cognition. Marijuana may also be incorporated into a strategy of maintaining good mental health.
Also, for some people, marijuana may offer a safer alternative to prescription meds.
But there is a major catch or two …
Safety and abuse issues
All medications, including psychiatric meds, carry substantial risks that must be weighed against potential benefits. Marijuana is no exception.
"Self-medicating" is an extremely serious concern for our population. Six in ten of those with bipolar have experienced substance abuse sometime during their life, five times the rate of the general population. Co-occurring substance abuse can effectively turn treatable bipolar into untreatable bipolar.
In addition, a number of studies have linked marijuana use to an increased risk of psychosis. This is not the same as saying marijuana "causes" psychosis. Moreover, the studies suggest that the risk is greatest in those who begin marijuana in their teens. Nevertheless, we need to be mindful of the risk.
And it goes without saying: Cognitive abilities take a major hit (pun intended).
Last but not least, smoking marijuana raises the same health concerns as smoking tobacco.
There are no clinical trials to support the use of marijuana in treating bipolar. Having said that, "absence of evidence" does not equate to "evidence of absence." Nevertheless, we lack essential medical guidance in terms of best practices and treatment strategies.
An alcohol parallel
"Glass of wine a day may ward off depression," reads a headline on WebMD.
The catch is when that one glass of wine turns into two or three - when a small indulgence turns into a craving and an addiction, when an escape from stress turns into an escape from reality, when an enhanced ability to function turns into a major impairment and a ruined life.
In other words, can we trust ourselves?
Two possible marijuana strategies
Assuming we can trust ourselves …
The first strategy is analogous taking an anti-anxiety med PRN, "as needed." In an ideal situation, the med does its job and life returns to normal. We stop taking the med before building up a tolerance or dependency or incurring long-term side effects.
The second is analogous to staying on a mood stabilizer as part of a maintenance strategy, perhaps not continuously but on a more regular basis. In an ideal situation, the med is running in the background. We are hardly aware of it.
It is very important to note that neither strategy calls for getting high. A "medical" dose is not to be equated with a recreational dose. Likewise, a medical bipolar dose (whatever that may be) is not to be equated with a dose for another medical condition, such as chronic pain.
To put it another way: Getting high is not a sign of the efficacy of the treatment. Nor is it a legitimate side effect. The result you’re looking for is extremely subtle but profound - a brain that works.
Nevertheless, some short-term cognitive impairment may be inevitable. As with any medication, this needs to be incorporated into your treatment strategy, such as, perhaps, using only before bedtime.
Please endeavor to find a physician or therapist you can work with. If you are on any medication, you need to inform your physician.
Choosing your product
All marijuana plants are technically cannabis sativa. But there is an indica variety that has the effect of slowing down the brain, as opposed to the more uplifting effects of sativa. As a general rule, sativa may help more with depression, indica for a runaway brain and regulating sleep. Dispensaries supply clearly labeled products. There are also various blends and hybrids.
Doses and delivery systems
The main concern for medical marijuana, especially for bipolar, is calibrating doses. Back in the old days of nickel bags and marijuana brownies, this was virtually impossible. These days, dispensaries carry very sophisticated products that promise some degree of consistency. We are still in a wild west market, but the before and after represents a quantum improvement.
Ingestible cannabis - Typically, it takes 30-60 minutes to feel the effects of ingested cannabis. The effect also tends to be longer lasting. Accordingly, ingestibles may lend themselves to maintenance strategies. A very little goes a very long way.
Inhaled cannabis - The effect is instant and more transient, which lends itself to "as needed" strategies. Inhaled cannabis is far less potent than the ingestible variety, but one hit may be all you need.
Vaporizers and pens - In their latest incarnation, these are e-cigarettes applied to marijuana. Depending on the pen, the user inhales the vapor of a concentrate or flower, without the health risks of traditional smoking. Because no lighting up is involved and because there is little or no telltale aroma, users can take a discreet hit with little fear of discovery.
Lest there be any misunderstandings …
Please do not construe any of the above as an endorsement for using marijuana to treat your bipolar. Nor should any of the above be interpreted as any kind of medical or consumer guideline. Rather, we are seeking an intelligent discussion on an issue that is fraught with ignorance and lack of understanding.
Please feel free to share your insight and experience. Comments below …
John is an author and advocate for Mental Health. He wrote for HealthCentral as a patient expert for Depression and Bipolar Disorder.