Concerns associated with the use of medical cannabis

Kevin Hill, MD, MS, is an addiction psychiatrist and director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center and associate professor of psychiatry at Harvard Medical School, USA. His research interests include the development of medications to treat cannabis use disorder. He provides consultations to organizations seeking assistance with cannabis or opioid policy.

What should be the main concerns associated with the use of medical cannabis?

Kevin Hill, MD, MS: We always want to have an important risk-benefit discussion with patients. I do think there are some limited indications for the use of medical cannabis therapeutically, but with all of those discussions, we also want to make sure that we talk about what the risks are.

And there are a lot of risks. You can have acute problems associated with cannabis use: it can affect your ability to make decisions, it can affect your ability to drive. Those are a couple of them. Most of the problems that we see with cannabis use are associated with chronic use. People are using it multiple times a day, often every day, and so those are a myriad. It could be cognitive difficulties, sometimes people have memory difficulties related to their cannabis use. It can worsen existing psychiatric conditions like depression or anxiety, it can increase the likelihood that somebody has suicidal ideation, and perhaps most prominently for those who have a family history of a psychotic disorder like schizophrenia or schizoaffective disorder, or bipolar disorder with psychotic features, using cannabis regularly, particularly at an early age, may increase the likelihood that they express those disorders. So that may be increasing those odds by 1.5 to even 5 times.

That’s why it’s so important, when any patient is interested in using medical cannabis or other cannabinoids, that we have a clear and sensible evidence-based conversation about not only what the possible benefits might be, but also what the risks may be.