Changing conversation about marijuana may improve public health, policy outcomes

TORONTO — As legislation continues to address the hotly debated topic of marijuana use, psychiatrists have a potentially key role in educating patients, the public and policymakers about evidence-based benefits and risks of marijuana use.

According to Kevin P. Hill, MD, MHS, of the division of alcohol and drug abuse at McLean Hospital, the best way to address a patient who uses marijuana is not to reprimand them but take a more balanced approach.

“If a 17-year old adolescent who uses marijuana every day comes into the office and I hammer him with the negatives of marijuana based off of scientific data, I’m not going to get anywhere. He probably won’t come back unless forced by his parents,” Hill said during a presentation at the American Psychiatric Association Annual Meeting. “I think it is important to try to understand where they are coming from and what their perceived benefit is.”

Hill suggests psychiatrists address the short-term risks and benefits to young patients who use marijuana. For example, using their desire to enroll in a particular university to illustrate the risk of using.

Public opinions on marijuana use are often opposing extremes — either vehemently opposed to legalization of marijuana or strongly supportive of legalization.

Public policy follows the same pattern, according to Hill.

“In state after state we have a very strong pro-marijuana side that believes marijuana use is harmless — and that’s not the case. On the other side, we have some very strong anti-marijuana folks who go into schools and relay the message that if you engage in any marijuana use you’re doomed — that's not the case either” he said.

Hill suggests the approach to public policy mimic his outlined approach for clinicians: Firmly opposing or supporting marijuana use may not have the best long-term effects. The key, according to Hill, is balance.

“What we’ve seen happen with the 23 states and the District of Columbia that have medical marijuana and the four states and the district that have legalized recreational marijuana is two competing sides digging in their heels without compromise. And we end up with policy that just doesn’t work,” he said.

Marijuana is one of the most commonly used drugs across the globe, with 20 million Americans reporting use in the last year, according to Hill.

With these numbers in mind, marijuana use cannot be ignored. Future policy should draw from the successes and failures of current systems to establish legislation that represents benefits of marijuana use and recognizes the risks and harms.

“This is a critical period. It’s so important to know what the evidence is. Trends are ominous. It is hard not to look at these data and not believe things are probably going to get worse before they get better unless we do a better job of educating people on this matter,” Hill said. “I think we can provide a service by being informed and educating other providers and patients about these issues.” – by Amanda Oldt

Reference:

Hill KP. Medical marijuana: What a psychiatrist needs to know. Presented at: American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto.

Disclosure: Hill reports no relevant financial disclosures.