Easily the coolest college professor you could ever hope to have.

Every Wednesday on NORML SHOW LIVE, Dr. Mitch Earleywine joins us to discuss the latest research in cannabis and to take live calls and chat questions from listeners on marijuana culture, history, medicine, and science.  He is a member of the NORML Advisory Board and his research has been published in over fifty scientific journals on drugs and addiction.  He is the author of Understanding Marijuana, Pot Politics, and Parents’ Guide to Marijuana, and a professor of psychology at SUNY Albany.  We asked Dr. Mitch his opinions of the latest meta-analysis on cannabis and schizophrenia.

Download full interview at http://audio.norml.org/events/Dr. Mitch Earleywine – Latest Cannabis Psychoses Bunk.mp3

NORML SHOW LIVE: The headlines are out there – CNN, WebMD, NPR, every little bit of alphabet soup out there on the cable channels and the news – is trumpeting this headline, this study – Matthew Large, I believe, is the lead researcher on this – from Prince of Wales Hospital in New South Wales Australia says quote:

“It is increasingly clear that marijuana is a cause of schizophrenia and that schizophrenia caused by cannabis starts earlier than schizophrenia with other causes.”

DR. MITCH EARLEYWINE:  Alas, no.  There are no new data – I want to emphasize that – this is a meta-analysis, which means it takes the studies that were already out there and tries to combine them mathematically to make sense of it all.  What you’re not hearing in the media is that in fact, this is probably early-onset folks self-medicating.

You can imagine somebody who is experiencing some symptoms of psychosis, particularly folks with less access to medical care, or folks who are already a little bit paranoid because of the disorder and they’re unwilling to go to a physician.  They hear their friends are using cannabis and enjoying it.  They do it, too, they notice some mild improvements in their symptoms, they turn to it later when they have a psychotic break.   What a surprise, [the researchers] say, “they smoked cannabis first, that’s the big issue.”

What burns my ass is that this same journal a month before had another article failing to replicate this data where we find folks with a special genetic risk and if they’re heavily involved with cannabis early in life they’re more likely to develop schizophrenia.  So all this malarkey about, “oh, if you’re a genetic risk then you’re really gonna get it” isn’t showing up in other data sets.  The media isn’t covering that in the least.

The other finding in this big meta-analysis is that early onset of psychosis showed up for folks who were using drugs more generally – not just cannabis – and this makes much more sense pharmacologically.  When you think about cocaine, amphetamine, and other drugs that work directly in the dopamine system, that’s the system that schizophrenia is all about.  And what a surprise, these folks are more likely to have an early onset.

I’m concerned that the cannabis-related studies are really spurious and they’re compounded by  use of amphetamines, Ritalin, Adderall, all these other stimulant drugs that people were – particularly in Australia – unwilling to fess up to, but more than willing to say they used cannabis.  We’ve got a big problem here.

As we’ve seen time and again none of us want children to have access to cannabis. And the way to get that access limited is, of course, not an underground market that never cards anybody, but a taxed and regulated one, where folks that are too young to be experimenting with this and folks who have psychosis in the family can be markedly more advised and essentially educated before they even purchase the plant.

NSL: Matthew Large, this researcher here, even addressed what we just discussed about the self-medication; he said, quote:

“There is not so much evidence for the widely-held view those patients self-medicate with marijuana.  Marijuana smoking almost always comes before psychosis and few patients with psychosis start smoking marijuana for the first time.”

Is this a case then where they’re just defining psychosis as their starting point of looking at these people rather than the onset of symptoms that would pre-date or pre-sage the psychosis that’s about to come?

DR. MITCH: That’s it exactly, Russ, and as we’ve mentioned in the past what often happens is they find a big record of people who’ve had psychotic breaks and then go back and see if they’ve reported cannabis earlier.  But we have very poor assessments of these potential psychotic symptoms before these people used cannabis and the few studies that do do that, the measures are slightly biased against cannabis users.

I’ve pointed out in the past one of the big questionnaires for this – a schizotypal personality questionnaire – has an item that says “I use words in strange and unusual ways.” Well, sure, schizophrenics certainly do that.  They make words up; that’s part of the way that you manifest the diagnosis.  But we also have a whole subculture here where people are “kickin’ back with the chronic at 420.”  Well, what a surprise, people who do that may say “I use words in a strange and unusual ways.”  In my dataset when you drop that item out, suddenly the link between schizotypy and cannabis use disappears. I’m concerned there are comparable problems in these other datasets.

NSL: One of the things we’ve always said in these pieces with you and I talking about this is how worldwide the rates of schizophrenia and psychosis seemed to stay stable at about 1% of the population, even if that population starts smoking a whole lot of weed – if a lot of them start smoking or if they start smoking a lot of it – doesn’t matter is still stays the same.

But one of the hypotheses they have here is that, “Yeah, sure, there’s a certain 1% that are gonna get psychosis but these 1% are gonna get it earlier and then they’d have these extra two or three years of psychosis-free functioning that they would be losing out of because of their use of marijuana.”

My first thought on that is if this were the case, wouldn’t we see a lowering of the median age of psychosis onset when we have higher use of cannabis in a society?

DR. MITCH: In fact, Wayne Hall in Australia has made this same suggestion and they have yet to detect this change in the median age of first onset. But he’s suggesting that some new data are going to reveal that in the current younger cohort, this is the case.  I haven’t seen those data yet and I’m a little concerned.  In part we go to so much effort now to try to identify psychosis earlier that it seems like if that is the case, it may be simply that we are better at identifying psychotic disorders than we were 20 years ago, so we have this other potential confound.  And as Paul [Armentano] has emphasized time and again, we do have a subset of folks who really respond well to cannabis-based medicines in controlling psychotic episodes, and I think it may be a cannabidiol issue where Project CBD may be able to help us isolate who might be helped and who might not from this.

And then, of course, that fits that self-medication hypothesis better.  I feel like the critique of that self-medication that they offer in this meta-analysis is premature, in part because of how poorly we assess psychotic symptoms prior to anyone’s cannabis use.

NSL: What is the actual risk to people who have a history of mental illness or who feel they may have a certain mental illness and how they should entertain the notion of using cannabis to treat themselves?

DR. MITCH: In fact, cannabis is rarely my first choice for any of the more common mental illnesses. So we’ve talked before about depression, anxiety, and PTSD.  With depression, cannabis may help a subset of folks.  A number of my friends who’re in clinical practice say that the people who are using it are having more troubles in their practice.  But that may be a different subset.

But my first line of defense – it really sounds corny – but kind of a bibliotherapy.  Educate yourself about depression. If you have a mental health center that you appreciate, 12 weeks of good hard work, of taking a look at your own faults, how you behave during the day, the way you frame the events in your life; that can last a lifetime in the treatment of depression.  And then cannabis is just to enjoy, not something you have to lean on in order to make sure you have a happy day.

With anxiety, I’ve done this both on Facebook to some of our friends and repeatedly in emails and my published work.  Anxiety is one of the psychological disorders that psychology really has mastered. If folks again are willing to go see a therapist for a good couple of months and really put some effort in, you can literally tame this kind of thing and make it so anxiety is no longer debilitating, and then suddenly your cannabis again is just for fun.  The idea that cannabis is actually going to help anxiety is very dose-dependent, very strain-dependent, and not the most efficient way to get at this.

PTSD, I just got those new data on that.  A ton of people think that cannabis helps some of the symptoms of PTSD.  I completely believe them.  But compared to these exposure-based treatments – which I know are a drag – [cannabis] is not going to last a lifetime the way that that kind of treatment can, and then again cannabis is just for fun.  It doesn’t have to be for medication and you’re less likely to have these lingering symptoms of the emotional numbing, the distancing from your family, or these kind of freaking-out experiences when you’re in a big crowd.  And then, what a surprise, you basically worked hard for three months and kicked this disorder rather than felt like “I have to lean on cannabis for the rest of my life.”

To add insult to injury, this latest dose of reefer rhetoric comes only days after investigators in the United Kingdom reported in the prestigious scientific journal Addiction that the available evidence in support of this theory is “neither very new, nor by normal criteria, particularly compelling.” (Predictably, the conclusions of that study went all together unnoticed by the mainstream press.)

Yet today’s latest alarmist report, like those studies touting similar claims before it, fails to account for the following: If, as the authors of this latest study suggest, cannabis use is a cause of mental illness (and schizophrenia in particular), then why have diagnosed incidences of schizophrenia not paralleled rising trends in cannabis use over time?

In fact, it was only in September when investigators at the Keele University Medical School in Britain smashed the pot = schizophrenia theory to smithereens. Writing in the journal Schizophrenia Research, the team compared trends in marijuana use and incidences of schizophrenia in the United Kingdom from 1996 to 2005. Researchers reported that the “incidence and prevalence of schizophrenia and psychoses were either stable or declining” during this period, even the use of cannabis among the general population was rising.

That said, none of this is to suggest that there may not be some association between marijuana use and certain psychiatric ailments. Cannabis use can correlate with mental illness for many reasons. People often turn to cannabis to alleviate the symptoms of distress. One study performed in Germany showed that cannabis offsets certain cognitive declines in schizophrenic patients. Another study demonstrated that psychotic symptoms predict later use of cannabis, suggesting that people might turn to the plant for help rather than become ill after use.

Of course, even if one takes the MSM’s latest ‘sky is falling’ scenario at face value, health risks connected with pot use — when scientifically documented — should not be seen as legitimate reasons for criminal prohibition, but instead, as reasons for the plant’s legal regulation.

For instance, as I told AOL News earlier today: “We don’t outlaw peanuts because a small percentage of people have allergic reactions. We educate the community, we regulate where and when peanuts can be exchanged. That seems like it ought to apply to marijuana, too.”

To draw another real world comparison, millions of Americans safely use ibuprofen as an effective pain reliever. However, among a minority of the population who suffer from liver and kidney problems, ibuprofen presents a legitimate and substantial health risk. However, this fact no more calls for the criminalization of ibuprofen among adults than do these latest anti-pot allegations, even if true, call for the current prohibition of cannabis.

Placed in this context, today’s warnings latest do little to advance the government’s position in favor of tightening prohibition, and provide ample ammunition to wage for its repeal.

Researchers worldwide have performed 37 separate clinical trials assessing the therapeutic safety and efficacy of inhaled cannabis and marijuana-based medicines since 2005, according to a review published online last week in the journal Cannabinoids: The Journal of the International Association for Cannabinoid Medicines (IACM).

Investigators from Leiden University in the Netherlands and the nova-Institut in Germany conducted a systematic review of recent clinical trial data pertaining to the medical use of whole smoked marijuana and cannabinoids.

Authors identified 37 controlled studies since 2005 evaluating the therapeutic effects of cannabinoids. The trials involved a total of 2,563 subjects.

Of the 37 clinical trials that have been recently conducted, eleven assessed the drug’s impact on chronic neuropathic pain – a difficult to treat type of pain resulting from nerve damage. Other studies assessed the efficacy of cannabinoids to treat multiple sclerosis-associated spasticity (nine separate studies); HIV/AIDS (four); experimental pain (four); intestinal dysfunction (two); nausea/vomiting/appetite (two); schizophrenia (two); glaucoma (one); and ‘other indications (two).

Authors concluded, “Based on the clinical results, cannabinoids present an interesting therapeutic potential mainly as analgesics in chronic neuropathic pain, appetite stimulants in debilitating diseases (cancer and AIDS), as well as in the treatment of multiple sclerosis.”

Last Wednesday investigators from the California Center for Medicinal Cannabis Research released the results of a series of double-blind, placebo-controlled trials that determined that cannabinoids could be “a first-line treatment” for patients suffering from neuropathy.

Commenting on the review, NORML Deputy Director Paul Armentano said: “The safety and efficacy of marijuana as a medicine has now been established by the ‘gold standard’ of clinical study. Further, over 2,500 patients have used cannabinoids in controlled clinical trials over the past five years alone. This is a far greater total than the number of subjects that would likely be administered any other new drug pending United States FDA approval, and is a large enough population to once and for all establish marijuana’s objective value as a medicine.”

Clinical evidence indicating that marijuana use may be casually linked to incidences of schizophrenia or other psychological harms is not compelling, according to a scientific review published online by the journal Addiction.

Investigators at the University of Bristol, Department of Social Medicine assessed the potential health risks of cannabis, particularly whether use of the drug may be causally linked with mental illness.

Authors wrote: “We continue to take the view that the evidence that cannabis use causes schizophrenia is neither very new, nor by normal criteria, particularly compelling. … For example, our recent modeling suggests that we would need to prevent between 3000 and 5000 cases of heavy cannabis use among young men and women to prevent one case of schizophrenia, and that four or five times more young people would need to avoid light cannabis use to prevent a single schizophrenia case. … We conclude that the strongest evidence of a possible causal relation between cannabis use and schizophrenia emerged more than 20 years ago and that the strength of more recent evidence may have been overstated.”

In 2007, an analysis in the British medical journal The Lancet estimated that experimenting with marijuana could increase one’s risk of developing a psychotic illness later in life by some 40 percent. Following this report, Parliament in 2008 voted to reclassify marijuana as a Class B substance, making its possession punishable by up to five years in prison.

University of Bristol researchers also criticized Parliament’s reclassification of the drug, which took effect earlier this year. They concluded: “The only important possible benefit of prohibition is prevention of cannabis use. There is little or no evidence that it effectively achieves this benefit. Patterns of cannabis use in the population appear to be independent of the policy surrounding use, and criminalizing individual cannabis users does not appear to modify their use in a healthy way.”

Overall, investigators determined that marijuana’s most significant health risk was its association and reinforcement with tobacco smoking.

Apparently my latest missive has hit a nerve — as it has quickly risen to become the most read story on Alternet.

5 Things the Corporate Media Don’t Want You to Know About Cannabis
via Alternet.org

1. Marijuana Use Is Not Associated With a Rise in Incidences of Schizophrenia

2. Marijuana Smoke Doesn’t Damage the Lungs Like Tobacco

3. Cannabis Use Potentially Protects, Rather Than Harms, the Brain

4. Marijuana Is a Terminus, Not a ‘Gateway,’ to Hard Drug Use

5. Government’s Anti-Pot Ads Encourage, Rather Than Discourage, Marijuana Use

Read the full text of the story here.

Doubt cast on cannabis, schizophrenia link
via CBC

A British study has cast doubt on the supposed link between cannabis use and schizophrenia.

… This latest study, led by Dr. Martin Frisher of Keele University, examined the records of 600,000 patients aged between 16 and 44.

… Frisher and colleagues compared the trends of cannabis use with general practitioner records of schizophrenia and psychosis.

They argue that if cannabis use does cause schizophrenia, an increase in cannabis use should be followed by an increase in the incidence of schizophrenia.

According to the study, cannabis use in the United Kingdom between 1972 and 2002 has increased four-fold in the general population, and 18-fold among under-18s.

Based on the literature supporting the link, the authors argue that this should be followed by an increase in schizophrenia incidence of 29 per cent between 1990 and 2010.

But the researchers found no increase in the rates of schizophrenia and psychosis diagnosis during that period. In fact, some of the data suggested the incidence of these conditions had decreased.

Over the past few years the mainstream media, as well as federal politicians, have enjoyed promoting the notion that smoking pot induces mental illness. Perhaps most notably, in 2007 the MSM touted that cannabis “could boost the risk of developing a psychotic illness later in life by about 40 percent” — a talking point that was also publicly promoted US anti-drug officials. Similarly, Canadian bureaucrats alleged — just two weeks ago — that marijuana users have a “seven-fold increase” in risk of developing schizophrenia.

Given this environment, I held little hope that anyone in the MSM would bother to report on the Keele University study — which initially appeared online on the website of the journal Schizophrenia Research in late June and was reported on by NORML on July 2 — despite its obvious newsworthiness.

And for nearly two months no one did. But kudos to the Australian Broadcasting Corporation and a handful of British tabloids for just now bringing these findings to light (and even acknowledging that the MSM would have arguably provided far more prominence to this story had the findings demonstrated the opposite result.)

For now, let’s score one for the good guys, and cross your fingers that the American press will also eventually take notice.

Most notably perhaps, a team of researchers writing in the July 28, 2007 edition of the prestigious scientific journal The Lancet, boldly proclaimed that smoking cannabis could boost one’s risk of a psychotic episode by 40 percent or more.

Naturally, this alarmist rhetoric received wall-to-wall coverage by the mainstream press. Even more troubling, the supposed ‘pot-and-schizophrenia’ link was one of the primary reasons cited by British PM Gordon Brown, ex-Home Secretary Jacqui Smith and others as the impetus for reclassifying cannabis (from a verbal warning to a criminal offense punishable by up to five years in jail) in the United Kingdom.

Of course, there was a fatal flaw with The Lancet‘s argument — one that, oddly enough, every single MSM outlet failed to mention. Empirical data did not support the investigators’ hypothesis that smoking marijuana was associated with increased rates of schizophrenia or other mental illnesses among the general public — a fact that even the authors begrudgingly admitted when they declared, “Projected trends for schizophrenia incidence have not paralleled trends in cannabis use over time.”

Which brings us to 2009.

Two years after The Lancet‘s dire predictions, a team of researchers at the Keele University Medical School have once and for all put the ‘pot-and-mental illness’ claims to the test. Writing in a forthcoming edition of the scientific journal Schizophrenia Research, they compare long-term trends in marijuana use and incidences of schizophrenia and/or psychoses in the United Kingdom. And what do they find?

“[T]he expected rise in diagnoses of schizophrenia and psychoses did not occur over a 10 year period. This study does not therefore support the specific causal link between cannabis use and incidence of psychotic disorders. … This concurs with other reports indicating that increases in population cannabis use have not been followed by increases in psychotic incidence.”

Should we expect an apology — or even better, a change in policy — from the Gordon Brown regime any time soon? Or at the very least, will some sort of ‘correction’ be forthcoming from the mainstream news media?

I wouldn’t hold my breath.

Feds: Teen use of pot can lead to mental illness
via The Associated Press

WASHINGTON (AP) —Depression, teens and marijuana are a dangerous mix that can lead to dependency, mental illness or suicidal thoughts, according to a White House report released Friday.A teen who has been depressed at some point in the past year is more than twice as likely to have used marijuana as teens who have not reported being depressed — 25 percent compared with 12 percent, said the report by the White House Office of National Drug Control Policy.

“Marijuana is a more consequential substance of abuse than our culture has treated it in the last 20 years,” said John Walters, director of the office. “This is not just youthful experimentation that they’ll get over as we used to think in the past.”

…

“It’s not something you look the other way about when your teen starts appearing careless about their grooming, withdrawing from the family, losing interest in daily activities,” Walters said. “Find out what’s wrong.”

Gotta love Walters’ remark about hygiene — which he appears to have taken almost verbatim from Above The Influence’s hateful propaganda film, Stoners In The Mist.

Seriously though, it goes without saying that this so-called White House ‘report‘ (I use the term euphemistically here, given that said ‘report’ is under five pages and consists mostly of bar charts rather than text) is much ado about nothing. In fact, the only newsworthy aspect of this supposed ‘study’ is that the lapdog mainstream media gave it any coverage at all.

In short, there’s nothing to the Drug Czar’s marijuana and mental health claims that NORML Advisory Board member Dr. Mitch Earleywine and I haven’t previously addressed in our essay here:

Pot Smoking Won’t Make You Crazy, But Dealing With The Lies About It Will
via Alternet

Perhaps the most impressive evidence against the cause-and-effect relationship concerns the unvarying rate of psychoses across different eras and different countries. People are no more likely to be psychotic in Canada or the United States (two nations where large percentages of citizens use cannabis) than they are in Sweden or Japan (where self-reported marijuana use is extremely low). Even after the enormous popularity of cannabis in the 1960s and 1970s, rates of psychotic disorders haven’t increased.

Ironically, just two days prior to the Drug Czar’s much ballyhooed press conference, Britain’s Advisory Panel on the Misuse of Drugs refuted the notion that pot use causes mental illness, stating, “The evidence for the existence of an association between frequency of cannabis use and the development of psychosis is, on the available evidence, weak.”

A 2006 review by the same commission previously concluded, “The current evidence suggests, at worst, that using cannabis increases lifetime risk of developing schizophrenia by one percent.” And more recently, a highly touted meta-analysis in the British medical journal, The Lancet, reported that there is a dearth of scientific evidence indicating that cannabis use causes psychotic behavior, noting, “Projected trends for schizophrenia incidence have not paralleled trends in cannabis use over time.”

Of course, none of this dismisses the possibility that pot use may exacerbate certain mental health problems in a handful of individuals. As NORML notes in a recent white paper, “Cannabis, Mental Health and Context:”

There is limited data suggesting an association, albiet a minor one, between chronic cannabis (primarily among adolescents and/or those predisposed to mental illness) and increased symptoms of depression, psychotic symptoms, and/or schizophrenia. However, interpretation of this data is troublesome and, to date, this observation association is not well understood. Identified as well as unidentified confounding factors (such as poverty, family history, polydrug use, etc.) make it difficult, if not impossible, for researchers to adequately determine whether any cause-and-effect relationship exists between cannabis use and mental illness. Also, many experts point out that this association may be due to patients’ self-medicating with cannabis, as survey data and anecdotal reports of individuals finding therapeutic relief from both clinical depression and schizotypal behavior are common within medical lore, and clinical testing on the use of cannabinoids to treat certain symptoms of mental illness has been recommended.

That said, however, the most practical public policy to address these concerns is not criminal prohibition, but regulation.

If there does exist a minority population of citizens who may be genetically prone to potential harms from cannabis (such as, possibly, those predisposed to schizophrenia), then a regulated system would best identify and educate this sub-population to pot’s potential risks so that they may refrain from its use, if they so choose.

To draw a real world comparison, millions of Americans safely use ibuprofen as an effective pain reliever. However, among a minority of the population who suffer from liver and kidney problems, ibuprofen presents a legitimate and substantial health risk. However, this fact no more calls for the criminalization of ibuprofen among adults than do these latest allegations, even if true, call for the current prohibition of cannabis.

You can read the full report here.