Pubdate: Mon, 06 Jun 2016
Source: Toronto Star (CN ON)
Page: A1
Copyright: 2016 The Toronto Star
Author: Marina Jimenez


Scientists Studying What Triggers the Phenomenon Say It's A Myth That 
Using Cannabis Is Free of Risks

At first, the voices he heard in his head were pleasant. But then, 
they turned malevolent.

Jean Thibodeau, a 19-year-old University of Toronto student and avid 
pot smoker, became convinced he was possessed by the devil. He could 
see blood gushing down his chest and feel a deep gash in his neck.

"I remember thinking, 'I'm going to die,' " Thibodeau said.

His roommate became so concerned he took him to the emergency 
department of the Centre for Addiction and Mental Health (CAMH).

"They told me I was having a psychotic episode brought on by 
cannabis," said Thibodeau, who requested that the Star use his 
grandmother's surname as he is still recovering from the breakdown.

"I was shocked. We live in a society where there is such a culture 
around smoking dope that people think it is cool to be a stoner. 
Nobody ever talks about the pitfalls."

Researchers have established a link between cannabis and psychosis 
among young people, although they cannot predict who will be triggered, or why.

Youths who are especially at risk are those with a family history of 
mental illness, or who have suffered sexual or physical abuse.

Thibodeau, who went to private school and has a supportive, intact 
family, doesn't fit any of these categories. "When people start 
smoking before the age of 16, there is a higher risk of having a 
psychotic experience. We know that early use is dangerous," said Dr. 
Romina Mizrahi, a psychiatrist and director of the Focus on Youth 
Psychosis Prevention Clinic at CAMH. "The brain continues to develop 
until the age of 25."

The clinic has treated 55 teenagers and people in their early 20s for 
what Mizrahi calls "pre-psychosis" in the past 2 1/2 years. These are 
people who, like Thibodeau, report hearing voices in their heads, or 
experience paranoid delusions, and are referred by a family doctor or 
psychiatrist to the program.

"They are not sick yet, but they are having symptoms. They are still 
rational, and we can help prevent further experiences of psychosis or 
full-blown disorders such as schizophrenia," Mizrahi explained. "We 
advise them to abstain from smoking marijuana."

Experts do not believe that legalizing cannabis will make it any 
easier for teenagers or young people to buy it, because it is so 
readily available already. By the end of Grade 12 in Ontario, 37 per 
cent of students will have used cannabis, according to a 2015 
longitudinal CAMH study on drug use.

But psychologists and researchers want to have a more nuanced 
conversation about the drug's potential harmful effects, especially 
as pot dispensaries open across Toronto, Vancouver and other Canadian cities.

"A lot of teenagers who smoke dope say, 'I smoke dope and so do all 
my friends and none of us have gone crazy,' " said Cory Gerritsen, a 
clinical psychologist who facilitates CAMH's youth prevention clinic.

"They simply do not believe there are any risks."

Thibodeau wants people to know that there are risks. He had never 
tried marijuana in high school. But when he started at the U of T in 
the fall of 2013, his roommate offered him a joint. He became hooked. 
He bought a vaporizer pipe and started smoking daily, and neglected 
his course work. Then the voices began.

"I had the sensation of a gust of wind in my ear and it was like a 
second consciousness talking to me," he recalled. "At first, it was a 
force for good. But then the voice became abusive."

The voice said he would die. And Thibodeau believed it to be true. He 
continued to smoke pot daily, and didn't make the link between 
marijuana and his delusions until he ended up in CAMH a year later.

He was prescribed an anti-psychotic drug and enrolled in the youth 
prevention clinic. To combat his anxiety, he learned mindfulness 
meditation, as well as positive imaging and distraction techniques. 
Slowly, the voices retreated.

"We are trying to build up young people's resilience and get them 
back on a positive trajectory," said Gerritsen. "We are trying to 
prevent kids from becoming lost. If they say they cannot quit smoking 
dope, we send them to an addictions program."

Research studies have found that people who use high doses of 
marijuana frequently over many years, or who start using it in 
adolescence, are at increased risk of suffering side effects. A 
review of research on recreational use looked at 116 studies and 
concluded that it is linked to various mental effects, including 
panic attacks, anxiety, cognitive impairment and psychosis. The study 
was published in 2015 in Deutsches Arzteblatt, a German medical magazine.

Mizrahi, who is also a research scientist, is studying the effects of 
tetrahydrocannabinol (THC) and cannabidiol (CBD) - two ingredients in 
marijuana - on the brain, among smokers and non-smokers, patients 
with schizophrenia, and those at risk of developing it.

THC provides a euphoric effect, while CBD has anti-psychotic, 
anti-anxiety effects. In the past decade, growers have created 
strains with more THC because users enjoy the feeling of euphoria. 
But THC is also associated with psychosis.

"There are significant changes in the brain when people use 
cannabis," she said. It may be that people self-medicate with 
marijuana because there is something wrong with their own natural 
endocannabinoid system, which regulates stress, she said.

Contrary to popular belief, cannabis can be addictive, though 
withdrawal symptoms are not as strong as they are for other drugs, 
such as heroin. Thibodeau said he fights the urge to smoke every day 
and feels a deep sense of shame about what happened to him, even as 
he looks forward to completing his degree and leaving the stoner life behind.
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MAP posted-by: Jay Bergstrom