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November 2020

Cannabis: Caution Patients About Psychiatric Side Effects

There is mounting evidence that psychiatric side effects are a greater concern for edible and high-potency cannabis products. Talk to patients about why some forms and doses of cannabis pose greater risks, and why some patients should avoid cannabis altogether.

Reports suggest that over 40% of recreational cannabis users consume edible products. Despite their popularity, ambiguous dosing and delayed effects can be a major problem, increasing the risk for unintended side effects and overdose. While inhaling cannabis results in an immediate effect, edible products may not produce effects for more than 3 hours, which can then last for many more hours. Caution patients about this delayed effect –  consuming more cannabis while waiting for the initial effect can increase the risk of toxicity. Make sure patients understand that psychiatric and cardiovascular side effects appear to be more common with edible products. And edible products containing 50 mg of THC or more have been linked to psychosis, anxiety, and heart attack.

High-potency cannabis products are also becoming a major concern, particularly for adolescents. These products are increasingly available. Research shows that inhaling cannabis products containing 10% or more of THC is linked to increased risk for anxiety and cannabis use disorders. Make sure your adolescent patients understand these risks. And talk to them about the potential long-term consequences of habitual use, including cannabinoid hyperemesis syndrome (CHS). Also, explain to patients with existing psychiatric disorders that cannabis might actually make their symptoms worse, no matter what form of cannabis they use. There’s a fair amount of observational evidence supporting this concern, despite the fact that cannabis is often recommended to help manage psychiatric disorders.

In general, chronic cannabis use is a growing concern. It’s important to counsel patients about the risks of dependence and potential psychiatric effects, particularly those patients who are already at risk for psychiatric illness. Advise all patients to steer clear of high-potency products, and to use caution with edibles. And reiterate to your pregnant patients that using cannabis in any form is unsafe – it’s been linked to developmental problems in the baby, including lower intelligence and emotional problems.

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