S1: We have this attitude in our society that it's sort
S1: of a benign drug.
S2: All three of my sons claim that their smoking marijuana
S2: in high school with their friends brought on the symptoms
S2: of psychosis. Well, I'm sure that it did not help
S2: because I have read that if they already have the
S2: structure in their brain, the neurons in their brain, they
S2: are going to be schizophrenic, then the use of drugs
S2: can make it come on earlier.
S3: My doctor, who is probably in his late 60s now, he says
S3: he knows for a fact that marijuana brings on psychosis.
S3: He says, "why don't they ask me? I've been treating people
S3: for this all my life."
S4: We went to a family sort of training thing that
S4: they had. It went on for several weeks. So there
S4: were quite a few people. And one of the first
S4: questions the facilitator asked was about marijuana and and how
S4: many people here. Their loved one first started to show
S4: symptoms of psychosis after marijuana use and almost every hand
S4: went up.
S2: In addition to just the health efforts, it's made their
S2: treatment much more complicated. Some of them, they'll be admitted
S2: to a hospital because they're off meds and they say, well,
S2: we can't do anything until we use marijuana because it
S2: complicates all our observations. I'm thinking it's kind of a
S2: chicken and the egg thing, marijuana. You wonder if they
S2: took the marijuana and brought on the psychosis or they
S2: got the psychosis. So they took the marijuana to cope
S2: with their symptoms. I don't know. It's a tough one, but, yeah,
S2: definitely complicates everything. That's a good way to say it.
Faydra Aldridge: My name is Faydra Aldridge . Welcome to Look Again. Mental
Faydra Aldridge: Illness Re-examined, a podcast brought to you by the BC
Faydra Aldridge: Schizophrenia Society, otherwise known as BCSS, as well as our
Faydra Aldridge: partner organizations. Today on the show, we're talking about weed, weed, marijuana, pot,
Faydra Aldridge: lots of terms... there's an idea out there right now
Faydra Aldridge: in society at large, which I'm sure we've all heard of,
Faydra Aldridge: that cannabis is a harmless drug. It appears in nature.
Faydra Aldridge: It's fine for us. Some people even use it to
Faydra Aldridge: self medicate. But for those with a predisposition for serious
Faydra Aldridge: mental illness, such as schizophrenia, science now tells us that
Faydra Aldridge: it's not so cut and dry. So how do we
Faydra Aldridge: as a society grapple with this knowledge in a time
Faydra Aldridge: of greater legalization? And how can cannabis be both helpful
Faydra Aldridge: and dangerous to people with mental illness? Today on the show,
Faydra Aldridge: we're going to find out.
Faydra Aldridge: Today, we have the great honor of speaking with Dr.
Faydra Aldridge: Nick Mathew, he has a very long title, but here's
Faydra Aldridge: just a little bit about him. Dr. Mathew completed an
Faydra Aldridge: addiction psychiatry fellowship at Yale University and a forensic psychiatry
Faydra Aldridge: fellowship at the University of British Columbia. He is board
Faydra Aldridge: certified in addiction, psychiatry, addiction medicine and forensic psychiatry. He's
Faydra Aldridge: a clinical associate professor at UBC and he's currently serving
Faydra Aldridge: as the medical director of Complex Mental Health and Substance
Faydra Aldridge: Use Services at the Provincial Health Services Authority. That's quite
Faydra Aldridge: a mouthful. We are so honored to have you. You're
Faydra Aldridge: joining us from your home in Vancouver, B.C. And we
Faydra Aldridge: understand your kids are playing in the background. So we
Faydra Aldridge: might hear a little bit of noise from them. Thanks
Faydra Aldridge: for being a multitasking dad and for joining us today.
Faydra Aldridge: Welcome to the show.
Dr. Nick Mathew: Thanks for having me.
Faydra Aldridge: So, let's get right into it. Cannabis. We talk about it.
Faydra Aldridge: We smell it. It's everywhere. And there's even some people
Faydra Aldridge: that are saying now that it's being used as a
Faydra Aldridge: miracle drug, it's helped them immensely and it's actually good
Faydra Aldridge: for you and perhaps even a substitute for medication. So
Faydra Aldridge: I'd love to get your perspective and your thoughts on this.
Faydra Aldridge: Can cannabis be useful as a medication?
Dr. Nick Mathew: We should think of cannabis as a drug. Is cannabis
Dr. Nick Mathew: a medicine? Well, it is. I mean there is a
Dr. Nick Mathew: lot of good uses for cannabis and cannabinoids, but we
Dr. Nick Mathew: have to get an idea of the effect size of
Dr. Nick Mathew: these things, and are there other alternatives that are better? So
Dr. Nick Mathew: if we're looking at mental health. They've looked at things
Dr. Nick Mathew: like depression, PTSD, anxiety, psychosis, Tourette's, and they really haven't
Dr. Nick Mathew: found good outcomes using THC for any of those things
Dr. Nick Mathew: with anxiety. It's pretty non-specific. So if we drill down
Dr. Nick Mathew: to the positive studies for cannabis, the things that it's
Dr. Nick Mathew: been used for is one, performance anxiety. The second thing
Dr. Nick Mathew: is using CBD for the treatment of anxiety caused by THC.
Dr. Nick Mathew: So we really have to drill down into the terms
Dr. Nick Mathew: when people say this is good for. hat exactly do
Dr. Nick Mathew: you mean? They have used it for psychosis and what
Dr. Nick Mathew: they found is with THC, you can actually worsen the symptoms of psychosis.
Faydra Aldridge: So, Dr. Mathew, you talked about CBD and THC. You
Faydra Aldridge: touched on it. But I would love to hear, number one,
Faydra Aldridge: what is CBD and THC? If you could just give
Faydra Aldridge: us a little elevator pitch. And number two, what is
Faydra Aldridge: the connection between THC and severe psychosis or severe mental
Faydra Aldridge: illness such as schizophrenia?
Dr. Nick Mathew: So the more psychoactive compound within the cannabis plant is THC.
Dr. Nick Mathew: And so this is the compound that's going to cause
Dr. Nick Mathew: the intoxicating effects of cannabis. The opposite compound would be CBD,
Dr. Nick Mathew: which helps attenuate some of the psychoactive effects of THC
Dr. Nick Mathew: over time. So over time, plants have been bred with
Dr. Nick Mathew: higher amounts of THC and lower amounts of CBD. So
Dr. Nick Mathew: for people who have severe mental illness, the higher potency
Dr. Nick Mathew: plants with the higher THC and lower CBD are more
Dr. Nick Mathew: likely to cause negative mental health issues in those patients.
Faydra Aldridge: I'd like to delve into the connection with mental illness.
Faydra Aldridge: I think it's so valuable to hear from experts such
Faydra Aldridge: as yourself with so much knowledge in this area, to
Faydra Aldridge: really dig into the link -- or the possible links -- between
Faydra Aldridge: a drug like cannabis and serious mental illnesses such as schizophrenia.
Dr. Nick Mathew: A lot of times when people have severe mental illness, schizophrenia,
Dr. Nick Mathew: bipolar depression, it tends to be that using cannabis will
Dr. Nick Mathew: worsen the progression of these illnesses as far as if
Dr. Nick Mathew: something's a risk factor or causative. So risk factors can
Dr. Nick Mathew: be something that can predict something occurring, and it can
Dr. Nick Mathew: also be causative. And those two aren't the same thing. So,
Dr. Nick Mathew: for example, if you're looking at breast cancer, being not
Dr. Nick Mathew: married predicts having breast cancer, but it's not cause of
Dr. Nick Mathew: it. The BRCA1 and BRCA2 genes are both predictive and causative of breast cancer.
Dr. Nick Mathew: So when we look at the link between cannabis and schizophrenia,
Dr. Nick Mathew: there's four main theories. The first theory is that it's
Dr. Nick Mathew: a component cause. So what does that mean? That means
Dr. Nick Mathew: that it's something that can cause schizophrenia but is not
Dr. Nick Mathew: necessary for schizophrenia. The other link between schizophrenia and cannabis
Dr. Nick Mathew: is that it can speed up the debut of symptoms
Dr. Nick Mathew: of people who would already get schizophrenia. Then the third
Dr. Nick Mathew: thing is common genetic vulnerability so somebody who's going to
Dr. Nick Mathew: get schizophrenia might already have a predilection to using cannabis.
Dr. Nick Mathew: And then the fourth thing is that people might be
Dr. Nick Mathew: self-medicating prodromal symptoms of schizophrenia. So we don't really know
Dr. Nick Mathew: which of these or which combination of these causes or
Dr. Nick Mathew: the link between cannabis and schizophrenia are true. We're not
Dr. Nick Mathew: seeing a flood of increased schizophrenia at a population level
Dr. Nick Mathew: depending on cannabis use, and it doesn't seem to be related.
Dr. Nick Mathew: And even in hospitals, it's not like our psychiatric wards are
Dr. Nick Mathew: suddenly being flooded by people using cannabis, even though there's
Dr. Nick Mathew: more cannabis in the population and there's a greater potency
Dr. Nick Mathew: of cannabis. So my suspicion is, out of the four causes,
Dr. Nick Mathew: I think it might be some combination of the last three.
Faydra Aldridge: That is a perfect tie-in because a mother that we
Faydra Aldridge: spoke to, Dr. Matthew, told us that her son started
Faydra Aldridge: self medicating when he first started to experience his symptoms
Faydra Aldridge: of schizophrenia. So how common is it within your practice
Faydra Aldridge: for people with schizophrenia or other serious mental illnesses to
Faydra Aldridge: attempt to self medicate using cannabis or other drugs like cannabis?
Dr. Nick Mathew: I think concurrent disorders is more the rule rather than
Dr. Nick Mathew: the exception. I mean, the people that we actually see
Dr. Nick Mathew: in the psych emergency rooms, on the psychiatric wards, most
Dr. Nick Mathew: of these people are using substances as well, and they
Dr. Nick Mathew: are getting benefits from the substances, I mean, the self-perceived benefits.
Dr. Nick Mathew: I'm not saying that they're good strategies as treatment overall
Dr. Nick Mathew: or long term, but there is an immediate benefit. So
Dr. Nick Mathew: one thing that all these substances that people use have
Dr. Nick Mathew: in common is that they increase dopamine.
Faydra Aldridge: And you've already given us some very interesting stats. But
Faydra Aldridge: here's another one. This is from the BMC Medicine Journal.
Faydra Aldridge: And the Journal states that up to 64 percent of
Faydra Aldridge: individuals who have experienced a first episode of psychosis have
Faydra Aldridge: used cannabis and 30 percent of these individuals have a
Faydra Aldridge: cannabis use disorder. Those are some pretty high numbers. So
Faydra Aldridge: what do you think we can do to get the
Faydra Aldridge: message out there to the general population around these risks?
Dr. Nick Mathew: I think the thing with cannabis use is it is ubiquitous.
Dr. Nick Mathew: I'm not sure if there's a way to prevent high
Dr. Nick Mathew: schoolers from dabbling or trying cannabis, but I think some
Dr. Nick Mathew: of the things to consider are the risk factors. So
Dr. Nick Mathew: if people had a family history of psychosis, you might
Dr. Nick Mathew: want to stay away from cannabis. So that might be
Dr. Nick Mathew: a message to put out there.
Faydra Aldridge: You're listening to Look Again, Mental Illness Re-examined, a podcast
Faydra Aldridge: brought to you by the BC Schizophrenia Society and B.C.
Faydra Aldridge: Partner organizations. I'm your host, Faydra Aldridge. This podcast would not
Faydra Aldridge: be possible without the support of the entire community. Thank
Faydra Aldridge: you for caring about mental illness. Together, we truly can
Faydra Aldridge: make a difference. [PROMO INSERTED] Welcome back to Look Again, Mental Illness Re-examined. I'm Faydra. Thanks
Faydra Aldridge: for sticking with us. And here's where we left off.
Faydra Aldridge: This is just so fascinating and you've been able to
Faydra Aldridge: provide us with so much valuable information. So now I'd
Faydra Aldridge: like to share some thoughts from one of our panelists.
Faydra Aldridge: We talked to some people on Look Again. And here's
Faydra Aldridge: a clip from a young man with schizophrenia. So listen,
Faydra Aldridge: because I'd love to get your thoughts on what this
Faydra Aldridge: young man has to say.
S3: I started smoking weed when I was like 16, and
S3: at first, it was just like once a month or
S3: once every three months. But once I got to university,
S3: I started smoking like every day, like when I got
S3: up in the morning to like all the time. And
S3: I -- up until the point I got arrested -- I
S3: was pretty much smoking weed the whole time. But yeah,
S3: I used to, my kind of tongue-in-cheek joke was "I'm not addicted,
S3: I just can't eat or sleep without it." It did make me paranoid, definitely,
S3: but the time when I first had delusions was when
S3: I took two hits of acid, two grams of shrooms,
S3: and yeah, I started, that's when I started thinking undercover
S3: cops were following me. So weed definitely didn't help. Once
S3: I got arrested, I took a six and a half
S3: year break from weed, but then just recently, before I
S3: went to the psych ward, when I start hearing voices
S3: again and stuff, I did smoke it. And it was,
S3: I was told it was a really, really, weak. It was supposed
S3: to be really, really weak. But I did I definitely
S3: did feel high from it. And yeah, I mean, is was
S3: a culmination of a lot of things that made my auditory hallucinations come back.
S3: But that was probably one of the big, one of
S3: the big reasons. And I regret doing that. Yeah, I
S3: think there's there's definitely a link between resurgence of my mental
S3: health symptoms and smoking weed. There's a link. There's a link.
Faydra Aldridge: So, Dr. Mathew, that was obviously one young man's perspective
Faydra Aldridge: and his last quote there said, "There's a definite link"
Faydra Aldridge: between mental health issues and cannabis use. What are your
Faydra Aldridge: thoughts on that?
Dr. Nick Mathew: I would definitely agree with him. I definitely believe that
Dr. Nick Mathew: there is a link between cannabis use and mental illness.
Dr. Nick Mathew: This might have been a speed up of the debut of mental
Dr. Nick Mathew: health symptoms, and it seemed to be linked. But one
Dr. Nick Mathew: thing with substance-induced psychosis is that it's a neurotoxic event.
Dr. Nick Mathew: So the general pattern that you tend to see is
Dr. Nick Mathew: people use substances and they don't really have any kind
Dr. Nick Mathew: of issue with them. And then when we relate it to psychosis,
Dr. Nick Mathew: someone might start getting some minor psychotic symptoms during intoxication.
Dr. Nick Mathew: And then these symptoms become more severe, then these symptoms
Dr. Nick Mathew: last to the withdrawal phase than they last longer and
Dr. Nick Mathew: longer over a period of time. And it seems like
Dr. Nick Mathew: that's what's happened with this gentleman. And that is what
Dr. Nick Mathew: I tend to see. If you do have a severe
Dr. Nick Mathew: mental illness such as schizophrenia or bipolar or depression, you
Dr. Nick Mathew: might want to stay away from cannabis because it hasn't
Dr. Nick Mathew: been shown to benefit these syndromes. There's some nuance in
Dr. Nick Mathew: there with CBT, with high doses, it can help attenuate
Dr. Nick Mathew: some positive symptoms of schizophrenia, but people tend to use
Dr. Nick Mathew: cannabis as a recreational drug. And that's another thing to
Dr. Nick Mathew: consider with this person was that you saw the development
Dr. Nick Mathew: of a cannabis use disorder long before they had a psychosis.
Dr. Nick Mathew: I mean, this was affecting his ability to function and
Dr. Nick Mathew: continue to use, despite these negative consequences.
Faydra Aldridge: So as we talked about, Dr. Mathew, schizophrenia is a
Faydra Aldridge: disorder that usually affects people in their late teens or
Faydra Aldridge: early adulthood. And we've mentioned that, of course, this is
Faydra Aldridge: also a time when many young people are starting to
Faydra Aldridge: experiment with drugs. So according to the BC Early Psychosis
Faydra Aldridge: Intervention Program, studies have shown that heavy use of cannabis
Faydra Aldridge: increases the risk of developing schizophrenia -- ready for this -- two
Faydra Aldridge: to four times. But as we've talked about, the vast
Faydra Aldridge: majority of users never end up developing psychosis and never
Faydra Aldridge: end up developing schizophrenia. So how do we explain this?
Dr. Nick Mathew: Some years ago, there was a highly touted study where
Dr. Nick Mathew: they showed that there was an eight-point drop in IQ
Dr. Nick Mathew: for kids who started using cannabis, and it was really
Dr. Nick Mathew: interesting how that whole thing rolled out, because after that
Dr. Nick Mathew: study was published, there were letters published, the editors saying, well,
Dr. Nick Mathew: maybe this is associated and not causative. And so the
Dr. Nick Mathew: same author actually came up with a study later with twins.
Dr. Nick Mathew: And what they showed was that they had twins, one
Dr. Nick Mathew: who would use cannabis, one who wouldn't. And they started
Dr. Nick Mathew: at the age of 13 and they followed them over
Dr. Nick Mathew: to the second study was into their 20s. And what
Dr. Nick Mathew: they found was the drop in IQ actually occurred with
Dr. Nick Mathew: both twins and it wasn't actually increased. So maybe there's
Dr. Nick Mathew: a fundamental difference in kids who are able to use
Dr. Nick Mathew: cannabis at the age of 13, then ones that aren't.
Dr. Nick Mathew: There's risk factors that can help predict something that will occur,
Dr. Nick Mathew: but it doesn't mean they're causative. And I think that's
Dr. Nick Mathew: what might be going on with the two-point four times,
Dr. Nick Mathew: that is, that it might be an associated risk, but
Dr. Nick Mathew: not a causative risk. Does that make sense?
Faydra Aldridge: Yeah, because I could see how people would argue that
Faydra Aldridge: people would say, OK, you have all these stats, the
Faydra Aldridge: stat that we talked about before, you know, up to
Faydra Aldridge: 64 percent of individuals have experienced a first episode of psychosis,
Faydra Aldridge: have used cannabis or the stat we just talked about.
Faydra Aldridge: I can see people saying, so there's these high numbers.
Faydra Aldridge: But yet schizophrenia is in quotations, "only" one out of
Faydra Aldridge: one hundred people. So I could see people using that
Faydra Aldridge: as an argument. So that's why I wanted to get
Faydra Aldridge: into it a little bit more. If people are saying, OK,
Faydra Aldridge: you're showing me all these stats, but how does this
Faydra Aldridge: translate into reality?
Dr. Nick Mathew: My opinion is that I'm not sure if cannabis is
Dr. Nick Mathew: a component cause of schizophrenia. I'm not sure if you
Dr. Nick Mathew: can take someone who would never develop schizophrenia, give them
Dr. Nick Mathew: cannabis and cause schizophrenia in somebody. And I think we're
Dr. Nick Mathew: seeing that at a population level. We're not seeing our
Dr. Nick Mathew: hospital beds flooded with people with schizophrenia. The cannabis now
Dr. Nick Mathew: is more potent than it's ever been. The rates of
Dr. Nick Mathew: cannabis use are higher than it is unusual for someone
Dr. Nick Mathew: to graduate high school and not to have tried cannabis.
Dr. Nick Mathew: Seventy percent of people who graduate high school have tried cannabis.
Dr. Nick Mathew: So the number of people who have first episode psychosis,
Dr. Nick Mathew: sixty four percent, is actually less than the population that's
Dr. Nick Mathew: tried cannabis.
Faydra Aldridge: Wow. That's really fascinating, Dr. Mathew. So if I hear
Faydra Aldridge: you correctly, what you're saying is that cannabis use on
Faydra Aldridge: its own doesn't necessarily cause schizophrenia. But I'm also hearing
Faydra Aldridge: you say that if you have a combination of other
Faydra Aldridge: factors like genetic history, the presence of high THC levels,
Faydra Aldridge: smoking pot at a young age, then you can put
Faydra Aldridge: yourself at greater risk for the onset of mental illness.
Faydra Aldridge: You're obviously a father, Dr. Mathew. I can still hear your
Faydra Aldridge: little one playing in the background. So what message would you,
Faydra Aldridge: as a father, give your own child around cannabis use?
Dr. Nick Mathew: First, I would ask them to delay this. Or if
Dr. Nick Mathew: you have to try now, please, one, get it from
Dr. Nick Mathew: a safe source. And I think some of the things
Dr. Nick Mathew: that we talked about earlier... if they could delay it,
Dr. Nick Mathew: if they could use less, if they can use less
Dr. Nick Mathew: potent versions, because I think it's very hard to get
Dr. Nick Mathew: kids to stop trying these things. I mean, I think
Dr. Nick Mathew: most kids are going to try things like alcohol. They're
Dr. Nick Mathew: going to try things like cannabis. So if they're going
Dr. Nick Mathew: to do it, do it in the safest possible manner.
Dr. Nick Mathew: Of course, the best outcome is if they didn't try it,
Dr. Nick Mathew: I'm not sure if that's realistic.
Faydra Aldridge: So, as you said, 70 percent of youth are going
Faydra Aldridge: to try most likely to try cannabis. So if somebody
Faydra Aldridge: does start using and does start to experience psychosis in
Faydra Aldridge: some form, what should they do?
Dr. Nick Mathew: So one is to get help early. So with your supports,
Dr. Nick Mathew: try to see a physician and try to get a
Dr. Nick Mathew: referral to a psychiatrist as early as possible. If you
Dr. Nick Mathew: start developing those symptoms, after getting help, you also need
Dr. Nick Mathew: to abstain from substance use. It's something that's not good
Dr. Nick Mathew: for your body and it will only worsen over time.
Faydra Aldridge: I hear from even friends, colleagues, it's natural. Cannabis is everywhere.
Faydra Aldridge: It's been around forever. It's a plant. It's a natural product.
Faydra Aldridge: Why shouldn't I use it? It's better for me than alcohol.
Faydra Aldridge: What's your response to that?
Dr. Nick Mathew: I mean, I think the fact is that they have
Dr. Nick Mathew: a lot of valid points. And the way I would
Dr. Nick Mathew: liken it is to something like alcohol. So most people
Dr. Nick Mathew: in the population drink alcohol. In the same way, a
Dr. Nick Mathew: lot of people use cannabis and it's the minority that
Dr. Nick Mathew: have issues with it. And so if you start developing
Dr. Nick Mathew: a substance use disorder, you start developing mental health symptoms,
Dr. Nick Mathew: then it's not for you.
Faydra Aldridge: This has been such an informative conversation and a very,
Faydra Aldridge: very important topic. The fact is that, as you said, cannabis
Faydra Aldridge: is everywhere right now and there's so much emphasis on
Faydra Aldridge: the legalization of it. And I'm just thrilled that we
Faydra Aldridge: can now start to really focus on the health and
Faydra Aldridge: possible health implications of cannabis. So thank you so much
Faydra Aldridge: for joining me today, Dr. Mathew. And we look forward
Faydra Aldridge: to speaking with you again.
Dr. Nick Mathew: Thank you for having me.
Faydra Aldridge: And now it's time to thank my incredible guest today
Faydra Aldridge: on Look Again, Mental Illness Re-examined. And I want to
Faydra Aldridge: thank you for listening. Your support means absolutely everything. Mental
Faydra Aldridge: illness literacy is so important. It's important to you, to
Faydra Aldridge: me and to us as an entire society. We have
Faydra Aldridge: to talk about this. And together, I know we can
Faydra Aldridge: do a better job of taking action. Talk to you soon.
Dr. Nick Mathew: This podcast is brought to you by the BC Schizophrenia
Dr. Nick Mathew: Society and the B.C. Partners for Mental Health and Substance
Dr. Nick Mathew: Use Information, where a group of non-profit agencies providing good
Dr. Nick Mathew: quality information to help individuals and families maintain or improve
Dr. Nick Mathew: their mental well-being. The B.C. Partners Members are Anxiety. Canada,
Dr. Nick Mathew: BC Schizophrenia Society, Canadian Institute for Substance Use Research. Canadian
Dr. Nick Mathew: Mental Health Associations, B.C. Division, Family Smart, Jessie's Legacy, the
Dr. Nick Mathew: North Shore Family Services Program, and Mood Disorders Association of B.C.,
Dr. Nick Mathew: a branch of Lookout Housing and Health Society. The B.C.
Dr. Nick Mathew: partners are funded and stewarded by B.C. Mental Health and
Dr. Nick Mathew: Substance Use Services, an agency of the Provincial Health Services Authority.
Dr. Nick Mathew: For more information, visit heretohelp.bc.ca