Over-the-counter herbal cannabis: Opportunity or danger?

Legalization of herbal cannabis is a much-talked-about topic in Germany. For many, marijuana is a gateway drug with health risks, especially for the soul. Others see legalization as an opportunity to decriminalize and ensure certain product standards. dr Martin Heilmann is head of the Psychiatry and Psychotherapy Clinic at AMEOS Klinikum St. Joseph Oberhausen. In the interview he talked about the advantages and disadvantages of legal relaxation plans.

dr. Heilmann, how dangerous is herbal cannabis?

Herbal cannabis (there are also chemically produced cannabinoids) is the most widely consumed drug in the world. Almost none of the deaths can be traced back to previous marijuana use. However, the physical damage (long term) is similar to consuming nicotine cigarettes. Psychological damage must also be considered in a different way. Tetrahydrocannabinol (THC) is the main psychologically active ingredient in marijuana. Cultivated cannabis varieties differ in their THC content of around 8 to 35 percent. The higher the THC content, the frequency of consumption and the longer the duration of consumption, the more likely it is that psychological symptoms will develop, such as dependence on marijuana, amotivational syndrome (loss of maximum activity) or psychosis. The psychological effect on the consumer when intoxicated depends on the mood and external conditions during consumption. Occasional marijuana consumption should be harmless in most cases.

Does intense marijuana use always trigger psychosis?

The only association between cannabis use and the occurrence of cannabis-induced psychosis or ongoing schizophrenia is likely to be overstated. However, repeated consumption of marijuana is a risk factor for developing psychosis, anxiety disorders, depression or even bipolar disorder. Depending on the frequency of marijuana use, the risk of developing psychosis is two to three times higher. There is also statistical evidence that there is an association between the number and recurrence of marijuana use and the occurrence of psychotic or schizophrenia symptoms.

Is marijuana a typical gateway to “harder” drugs?

Studies do not prove this relationship. It cannot be said that marijuana use is automatically followed by the use of stronger drugs. The risk factors for addiction to hard drugs like heroin are complex and cannot be simply explained by the fact that people smoke too much marijuana at any given time.

How is the use of cannabis products assessed in the field of organ medicine?

Cannabis products have promising potential in the treatment of organs, for example in the treatment of spasticity, pain and Tourette’s syndrome. Marijuana also increases appetite and is therefore used in tumor patients or HIV patients.

Is there a good reason to legalize marijuana?

This question cannot be answered in general. Legalization of herbal cannabis is very beneficial for occasional users. They are no longer criminalized. Marijuana sold legally must meet certain standards for THC content and additives, which will determine the price and taxation.

What are the risks of selling marijuana legally?

Legal consumption requires responsible use of marijuana because, like alcohol, marijuana impacts psychomotor performance such as driving a car or working on machinery. And the consumption of legally obtained marijuana can also lead to addiction. Inpatient medical treatment for this addiction is difficult because of the assumption of costs by mandatory health insurance companies. Health insurance companies currently require outpatient connection to addiction counseling and documented failed attempts at outpatient “detoxification” under medical supervision before qualifying inpatient withdrawal syndrome treatment at a specialist clinic is possible. However, many marijuana users cannot even attempt a marijuana “detox” in an outpatient setting.

How is marijuana withdrawal carried out in a specialist clinic?

If a failed outpatient detoxification attempt under medical supervision can be proven, inpatient withdrawal syndrome treatment is possible in our dedicated clinic. The stay usually lasts two to three weeks. The goal of withdrawal treatment is successful treatment of withdrawal symptoms with a decrease in “cannabis scores” in urine tests, at best until there is no evidence of the same. The severity of withdrawal symptoms depends, among other things, on the amount and duration of consumption. Depending on the severity of withdrawal symptoms, these are treated with medication as part of inpatient therapy.

Because marijuana induces a dominant psychological addiction, it is important to learn strategies to prevent relapse. In individual and group discussions, addiction triggers and possible problems in the social environment are analyzed and alternative conflict resolution strategies are worked out together. At the same time, marijuana-related comorbidities such as anxiety and personality disorders, depression or marijuana psychosis are also treated. It can be treated clinically at any time. For treatment after marijuana-related mental illness, outpatient treatment is also possible in the outpatient clinic of our institute of psychiatry. Additional connections to addiction counseling centers and addiction support groups are also recommended.

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