Cannabis Use Medical Problems: Cannabis Use Disorder

"I think broadly there is a lot of interest for people around the world in what the Canadian experience is." "In a way, much of the cannabis policy decisions made internationally are going to come from Canadian data and U.S. data."

"We found that there have been concerning increases over time in the percentage of people with a new schizophrenia diagnosis who had received care for a cannabis use disorder before their diagnosis."

"I think the concern is that daily cannabis use has really increased in the last 15 years and at the same time the potency of cannabis has rapidly risen. Both are what prior literature says are major risk factors for psychosis and schizophrenia."

Dr. Daniel Myran, Canada Research Chair in Social Accountability, University of Ottawa 

Cannabis is now widely available since being legalized in October 2018. (Heather Waldron/CBC )

 

Ottawa researcher Dr. Daniel Myran led two new studies, both published in the journal JAMA Network Open this week, establishing a link between higher rates of death, along with 'concerning increases' in new schizophrenia diagnoses and cannabis use disorder. Cases of schizophrenia associated with cannabis use disorder, according to one of the studies, tripled between 2006 and 2022, when people looking for hospital treatment for cannabis use disorder increased by 270 percent.

 

People treated at  hospitals for cannabis use disorder, according to the second study, were at a significantly higher risk of death in comparison to the general population. Both studies were based on Ontario data in a period including cannabis legalization. Canada has some of the most reliable research data, given its history as the second country to legalize cannabis in 2018, and the only country to date to have built a retail market. The research work being produced on the impact of cannabis use disorder has caught international attention.

 

Links between cannabis use disorder and schizophrenia, along with psychosis, represent one focus of the research. The recent study found cannabis use disorder contributing to new cases of schizophrenia had tripled over the past 17 years in Ontario.  Individuals unable to deter themselves from cannabis use despite knowing it can cause serious social and health problems are defined by the term 'Cannabis use disorder'. Such situations are not in the majority; many people use cannabis without suffering such consequences.

 

A sharp increase in cases of psychotic disorders "not otherwise specified" (no previous diagnosis with a specific disorder) associated with cannabis use disorder was also noted in the study. A strong association between cannabis use disorder and schizophrenia in young males surfaced in the research with an estimated 18.9 percent of incidents of schizophrenia cases associated with cannabis use disorder in young males. In young women, also, cases of diagnosed schizophrenia had increased, while decreasing among older adults. 

 

Researchers from ICES, The Ottawa Hospital, University of Ottawa Department of Family Medicine and Bruyere Health Research Institute participated in the study which focused on all Ontario residents age 14 to 65 , eligible for universal health care in the years 2005 to 2022. Three policy time periods were encompassed; prior to legalization, following liberalization of medical cannabis, and finally after legalization of non-medical cannabis when a total of 118,650  individuals sought emergency department aid or hospitalization during that period, for cannabis use disorder. 

 

Nine percent of people with cannabis use disorder developed schizophrenia over the study period, in comparison to 0.6 percent of the general population. The second paper found a significantly higher risk of death among people who had been treated at hospital for cannabis use disorder, including all individuals between the ages of 15 and 105 living in Ontario between 2006 and 2021. 

HealthDay

"Our study highlights the growing public health challenge posed by the combination of increasingly high-potency cannabis and rising regular cannabis use."

" Although our study cannot establish causality, individuals with a hospital-based diagnosis of cannabis use disorder were at elevated risk of death."

"Although cannabis use disorder may not be directly responsible, our findings highlight a growing segment of the population at elevated risk of death and [who] may benefit from preventative measures."

Dr. Daniel Myran, scientist/investigator with ICES, Bruyere Health Research Institute, and associate scientist, The Ottawa Hospital

Boosting An Unproven Treatment

"It sends a signal to all the fans out there that stem cells have more value than they really do."
"The risk from the stem-cell procedure is that it could give someone a false sense of confidence, and they could go back to play too early [and re-injure themselves]." 
"It’s extremely good PR for the people selling this kind of thing. But there’s no question that this is an unproven treatment."
James Rickert, president, Society for Patient Centered Orthopedics

"There's really not much evidence that it's going to help him [Max Scherzer, Washington Nationals], other than as a psychological boost or as a placebo effect."
Paul Knoepfler, professor of cell biology and human anatomy, David School of Medicine, University of California

Max Scherzer. Image: CBS

"These are the richest, most highly paid athletes around. So anything you can think of, they're getting."
"But I wouldn't use them as a role model for how to treat injuries."
Arthur Caplan, director, Division of Medical Ethics, School of Medicine, New York University

"Clinics provide free stem-cell treatments or offer procedures at a discounted rate, and in return they can generate YouTube testimonials, press releases and positive media coverage."
Leigh Turner, associate professor, Center for Bioethics, University of Minnesota

Stem-cell therapeutic injections have become the go-to solution for a growing number of super-athletes whose injuries on the playing field threaten to keep them from fulfilling their contracts and disappointing fans through lengthy recovery periods. Leading them to seek out almost instant relief in the belief that unproven stem-cell injections will greatly accelerate recovery. All the while doctors and ethicists admit to concerns that professional athletes are falling into a public relations trap benefiting clinics offering the injections they insist have no practical health value whatever.

Not only do these clinics which are proliferating in numbers and informing potential clients that their injuries are readily and swiftly certain to mend-on-the-quick with stem-cell injections when there is no scientific proof whatever that this is true, but their proffering false hope of quick recovery for the obvious purpose of making a killing -- so to speak -- is on the squeaky edge of malpractise. Platelet injections and stem cells have attracted athletes like Tiger Woods, Rafael Nadal, Gordie Hower, Kobe Bryant and Peyton Manning.

All highly respected top-performing athletes in their field of popular sports, their trust in therapies whose functional success has never been proven goes a long way to convincing the public that these are legitimate strategies for quick injury healing processes. That stem cells are on offer at a thousand clinics and even at some of the most highly respected hospitals lends legitimacy to the enterprise far beyond its perceived value. Cost of treatment ranges from hundreds to thousands of dollars for a type of treatment which, unproven, insurance will not cover.

Lots of hype and trust in the efficacy of the process, but proof of usefulness totally absent. The Major League Baseball website reported that Max Scherzer of the Washington Nationals had stem-cell injection treatment for a thumb injury. Then went on for additional treatment in response to a mild strain in his upper back and shoulder. According to Mr. Rickert, the diagnosed injury that Mr. Scherzer sought instant treatment for, would have healed itself following ten days of rest without the stem cell injection.

Injections for stem-cell treatments are prepared by withdrawing fat or bone marrow from the individual, which then sees the cells processed and injected back into the joints, tendons or muscles causing problems. The platelets that help blood to clot can be concentrated to be used in another popular sport injury treatment, used in a manner similar to the stem-cell injections. Human psychology is also at play here, where injections can act as powerful placebos alleviating pain, a result of patients placing faith in treatment.

Over 80 percent of patients with knee arthritis perceived a noted improvement in pain following a placebo of simple saltwater shots according to a recent analysis. Ethicist Dr. Caplan wonders: "Would the inflammation or problems have just gone away on its own?", after hearing of athletes speaking of the success of their stem cell treatments. Athletes are known to recover more rapidly from injuries than other people, owing to the fact that they are young and fit to begin with.

Safety Concerns for Unproven Stem Cell Treatments

All medical treatments have benefits and risks. But unproven stem cell therapies can be particularly unsafe.
For instance, attendees at a 2016 FDA public workshop discussed several cases of severe adverse events. One patient became blind due to an injection of stem cells into the eye. Another patient received a spinal cord injection that caused the growth of a spinal tumor.
Other potential safety concerns for unproven treatments include:

• Administration site reactions,
• The ability of cells to move from placement sites and change into inappropriate cell types or multiply,
• Failure of cells to work as expected, and
• The growth of tumors.

Note: Even if stem cells are your own cells, there are still safety risks such as those noted above. In addition, if cells are manipulated after removal, there is a risk of contamination of the cells.
U.S. Food and Drug Administration