Leading cannabis researcher, Dr Gabriella Gobbi, believes there needs to be separation between recreational and medicinal cannabis, as an increasing number of countries adopt drug reforms.
It is claimed that cannabis can be used to treat everything from pain and insomnia to anxiety and depression. Although there is a growing body of research exploring the use of cannabis as a potential treatment, the data to back these claims remains incomplete.
Dr Gabriella Gobbi, a leading cannabis researcher and professor at McGill University in Montreal, believes there is a danger in painting cannabis as a “magic drug”, and if used incorrectly, can have a detrimental effect on people’s mental health.
A recent report from Health Canada revealed that there has been an increase in self-medication amongst Canadians who are suffering from mental health issues like anxiety and stress.
As a psychiatrist and neuroscientist, Dr Gobbi sees the potential for the use of synthetic cannabinoids to treat mental health conditions through the regulation of the endocannabinoid system, however she believes that using THC or cannabis flower as a treatment is an “illusion”.
Cannabis Health spoke to Dr Gobbi to learn more about her research and why she believes it is vital to keep medicinal and recreational cannabis separate.
Cannabis Health: You first started studying cannabis in 2002. What were those early years of research like?
Dr Gabriella Gobbi: At that time, Canada had the highest rate of cannabis consumption in the world, among adolescents in particular. I met a lot of patients that had depression who were smoking cannabis, so I started to think that there must be a link between mood and cannabis.
This was the big question at the time. There was a lot of research about cannabis and psychosis, but there was [none] about the link between cannabis and mood disorders.
For this reason, we started to [study] if the endocannabinoid system was affecting mood. First, we demonstrated that a molecule called URB597, which increases endocannabinoids, has an antidepressant effect. We also found that CB1 agonists and THC both have antidepressant effects in the short term, but after a long time of consumption produce depression.
Over the years, we were really able to dissect the effect of cannabinoids on depression.
CH: People claim that cannabis can treat or help manage a long list of different conditions. What is your opinion on these claims?
GG: The problem today is that people use cannabis, both THC and CBD, for all kinds of diseases; for pain, for nausea, as antibiotics, for COVID-19, for increased immunity, the list goes on. It is not possible that THC and CBD will be a magic drug for everything. It is important to understand what is best for specific diseases and to understand the mechanism of action.
With pain, for example, it is very important that science can target one or two indications precisely, to know the doses of THC that should be used, and to understand which subtype of pain it can treat.
CH: Is there potential for cannabis as a treatment for mental health issues?
GG: This is a difficult question. It is very complex because in the short term it produces a euphoric effect, so it’s an antidepressant, an anxiolytic and it increases the capacity to socialise.
But, in the long term, after one or two years of high consumption, it has a [negative effect] on mental health.
You increase the risk of psychosis, you increase the risk of depression. I think it is only an illusion to think that cannabis can be used for mental health.
Having said that, we know that there are synthetic drugs that block the degradation of cannabinoids and increase the endogenous endocannabinoids which have sustained antidepressant, anxiolytic effects.
The way to go for mental health is not to use THC but to enhance the endocannabinoid system, so as to have a good effect on mental health.
CH: How does the effect of cannabis on the endocannabinoid system impact mental health?
GG: We must distinguish what THC does in the endocannabinoid system and how the endocannabinoid system can be used as a target for mental health.
There are a few studies saying that if adolescents consume a lot of THC, they actually create a down-regulation of the endocannabinoid system. This is very bad because it decreases 2AG [an important endocannabinoid] and causes the suppression of CB1 receptors.
We can find other pharmacological strategies to increase the natural endocannabinoids in the brain and this eventually can be a new target for mental health. But the illusion to use just THC to treat mental health is not viable and will not be a good strategy.
CH: The global push for the development of new cannabis-based medicines runs parallel with campaigns for the legalisation of recreational cannabis. Do you think the interconnection between the two poses any issues?
GG: The problem with cannabis is that since the beginning, 20 or 30 years ago, our society has mixed together the medical and the recreational. I don’t know why; for other plants it didn’t happen like that. This problem creates misunderstanding because people think that, since it’s a plant, it can only be good.
This is a big misconception that we have in our society. In my opinion, it is very important for medical cannabis to be distinct from recreational cannabis. We should keep medical cannabis and recreational cannabis separate.
It is also important not to use recreational cannabis at the same doses as medical cannabis. For example, the dose of medical cannabis for pain is about one gram a day, but for recreational cannabis, the dose should be much less.
When we have recreational cannabis with 25 percent THC, such as in Canada, this is a problem. This is not recreational cannabis; this is pharmacological cannabis with a lot of side effects.
CH: Canada legalised cannabis in 2018. What is your opinion on the country’s approach to legalisation?
GG: Canada included medical and recreational cannabis in the same law, but interestingly, the people that were against the legalisation were patients using cannabis because they didn’t want to be associated with recreational [users].
Canada does not have a maximum concentration of THC, so you can go into a shop and buy cannabis with 25 to 30 percent concentrations of THC, and buy up to 150 grams a month.
When I worked at the emergency ward, we saw people with psychosis that consumed up to five grams of cannabis per day. Before, we did not see these patients. When I asked where they bought it, they said SDQC [the sole retailer of legal recreational cannabis in Québec].
Before legalisation, it was mostly adolescents and people under the age of 25 consuming. Now, we have the elderly, a completely new population, consuming a lot of cannabis.
A good thing in Canada, however, is that it seems the consumption of cannabis in adolescents is slowing down.
CH: What are the risks of using cannabis as a teenager?
GG: We have demonstrated by doing a meta-analysis of studies from around the world, that if you smoke cannabis during adolescence, you increase the risk of developing depression later in your 20s – even in the absence of a predisposition. Cannabis is a trigger for depression later in life.
If you consume cannabis as an adolescent, you also have a greater chance of [developing] psychosis, even if you don’t have a predisposition. The same applies for schizophrenia and bipolar disorder.
If you have a predisposition for schizophrenia or bipolar disorder and you smoke cannabis, then your symptoms will be much worse, meaning the psychosis or bipolar disorder will start earlier.
There is a lot of evidence for this. There are so many epidemiological studies from around the world and we can’t just ignore the long term effect of cannabis in adolescence.
CH: Are you in favour of recreational cannabis?
GG: I’m not against it. I believe in good law and good legislation. We know that prohibition does not work, and we know that complete legalisation does not work either.
For recreational cannabis, I think it is very important to control the concentration of THC and the quantity that people can smoke. We have a lot of evidence-based data [suggesting] that high concentration cannabis is bad for people’s mental health.
I think we can do legalisation in a better way.
We need more campaigns warning people that cannabis is just temporary relief from anxiety and depression and not a treatment. Secondly, in my opinion, we need to control the percentage of THC in the cannabis that we sell and introduce a maximum recommended dose.
CH: What is your current research focusing on?
GG: What we are really interested in now is understanding a little bit more about CBD and its medical function. A lot of people use CBD oil, but we still don’t have the proof of concept for which diseases CBD can be used for.
We have to better understand CBD in pain and whether CBD can be used after opioid dependence. One of our studies in animals is to see if THC or CBD can help people recover from opioid dependence.
Another area of interest for us is to understand the co-administration of psychedelics and cannabis. We know that in the illicit market, a lot of people mix the two together and we want to understand what happens in the brain when the two meet.
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