The legalization of herbal cannabis is a much-discussed topic in Germany. For many people, cannabis is a gateway drug with health risks, especially for the psyche. Others see legalization as an opportunity to decriminalize and ensure certain product standards. dr Martin Heilmann is head of the Clinic for Psychiatry and Psychotherapy at the AMEOS Klinikum St. Josef Oberhausen. In the interview he talks about the advantages and disadvantages of the planned relaxation of the law.
Dr. Heilmann, how dangerous is herbal cannabis really?
Herbal cannabis (there are also chemically produced cannabinoids) is the most widely used drug in the world. There are hardly any deaths that can be traced back to previous use of cannabis. However, the physical (long-term) consequential damage is similar to that of consuming nicotine cigarettes. The psychological damage should also be considered in a differentiated manner. Tetrahydrocannabinol (THC) is the main psychologically active ingredient in cannabis. The cultivated cannabis varieties differ in terms of their THC content of around 8 to 35 percent. The higher the THC content, the consumption frequency and the longer the duration of consumption, the more likely it is that psychological symptoms will develop, such as dependence on cannabis, an amotivational syndrome (maximum loss of activity) or psychosis. The psychological effects on the consumer when intoxicated depend on the inner mood and the external conditions during consumption. Occasional consumption of cannabis should be harmless in most cases.
Does intense cannabis use always trigger psychosis?
The sole connection between cannabis use and the occurrence of an ongoing cannabis-induced or schizophrenic psychosis tends to be overestimated. However, constantly recurring cannabis consumption is a risk factor for developing psychoses, anxiety disorders, depression or even bipolar disorders. Depending on the frequency of cannabis use, the risk of developing a psychosis is two to three times higher. There is also statistical evidence that there is an association between the amount and recurrence of cannabis use and the occurrence of psychotic or schizophrenic symptoms.
Is cannabis the typical gateway to “harder” drugs?
Studies do not prove this connection. It cannot be said that the use of cannabis is automatically followed by the use of harder drugs. The risk factors for addiction to hard drugs such as heroin are complex and cannot simply be explained by the fact that people smoked too much pot at a certain point in time.
How should the use of cannabis products in organ medicine be assessed?
Cannabis products have promising potential in organ medicine, for example in spasticity, pain treatment and Tourette’s syndrome. Cannabis also promotes appetite and is therefore used in tumor patients or HIV patients.
Are there good reasons to legalize cannabis?
The question cannot be answered in general terms. A legalization of herbal cannabis is particularly beneficial for occasional users. They are no longer criminalized. The cannabis sold legally will certainly have to meet certain standards for THC content and additives, which will determine the price as well as taxation.
What are the risks of selling cannabis legally?
Legal consumption requires responsible use of cannabis because, like alcohol, cannabis has an impact on psychomotor performance such as driving a car or working on machines. And the consumption of legally acquired cannabis can also lead to addiction. The inpatient medical treatment of this addiction is difficult due to the assumption of costs by the statutory health insurance companies. The health insurance companies currently require outpatient connection of consumers to addiction counseling and the documented failed attempt at outpatient “detoxification” under medical supervision before inpatient qualified withdrawal syndrome treatment in a specialist clinic is possible. However, many cannabis users are unable to even attempt cannabis “detoxification” in an outpatient setting.
How is cannabis 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 specialized clinic. The stay usually lasts two to three weeks. The aim of withdrawal treatment is the successful treatment of withdrawal symptoms with a drop in the “cannabis values” in the urine tests, at best until there is no evidence of the same. The severity of the withdrawal symptoms depends, among other things, on the amount and duration of consumption. Depending on the severity of the withdrawal symptoms, these are treated with medication as part of the inpatient therapy.
Since cannabis 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, cannabis-related comorbidities such as anxiety and personality disorders, depression or cannabis psychoses are also treated. These can be treated clinically at any time. For aftercare of cannabis-related mental illnesses, outpatient care is also possible in our psychiatric institute outpatient clinic. An additional connection to an addiction counseling center and addiction support group is also recommended.