MonthNovember 2019

Reading of the Week: The Advocates – Beattie on Her Illness (Lexpert), Goldbloom on Progress Made (CBC Radio)

From the Editor

Sick with depression, he decided that the burden was too great. The suicide attempt failed, but after he was admitted – when I met him on the inpatient ward – he told me that his family wouldn’t visit. He explained that they couldn’t accept that he had mental illness.

He was right.

Times have changed, but stigma continues. This week, we consider the comments of two advocates.

In the first selection, lawyer Beth G. Beattie describes her illness and her fears. She also discusses her decision to speak out. Noting how few lawyers talk about mental illness – in part, because of the fear of job loss – she has written for a law publication. “The profession is in desperate need of role models, namely, lawyers who live with mental illness and are well established in our positions and prepared to share our stories.”

A waiting crowd in front of a microphone and podium

In the second selection, the University of Toronto’s Dr. David Goldbloom, a CAMH psychiatrist, remembers the silence on the topic of mental illness not so long ago. In an interview with CBC Radio’s Metro Morning, he notes that the silence was due to “secrecy, shame, stigma.” He weighs the progress that’s been made in recent years and he mulls the work to be done, particularly to reach “all communities.”

DG

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Reading of the Week: Cannabis in America (and Canada) – the New JAMA Psychiatry Paper with Commentary

From the Editor

It’s legal. Are people using more? And has cannabis use disorder become more common?

This week, we look at a new paper considering cannabis legalization and use. The authors draw on American data where legalization is increasingly found across different states though not as extensively as in Canada; to date, 11 US states have legalized recreational cannabis, with 33 (and D.C.) having legalized medical marijuana.

In a new JAMA Psychiatry paper, Magdalena Cerdá and her co-authors use the National Survey on Drug Use, a major survey involving more than half a million participants, considering marijuana use, frequent use, and cannabis use disorder. What effect does legalization have? They find that cannabis use disorder is more common in adolescents after legalization and for adults who are 26 years of age and older, use, frequent use, and substance use are all up.

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We consider the paper. We also discuss the commentary that accompanies it. Finally, with an eye closer to home, we ask: are the findings relevant here in Canada?

DG

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Reading of the Week: Cannabis for Mental Illness: Popular and Promoted by Industry – But Evidenced? The New Lancet Psychiatry Paper

From the Editor

“It’s the only thing that helps with my anxiety.”

It’s closing in on midnight, and the ED patient I’m seeing is adamant that cannabis has helped him with his generalized anxiety disorder. My day has been long, but I choose to push a bit. Why cannabis? He notes how challenging it was to access mental health care. When he finally did see a psychiatrist, he feels he was offered a prescription after only a few minutes, and the trial of sertraline left him feeling more anxious. Cannabis, in contrast, helps him sleep and takes an edge off the anxiety.

More and more, our patients are talking up cannabis. Google “medical marijuana,” and there are over 166 million hits. And, yes, industry has noticed. There are a half a dozen cannabis dispensaries within a 10-minute walk from the CAMH ED, where I work. In the spring, a former prime minister joined the board of Acreage Holdings, a marijuana company, explaining that he was excited by the potential of cannabis to treat PTSD.

But is any of this evidence based?

This week, we look at a new paper from The Lancet Psychiatry. University of New South Wales’ Nicola Black and her co-authors do a systematic review and meta-analysis. Considering a variety of psychiatric disorders including depression, they draw on the literature to try to understand the effectiveness and safety of cannabinoids. “There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.”

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We consider this big paper on the hot topic.

We also discuss the comment paper that accompanies this study. Yale University’s Deepak Cyril D’Souza writes: “The process of drug development in modern medicine is to first demonstrate efficacy and safety in clinical trials before using the drug clinically. With cannabinoids, it seems that the cart (use) is before the horse (evidence).” For the record, I don’t think Acreage Holdings will be distributing either paper to shareholders.

Please note that there will be no Reading next week.

DG

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