Mental Health

The Current Research on Cannabis-Alcohol Interactions and Risk Factors for Using Them Together

Title: Cannabis and Alcohol- From Basic Science to Public Policy

This new analysis summarizes the most recent preclinical trials and epidemiological studies concerning the interactions between cannabis and alcohol, as well as possible risk factors for co-use. Specific risk factors, such as frequency of use or belonging to particular groups, were found to be significant within studies (but not across separate studies.) The compiled data reveals that previous research is inconsistent and emphasizes the need for further research to elucidate at-risk populations.  


This article highlights a few secondary findings which all focus on the gaps in our knowledge concerning cannabis, of which there are many. There may be potential concerns with the integration of cannabis into modern culture, which has essentially normalized alcohol consumption. Future research will undoubtedly evaluate these concerns, and highlight potential advantages that cannabis consumption may offer as an alternative option.

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Benjamin Caplan, MDThe Current Research on Cannabis-Alcohol Interactions and Risk Factors for Using Them Together
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A Call for More Research: Adolescent Cannabis Use and Mental Health Risks

Title: Adolescent Cannabis Use and Risk of Mental Health Problems – The Need for Newer Data

Here, an article presenting a case, justifying the need for new research to determine how cannabis use in adolescents may affect their risk for mental health. Few recent studies have come out discussing mental health and adolescent use. This is problematic because, over the years, cannabis products have been curated to be significantly more potent than in the past. Considering how vulnerable the brain is, during adolescence, because it is still developing, longitudinal studies need to be conducted to fully elucidate the effects of cannabis on development. 


This review highlights how poorly adolescents consuming cannabis seem to be at titrating their dose, or correctly self-regulating consumption of cannabis. There is an overall need for greater education before cannabis is acquired, from a dispensary or otherwise. For adults and teens seeking to self-regulate their use of cannabis, irrespective of the consumption method, it is difficult to succeed, considering the gross lack of knowledge and sophistication around the dosage. The wide variability in choice and make-up of cannabis products, added to the complexity associated with how each patient may process the myriad of cannabinoids within the products consumed leads to a complexity of confounding variables, and here, a call for more studies to be conducted on more than just adolescents. 

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Benjamin Caplan, MDA Call for More Research: Adolescent Cannabis Use and Mental Health Risks
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Supplementing Antipsychotics with CBD Enhances Psychotic Symptom Treatment

Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial

Most schizophrenia medications function by blocking the action of the dopamine D2 receptor and effectively treat positive psychotic symptoms, such as delusions or hallucinations, but fail to treat negative psychotic symptoms, such as lack of motivation or the lack of an ability to feel pleasure. Anecdotal evidence has pointed toward the potential for CBD to attenuate psychotic symptoms in conjunction with normally prescribed antipsychotics; additionally, CBD is not hypothesized to act on the D2 receptor, suggesting that it may afford unique advantages over anti-psychotics.

Researchers interested in further exploring this conducted the first known placebo-controlled CBD trial among schizophrenia patients. Although results did not suggest a potential for CBD to treat negative psychotic symptoms, in conjunction with antipsychotics, the CBD group experienced marked lower levels of positive psychotic symptoms. Both the placebo and CBD groups experienced equal levels of treatment-induced adverse events, suggesting that CBD is well-tolerated.

These results suggest that CBD may be effective in treating not only schizophrenia but also psychotic symptoms associated with Parkinson’s disease and THC-induced psychosis.

Additional Point: CBD has shown to act in a neuroprotective manner and reduce the psychoactive effects of THC, making it a viable option for patients who have experienced negative side effects with THC.

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Benjamin Caplan, MDSupplementing Antipsychotics with CBD Enhances Psychotic Symptom Treatment
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Video: Cannabinoids, Internal States, and Anxiety

A new literature review summarizing the recent findings relating to cannabis and anxiety.

Researchers conclude that CBD and low-dose THC can cause relaxation and decrease anxiety and self-spun thoughts. Some studies show that high-dose THC can cause psychotic symptoms; however, studies also show that CBD can protect against those THC-induced symptoms. Therefore, using cannabis extracts with THC and CBD could be a safe way to reduce anxiety. 

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Benjamin Caplan, MDVideo: Cannabinoids, Internal States, and Anxiety
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A Report on the Psychiatric Effects of Cannabis Demonstrates the Progress and the Gaps in Cannabis Knowledge

Psychiatric effects of cannabis 

A report published by the British Journal of Psychiatry in 2001 demonstrates the progress the medical community has made but also what gaps still need to be filled in when utilizing cannabis. This report found that excess consumption of cannabis leads to feelings of panic and anxiety and that 15% of those willing to respond to a survey experienced acute psychotic symptoms. It was also found that cannabis dependence can occur, as well as withdrawal, which can last for close to a week.  This article was a review that synthesized relevant studies but also claimed that the casual conclusions of these papers were difficult to find or replicate. 

This paper is interesting given its age considering it put out what was current data but then ended by stating the casual conclusions of each paper may not stand. 18 years later, some of the data has stood, and some have not. Users can gain a tolerance to cannabis but many are looking to mitigate it. The author uses the word dependence when discussing cannabis which is a word that holds weight and is up for debate. Intoxicating cannabinoids, like THC, affect the reward center, but non-altering cannabinoids, such as CBD, tend to work more noticeably outside of the brain, although all have mixed effects in both regions. Cannabinoids are not all the same, apply quite differently to various ailments, and have divergent effects. Blanketing an entire crop with a misinformed warning label seems irresponsible and unduly harsh. Users or those looking into cannabis-based medicine are encouraged to do their research. 

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Benjamin Caplan, MDA Report on the Psychiatric Effects of Cannabis Demonstrates the Progress and the Gaps in Cannabis Knowledge
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Herbal Treatments may prove valuable to treat Alzheimer’s Disease

Promising Therapeutics with Natural Bioactive Compounds for Improving Learning and Memory — A Review of Randomized Trials  

A recent review has determined that herbal treatments, such as those including flavonoids, are beneficial when attempting to prevent neurocognitive decline, commonly seen in Alzheimer’s Disease. Galantamine, quercetin, examples of two flavonoids, as well as huperzine A, bacoside A, and ginkolide B, three flavonoid-like compounds, all proved to be effective when used as a treatment for poor memory function. The authors mention the need for similar results in clinical trials but find the current data compelling evidence for future drug development. 

Highlighted in this paper is the current perception of herbal products as natural, gentle, and safe in comparison to current synthetic drugs. While herbal products are generally safer and considered to be more gentle, it is important to note that for these herbal compounds to truly be effective when treating patients they likely need modification in order to optimize their benefits. The modification would increase potency, selectivity, and pharmacokinetic abilities, as well as lessen any possible side effects. Synthetic drugs may seem frightening, particularly in light of recent illnesses and mortality associated with their abuse, but technology can also be used to optimize novel drugs and it can be efficient to do so. 



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Benjamin Caplan, MDHerbal Treatments may prove valuable to treat Alzheimer’s Disease
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Stress Increases the Probability of Drug Abuse

The Effects of Trait Emotional Intelligence on Adolescent Substance Use- Findings From a Hungarian Representative Survey

A recent study has revealed that teenagers who have a difficult time managing stress and appear to lack empathy were more likely to abuse tobacco, alcohol, and cannabis.

The studies initial goal was to determine if emotional intelligence could predict future drug abuse, but found that those with more empathy and interpersonal competencies were less likely to engage in substance abuse. This study provides data that may help to develop targeted drug prevention programs in order to lessen adolescent drug abuse or the development of any future substance abuse disorders. 

Highlighted in this study was the possible inaccuracy of the conclusions as the results may have been skewed by teenagers merely providing what they thought was a socially acceptable answer. Despite the fact that the majority of states have legalized the use of medical marijuana a stigma against cannabis use remains.

Stigma has and continues to stand in the way of medical research. If the consumption of cannabis were less frowned upon then perhaps more observational studies, studies that relied on self-reporting use, or even appropriate medical treatment, would be improved. The more information that can be gathered, the more accurate the research that can be conducted. In order to fully understand all the benefits and limitations of cannabinoids, although this also applies to tobacco and alcohol consumption, the uninformed stigma must also be eroded.

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Benjamin Caplan, MDStress Increases the Probability of Drug Abuse
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Video: Cannabinoid Delivery Systems for Pain and Inflammation Treatment

A 2018 literature review summarizes the various ways patients can consume cannabis (orally, topically, etc.) and the pain reductions associated with each method. The review focuses on the treatment of multiple sclerosis, cancer, anorexia, arthritis, and other painful disorders.

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Benjamin Caplan, MDVideo: Cannabinoid Delivery Systems for Pain and Inflammation Treatment
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Development of Cannabis-Based Treatment for Bipolar Disorder

Bipolar disorder and the endocannabinoid system

A recently published article serves as a call for research to be conducted to discover how cannabis could impact the management of bipolar disorder (BD). Presented in the article is a full review of the advantages and disadvantages of cannabis-based medicine in the treatment of BD and provides insight into possible mechanisms might affect the pathophysiology of the disorder. The insights listed within the article provide the rationale for examining the endocannabinoid system, specifically the cannabinoid receptor 2, with the hopes of finding therapeutic targets for mood control associated with BD.  

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Benjamin Caplan, MDDevelopment of Cannabis-Based Treatment for Bipolar Disorder
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A systematic review of Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia

A 2019 literature review summarizes the finding on using THC and CBD on patients with dementia. Researchers found that Dronabinol and THC were associated with significant improvements in a range of psychiatric scores. Interestingly, cannabis products showed the most promising results in patients whose symptoms were previously unmanageable or resistant to other treatments.

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Benjamin Caplan, MDA systematic review of Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia
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