The Need For Health Warnings About Cannabis and Ps

Correspondence
is integrated with internal medicine The need for health variables such as polysubstance
at SRFCs, a crucial opportunity is use, and crude binary questions
presented to broaden appreciation of
warnings about or sampling of cannabis and non-
the burden of psychiatric disease and cannabis and psychosis cannabis use have occurred. Even
its interrelation with other chronic basic demographic information such
diseases for students of all intended We need to be cautious when calling as sex requires more attention than
specialties. for health warnings as Mathew Large at present.5
To reverse the troubling downward does on the issue of cannabis and Referral to cannabis as though it
trend in recruitment, we believe psychosis.1 Large asserts that “almost were one type of drug is unhelpful
that psychiatrists at medical schools nothing scientific was known about and misleading; researchers,
should work with students to develop the side effects of cannabis when clinicians, and policy makers need
creative and imaginative programmes cannabis use became popular in the to start differentiating the various
that address the mental health care second half of the past century” and forms that cannabis takes in their
burden of populations that are often goes on to compare this absence various endeavours. I agree with
neglected. Positive experiences caring of knowledge with contemporary Large that “young people deserve the
for patients can help recruit increasing teenagers’ access to distorted infor- best medical information”, but we
numbers of medical students to the mation via the internet about the are not yet in a position to provide
psychiatric profession and better benefits of cannabis. I would suggest the best medical information or
equip future physicians of all bents that we need to be careful in the health warnings about cannabis and
than those in the past with the skills assumptions that we make about how psychosis until we put our own house
for provision of mental health care to far scientific knowledge has advanced in order and address some of these
those who need it most. in exploring the links between cann- basic problems. If we do provide this
We declare no competing interests. abis and mental health. information, it needs to be accurate,
*Marco A Ramos, Lisa S Rotenstein, Many of the seminal and frequently credible, and, most importantly,
Douglas A Mata cited epidemiological studies and heard.
[email protected] systematic reviews on this issue I declare no competing interests.
Department of Psychiatry, Yale School of Medicine,

are outdated and largely irrelevant Ian Hamilton
Yale University, New Haven, CT 06510, USA (MAR); (see 2,3 for examples) because the [email protected]
Harvard Business School and Harvard Medical type of cannabis that teenagers and
School, Boston, MA, USA (LSR); and Department of University of York, Health Sciences, University of
others are supplied has changed York, York YO10 5DD, UK
Pathology, Brigham and Women’s Hospital,
Harvard Medical School, Boston, MA (DAM) substantially since the second half 1 Matthew L. The need for health warnings
1 National Resident Matching Program. of the last century. Several proxy about cannabis and psychosis.
Lancet Psychiatry 2016; 3: 188–89.
Results and data: 2014 main residency match. measures of cannabis availability
Washington, DC: National Resident Matching 2 Addington J, Addington D. Patterns, predictors
Program, 2014.
have identified a trend of increasing and impact of substance use in early psychosis:
2 Simpson SA, Long JA. Medical student-run tetrahydrocannabinol and decreasing a longitudinal study. Acta Psychiatr Scand
2007; 115: 304–09.
health clinics: important contributors to cannabinoid concentrations in 3 Moore TH, Zammit S, Lingford-Hughes A, et al.
patient care and medical education.
J Gen Intern Med 2007; 22: 352–56. cannabis.4 Exposure to these high- Cannabis use and risk of psychotic or affective
3 Schweitzer PJ, Rice TR. The student-run clinic: potency forms of cannabis and mental health outcomes: a systematic review.
a new opportunity for psychiatric education. Lancet 2007; 370: 319–28.
their effect on mental health is still 4 ElSohly MA, Mehmedic Z, Foster S, Gon C,
Acad Psychiatry 2012; 36: 233–36.
4 Soltani M, Smith S, Beck E, Johnson M. not fully understood. Beyond the Chandra S, Church JC. Changes in cannabis
potency over the last two decades (1995-2014):
Universal depression screening, diagnosis, limitations already mentioned in analysis of current data in the United States.
management, and outcomes at a student-run
free clinic. Acad Psychiatry 2015; 39: 259–66.
how scientific knowledge has been Biol Psychiatry 2016; published online Jan 19.
gathered so far, a consistent over- DOI:10.1016/j.biopsych.2016.01.004.
5 Barkil-Oteo A, Silva MA, Ramos MA,
5 Hamilton I, Galdas PM, Essex HN.
Rohrbaugh RM. Teaching global mental health reliance on self-reported data, an Cannabis psychosis, gender matters.
at home and abroad. Lancet Psychiatry
2014; 1: 328–29. absence of attention to confounding Advan Dual Diag 2015; 8: 153–62.
322 www.thelancet.com/psychiatry Vol 3 April 2016

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Department of Psychiatry, Yale School of Medicine,

322 www.thelancet.com/psychiatry Vol 3 April 2016

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