Thursday, August 30, 2012

Adolescent Cannabis Use and IQ

One thing I’m asked about quite regularly is my view and the naturopathic view on medicinal cannabis usage. Everyone seems to want to ask me about this, whether it be friends, colleagues, or patients – it seems that everyone wants to know whether I think it’s a good idea, what my experience with it has been, and whether or not I prescribe it.

I’m not sure whether it’s because I use a variety of other (legal) herbs in my practice, or because I’m an ‘alternative’ provider, but this is a question that some people can’t wait to pose to me.

The irony of all of this is that, in four years of naturopathic medical school, I don’t think that the use of medical cannabis was discussed once. If I recall, we discussed cannabis usage in our Addictions and Disorders class, we discussed it briefly in our Jurisprudence class, and I believe that we discussed it in Normal Maternity class one time as having a potentially damaging effect on the developing fetus. And that was pretty much it – we didn’t discuss it in Botanical Medicine class, we didn’t discuss it’s use for cancer patients in Oncology, we didn’t discuss it in the hours we spent discussing chronic pain in Orthopedics, Naturopathic Manipulation, and Sports Medicine classes. To be completely honest, if I were to go out and prescribe medical cannabis, I would be practicing pretty much in the dark, drawing on basically no instruction, very little research, and no clinical experience.

Few would argue that cannabis doesn’t have an effect on the human body, but important questions regarding clinical use have yet to be answered. These questions include: What is the proper dose of cannabis? What is the proper dosing schedule? How does one evaluate response to therapy? I feel confident in recommending 1000 mg of curcuminoids twice daily and re-evaluating at 4-6 weeks, but when I’m not aware of similar regimens for cannabis prescription. Prescribing cannabis in a manner that amounts to supervised self-medication is haphazard and prone to inconsistent results.

Not, of course, that I would prescribe medical cannabis. Though Washington, D.C., where I practice, does allow for the usage of medical cannabis, cannabis remains a scheduled drug that is without a doubt outside the prescriptive scope of naturopathic physicians. All of this continues to add to the irony.

What this all boils down to is the fact that I’m really not the guy to ask about medical cannabis. I haven’t been trained to use it, and even if I were, I wouldn’t be able to prescribe it. That said, I do take some interest in the topic, and so wanted to share an article that came across my desk recently.

A study published in the Proceedings of the National Academy of Sciences has found that chronic use of cannabis does in fact result in loss of IQ points. The study tracked approximately 1000 people from the area in and around Dunedin, New Zealand. The study has achieved a remarkable 96% retention rate since its inception in 1972, thus adding credibility to its results – not only were a large number of people included in this study, but they have been taking part in the study for approximately four decades. This is some of the first solid evidence that cannabis use does in fact impact cognition – we’ve suspected as much for several decades, but this study helps confirm it.

What was also extremely interesting is that the study found that those who started using cannabis before their 18th birthday were more susceptible to the damaging effects – those who started using cannabis in their teens suffered an average loss of 8 IQ points compared to their non-partaking counterparts. 8 IQ points may not seem like a lot for a test where people regularly score above 100, but can actually make a significant difference in percentile rankings – 8 points in either direction of 100 (the average score) can place you in either the 70th or 29th percentile.

So what’s the message of this study? It’s pretty plain: cannabis is not for kids. We live in a time when cannabis laws are becoming more relaxed, and are likely to continue to become more relaxed. Without making comments on that trend, I will say that this study indicates that, no matter the direction of legislation, future laws should maintain the same type of age restrictions that current laws for tobacco and alcohol do. The law restrictions for alcohol and tobacco were done a bit arbitrarily, but given that we now have some data to go on for in this case, I think we owe it to ourselves and our children to act on it.