Barbados’ proposed move to legalize and regulate the use of medical marijuana is not only a step welcomed by many but is also an opportunity to minimize risks to those in need of the drug and who might have been taking it from an illicit source.
Prime Minister Mia Mottley’s announcement earlier this month of Government’s plan to “put a framework in place for medical cannabis” comes after a series of public discussions on whether the plant should gain legal status either for medicinal purposes only or, in combination with recreational uses.
The most recent public discussions leading to Mottley’s announcement were held in November when Psychiatrist Dr Maisha Emmanuel spoke of a dilemma facing Barbadian medical practitioners.
“As a clinician, I am very much in favour [of] the use of marijuana for medicinal purposes and research. But as a psychiatrist, I’m also equally concerned about the effect on teenagers and young adults because we often admit patients who use marijuana and they present with psychotic symptoms.”
The University of the West Indies lecturer in Psychiatry referred to research “that shows whereas marijuana does not cause schizophrenia, there is an association for people who are genetically pre-disposed”.
Dr Emmanuel was speaking as a member of the audience attending a Barbados Association of Medical Practitioners public forum where Canadian Dr Mark Ware was the guest speaker on the topic, Cannabis: Lessons Learned from the Canadian Experience.
Observing, “yes, there are benefits but there are also disadvantages, especially for a certain sub-group of the population who might already have psychosis in their family and different risk factors for developing psychosis”, the Barbadian psychiatrist asked Dr Ware to share how Canada addressed these factors when it legalized marijuana use on October 17.
Dr Ware, Chief Medical Officer of Canopy Growth Corporation and currently on leave of absence as Associate Professor in Family Medicine and Anaesthesia at McGill University, said, “sensible public health messaging is the approach Canada took to this problem”.
He added that the messaging should have ‘a careful balance’.
“When you have millions of people using cannabis as we do in Canada, it is clear that not all of them are developing psychosis problems, so you don’t want to over-emphasize a problem that is restricted to a small number. But you want to minimize the likelihood that those people are going to be using cannabis harmfully.”
He said that, nonetheless, Dr Emmanuel’s question “illustrates so perfectly the challenge that we have between trying to maximize the benefits on one hand but minimize the risks on the other… there may be some therapeutic benefit but how do we prevent people from increasing the risk of psychosis? In Canada, what we have been doing is teaching people that if you have a history of psychosis in your family, or schizophrenia in a ‘first-degree relative’, for medical or recreational purposes, you should avoid using cannabis.”
He went on to describe another benefit of control that comes with legalizing use of the plant as Canada did for both medical and recreational uses.
“The problem prior to October 17 was when a young person bought cannabis off the streets they had no idea whether this was highly potent 25 per cent premium cannabis grown in very careful conditions underground by the illicit market.
“Now, at least when they go and purchase, they would be able to see the strength and potency so we can do public health interventions by saying ‘you should start by using low potency THC products’”.