Lääketieteellinen kannabiksen käyttö saattaa lisätä itsemurhayrityksiä

Medical Marijuana Use and Suicide Attempt in a Patient With Major Depressive Disorder

Abraham Nussbaum, M.D., Christian Thurstone, M.D., and Ingrid Binswanger, M.D., M.P.H 

Am J Psychiatry 168:778-781, August 2011

Discussion

As Ms. H's case illustrates, the rapid expansion of medical marijuana use raises concerns about the psychiatric complications of marijuana use, the relationship between patients and physicians, and the need for additional services and research.

The use of medical marijuana in the context of mental illness or substance abuse can be dangerous. While we cannot directly attribute Ms. H's two suicide attempts to marijuana use, the association between her increased use of marijuana and her suicide attempts is concerning, especially given the growing concern that frequent marijuana use is associated with suicide.

This is especially concerning in Colorado, where the CDPHE recorded 940 suicides in 2009, a suicide rate of 18.4 deaths per 100,000 residents, the highest rate in Colorado since 1988 and nearly twice the national average (17). Medical marijuana systems should attempt to identify not only the people who might benefit from medical marijuana but also those who might suffer from its use.

Amendment 20 does not require a laboratory, mental, physical, or other examination, only a physician's signature indicating that the user has a debilitating medical condition that "may be alleviated by the medical use of marijuana." Ms. H saw the referring doctor only a single time and reports that she did not receive a physical examination. Until recently, physicians recommending marijuana were not required to seek or review the person's medical, substance use, or psychiatric records; to be available if complications arose; or to coordinate care with other physicians treating the patient.

Permission to possess and use marijuana is excluded from the state's Prescription Drug Monitoring Program, which reports all other prescriptions for controlled substances. Finally, Ms. H's case shows our need for rigorous investigations into the effects of marijuana on medical and psychiatric conditions, especially its association with impulsivity and suicidality.

The medical marijuana industry, a system that encourages chronic and frequent use of marijuana, has expanded dramatically, and the ways in which this development will alter patterns of marijuana use and abuse remain unclear