Helps You Focus Marijuana

Mia is a stoner. One convinced. The art student consumes cannabis almost every day. She likes the intoxication. The 23-year-old also uses the drug as medicine because cannabis helps her concentrate: Mia has ADD, an attention deficit disorder. If she takes cannabis, she can concentrate for two hours, as the journalist Niko Kappel reported during a SZ health forum on cannabis, which Mia spent half a year for the magazine Now accompanied. But Mia is also afraid - of addiction, of harm.

Cannabis divides. For more and more people it is a pleasant, soft drug, with the help of which they can escape everyday life and enjoy a pleasant intoxication: Consumption in Germany has almost doubled in recent years. Others hope that cannabis preparations will alleviate physical complaints, such as chronic pain. And still others see the dangerous side effects on the psyche up to and including switching to harder drugs. As part of the Munich Psychiatry Days of Action, the SZ organized a health forum with experts from psychiatry, pharmacology and political science on this drug between good and bad, which recently took place online.

In doing so, some of the beloved assumptions were destroyed right at the beginning. Today's cannabis can no longer be compared with the hippie drug of the 1970s, said psychologist Eva Hoch. In fact, the levels of the psychoactive substance THC in marijuana and hashish have doubled over the past decade. The hemp plants were bred to produce more THC. This makes the intoxication more intense, especially since the content of CBD, an antagonist of THC, has also decreased in the plants. Hemp is one of the oldest cultivated plants in the world. Their use in the manufacture of clothing and other everyday goods has been documented since around 12,000 BC, reported the pharmacologist Thomas Gudermann. "But as early as 2000 BC, the founders of traditional Chinese medicine also pointed out the healing properties of cannabis," said Gudermann - and they warned: "If you ingest cannabis in large quantities, you can encounter demons."

Many patients report successes, but there are only a few scientific studies

Hashish, marijuana, THC and Co - a glossary

cannabis, German hemp: genus of plants from the hemp family; the male plant is mainly used for fiber production, the female plant contains active ingredients such as THC and CBD

THC, Tetrahydrocannabinol: psychoactive substance, main active ingredient in cannabis

CBD, Cannabidiol: non-psychoactive substance from the hemp plant, which, among other things, is said to have an antispasmodic and anxiolytic effect

Endocannabinoids: substances found in the human body that are chemically similar to THC and CBD

marijuana or grass: dried leaves or inflorescences of the female hemp plant

hashish: the dried and pressed resin of the female hemp plant

Dronabinol: THC variant that can be manufactured as a prescription drug, among other things against nausea and vomiting in cancer and against weight loss in AIDS

Nabiximols (Sativex): Ready-to-use medicinal product with THC and CBD, approved for spasms and pain in MS

Nabilone (Canemes): Finished medicinal product with a synthetic cannabinoid, approved for nausea and vomiting in cancer and loss of appetite in AIDS

Epidyolex: Ready-to-use drug with CBD for treatment-resistant epilepsy

Pharmacology now knows exactly why cannabis has such an intense and varied effect on humans. The effective components of the hemp plant can also be found in a similar form in the brain. In the 1990s, scientists discovered that THC and CBD bind to the same structures in the brain as natural endocannabinoids and can mimic their effects in the reward system, for example.

The medicinal effects of cannabis are now also undisputed. Since 2017, statutory health insurances have been able to reimburse medicinal products containing cannabis. Doctors are even allowed to prescribe the plant's natural flower, marijuana. The problem, however, is that the THC content in the flowers varies greatly, said Gudermann. Standardized drugs such as Nabiximols (trade name Sativex), which is approved for spastic convulsions in multiple sclerosis, and nabilone (trade name Canemes, a synthetic cannabinoid), which helps tumor patients who suffer from vomiting and nausea as a result of chemotherapy, are therefore more reliable and easier to dose . In addition, dronabinol can be produced by pharmacists with a precisely defined amount of THC.

All these preparations are subject to the Narcotics Act, the rules for prescribing them are strict. "Insured persons are only entitled to a therapy with cannabis if the other generally recognized therapy is not available and if there is also a prospect of a noticeable benefit," explained the psychiatrist Oliver Pogarell. The latter formulation is problematic for doctors. Because the effect of the preparations has only been well proven for very few ailments.

"Unfortunately, the data situation is very thin." Cannabis has many beneficial effects: "The drug affects a large number of physical and psychological functions - on thinking and feeling as well as on motor skills," said Pogarell. It can bring about relaxation and a sense of wellbeing, calming you down and increasing your concentration, relieving fears and cramps, relieving pain, fighting nausea and increasing your appetite. It even seems to work against itching.

But the second, the unpleasant side of the drug is just as diverse. The body and mind are slowed down in such a way that this can be dangerous, especially in traffic. "In adolescents, long-term use can also lead to developmental disorders with permanent impairment of intellectual abilities," warned Gudermann. And recently there have been increasing reports of serious psychological consequences. Cannabis can induce paranoid delusions and persistent psychosis, as well as worsen existing psychiatric illnesses. The risk of developing psychosis is up to twice as high for users as for non-users. It grows with the amount of THC in the drug and the frequency of use. People who start consuming as adolescents are particularly at risk. "Psychosis is a significant risk that every user should be aware of," says Pogarell.

Contrary to what is often rumored, cannabis is psychologically and physically dependent

Because of its pleasant effects, cannabis is often addictive, said Eva Hoch, who regularly deals with patients who have become addicted to cannabis. The dependence is often psychological and physical. Because the more people consume cannabis, the more fatigued the docking points for the cannabinoids in the brain. The consumer needs an ever higher dose more and more frequently. About one in ten cannabis users ultimately becomes addicted to the drug; the danger is twice as great if you started consuming it as a teenager, and among those who smoke weed every second, every second person becomes addicted. There are also other factors: "There are always many reasons for an addiction to develop," says Hoch. In addition to the biological, psychological and social factors are also involved. It also depends on whether people find other ways to deal with stress and negative events.

Mia has been smoking weed since she was 15 when someone offered her a joint at a party. She justifies her high consumption with her ADD. "Apparently cannabis is the only thing that helps her," said Niko Kappel. "She tried a lot in the process. She was with a child and adolescent psychologist, did behavioral therapy and also took drugs such as methylphenidate. Nothing really helped." Usually, Mia's head looks like a major intersection when the traffic lights are down - it's a mess. "Cannabis acts like a traffic cop for you," explained Kappel, her thoughts are then more orderly.

"Patients repeatedly report that cannabis helps them. ADHD patients also say that cannabis helps them better than methylphenidate," said Eva Hoch, who with Oliver Pogarell published a scientific review on the benefits of cannabis in medicine and an analysis for it Federal Ministry of Health. "But many patients also say that it doesn't help them." Perhaps, says Hoch, cannabis simply has different effects on people; a lot of research is still needed here.

The psychiatrist Pogarell added that cannabis has been studied in a variety of diseases. But the findings were often not convincing enough to justify a prescription. According to the law, the drug must work better than a placebo or standard therapy, which makes the requirements high. The proof of effectiveness is strongest in nausea and vomiting as well as in chronic neuropathic pain. This includes spasticity and pain in MS, but not the classic back pain. Cannabis also helps against anorexia and loss of appetite, for example in AIDS. In the case of mental illnesses such as ADD, ADHD, depression or anxiety disorders, however, the evidence is poor. For example, some studies, but not all, have shown a better effect on psychosis than with an antipsychotic.

Recently, CBD products have become fashionable as a supposedly harmless alternative

The situation is similar with CBD products. They are popular with some consumers because CBD does not lead to intoxication and is therefore considered a harmless alternative. However, products with CBD are even less well researched than those with THC. In the case of anxiety disorders, there are indications of a benefit, so Hoch, also in the case of psychoses. And for epilepsy, which cannot be treated otherwise, there is even an approved drug with Epidyolex. CBD may even help treat THC addiction. But the active ingredient also has undesirable effects. This can lead to undesirable interactions with other drugs, and animal experiments indicate possible damage to organs and sperm.In addition, many CBD products contain significant amounts of THC, despite declarations to the contrary.

Despite the high hurdles, cannabis was prescribed around 100,000 times last year, and the trend is rising. Has it been of any use to the patient? There is hardly any data on this. However, around 30 percent of patients discontinued their cannabis therapy in the first year because their hopes were not fulfilled or the undesirable effects were too strong - that is rather little compared to other long-term therapies. Serious side effects are rare with cannabis preparations anyway; fatigue and dizziness are the most common. However, there is also a risk of addiction to the drugs, warned Pogarell. It is therefore important that the dose and the intervals when taking are adhered to.

Precisely because of the risk of addiction and the danger for young people, experts and politicians are repeatedly calling for cannabis to be legalized. The black market and crime may then cease to exist, the drug would also be produced in a controlled manner, and the THC content could be prescribed. Well-founded hopes?

That depends very much on the implementation, reported the political scientist Christian Adam. "There is not the Legalization. "Rather, many screws could be turned. In the past few years cannabis has been legalized in several countries, for example in Uruguay, Canada, Luxembourg and several US states. Uruguay has taken the most conservative route there. Only two companies are allowed under There are only two products with a capped THC concentration that can only be sold through licensed pharmacies. The possibility of self-cultivation is very limited.

At the other end is Colorado, where opponents of legalization even speak of commercialization, so Adam. Private companies are allowed to grow, process and sell cannabis, there is a wide range of products, including with very high THC concentrations.

In the countries that dared to take the step, consumption by adolescents has not increased significantly, says Adam. The new legislation is therefore often praised as a success. But there are also critical voices. Drug consumption sometimes leads to behavior changes only in the long term. "There is a fear that the increasing normalization of dangerous consumption will increase," reported Adam. The hope that the black market will collapse has not yet been fulfilled either. In Uruguay, for example, 80 percent of cannabis is still sold on the black market, and in California the black market has even grown. So has legalization failed? "Even the judgment would be too harsh," said Adam, "it could be that these problems will be resolved over time." It is important to argue hard about whether to legalize - and if so, how.

Niko Kappel referred to the "My Brain, my Choice" initiative for a contemporary drug policy. The initiators demand that the dialogue be more transparent. "It is so important that consumers can understand the decisions made by politicians and that many voices flow into them," said Kappel. From his point of view, the drug commissioner of the federal government should be assisted by a scientific commission that includes all positions in order to develop a scientifically based drug policy. Psychological, sociological - all aspects of the multi-faceted cannabis plant.

The experts

Dr. Christian Adam, Chair for Empirical Theories of Politics, University of Munich

Prof. Dr. Thomas Gudermann, Walther Straub Institute for Pharmacology and Toxicology, University of Munich

Dr. Eva Hoch, Head of the Cannabinoids Research Group, Department of Psychiatry, University of Munich

Niko Kappel, Journalist, accompanied a stoner for Now, the young magazine of Süddeutsche Zeitung

Prof. Dr. Oliver Pogarell, Deputy Director of the Clinic for Psychiatry, University of Munich

Moderation: Dr. Christina Berndt, Southgerman newspaper