The annual number of people arriving in emergency wards due to use of marijuana has risen more than four-fold (27 to 118) in the last five years, according to a recent report by the Ministry of Health. The number of psychiatric hospitalizations has risen similarly, from 30 in 2013 to 125 in 2017.
The largest increase came in men aged 15 to 24. This worrisome trend is ascribed by the ministry to the rise in the number of users, the strength of the cannabis and the drop in the age of first-time users, as well as to careless usage. The rise also stems from a leakage from the medicinal cannabis market to the general population and from a perception, deriving from attempts to legalize it, that the drug is not dangerous.
The linkage between marijuana and psychiatric disorders is unclear, and not always negative – the drug is effective for people suffering from post-traumatic disorder.
The report notes that the situation requires monitoring and intervention. Prof. Pinchas Halpern, the director of emergency medicine at Tel Aviv’s Ichilov Hospital, believes the reported numbers are artificially low due to the system of recording patients.
“I believe the increase is significant,” he says. “Most people coming here have severe psychological reactions such as serious anxiety attacks.” Most of these get emergency treatment and are sent home, while others are directed to psychiatric care. Some arrivals suffer from breathing difficulties and vomiting.
“One of our problems in linking medical conditions to cannabis is that there is no blood test for cannabis,” says Halpern. A urine test works, but requires a patient’s collaboration. “It’s only done in a few cases,” he said.
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Despite the spike in numbers, says Halpern, the number of people hospitalized for longer periods or dying is low. Nevertheless, there are risks of brain damage when using the drug at a young age, as well as higher risks for involvement in road accidents or for violent behavior. One tenth of users become addicted, he says, and a larger percentage develop behavioral addiction.
Public discourse relating to cannabis has changed in recent years, due to increased medicinal use, an easing in legislation and enforcement, and the rise of cannabis-related companies. Many people welcome this due to the plant’s medicinal benefits. The Health Ministry’s report indicates a changing attitude to cannabis, with diminished concerns and a growing willingness to try it, including among adolescents.
There are currently 50,000 licensed users in Israel, but the number of recreational users is much higher. According to a 2017 report by the Anti-Drug Authority, one fifth of people aged 18-65 had used cannabis in the preceding year, totalling 1.2 million people. In 2008, the rate was only 8.8 percent. The report notes that one third of users aged 18-25 believed cannabis was not dangerous. This isn’t always true. Halpern says there are growing numbers of cannabis poisoning. “We never saw this before, since you needed to smoke 50 joints one after the other to get poisoning.”
He says this is a result of very concentrated cannabis, found in oils or food. Halpern is concerned about adults taking the drug on their own, since he can’t regulate the dosage and because users are often mentally vulnerable. Last year there were three babies and a few elderly people in emergency due to cannabis poisoning, he says.
More psychiatric hospitalizations
The Health Ministry report also notes a rise in psychiatric hospitalizations related to cannabis use. The most significant rise is in the 15-24 age group, as well as the 25-34 group. Experts here and overseas are concerned about using cannabis at a young age, while the brain is still developing, since it raises the risk of psychosis or schizophrenia.
There is no proof that cannabis cause psychiatric illness, but it could contribute to its expression. The report notes that schizophrenia is often accompanied by drug overuse, especially cannabis. “There is a potential for addiction and a deterioration of a psychotic state associated with cannabis” it adds. In extreme cases, cannabis can lead to hospitalization due to extreme anxiety or a psychotic attack. The DSM contains diagnoses associated with a use of or dependence on cannabis. It’s not always possible to pin the outburst on cannabis rather than other risk factors such as alcohol or stress.
Cannabis has become one of the more prominent psycho-active drugs, the abuse of which is dealt with at Ministry of Health rehabilitation centers. In 2018 it came in second, after opiates, but higher than alcohol and cocaine. A ministry official says that alcohol used to be the leading substance they dealt with, but cannabis has overtaken it, even though it’s not as addictive as opiates and cocaine. “The rehab centers see extreme cases, which probably reflects a much more widespread use of cannabis” says this official.
“As soon as it’s branded as medicine, the perception of its potential harm diminishes” says Prof. Shaul Lev-Ran, who heads the Israel Center on Addiction. “It’s then seen as more positive than negative, in addition to higher availability and the regulatory changes in many countries, which also contribute to its perception as less harmful” he says. “Even though the potential for becoming addicted is low, the high number of users leads to a rise in the total number of addicts.”
Further factors are the drop in the age of users and the higher concentration of the active ingredients, which makes cannabis effects stronger, and probably more addictive. The growing number of hospitalizations can also be attributed to a growing awareness by medical personnel.
The Lancet Psychiatry published a report showing that daily cannabis use raises the risk of psychosis three-fold over people who never use cannabis. This was the first report showing how the drug affects the incidence of psychotic events in a population, confirming earlier reports showing the deleterious effects of high levels of THC, the active ingredient in cannabis.