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MentalillnessandCannabis–thestoryof
David–themanwith thetransparenthead
no.1
OUTofYOURHEADguidesforpeoplewhousedrugsandhaveexperiencedmentalillness
2
MentalillnessisareactiontolifeThejourneybetweenourbirthanddeathis
thestoryofourlife.Onthisjourneywewillmeetwithdesperation,delight,loveandloneliness.Sometimesourmindsrespondtotheeventsandtheexperiencesinourlivesinwaysthatcanbecomeextremelydisturbingforusandthosearoundus.Doctorscallthisreactiontolife‘mentalillness’.
DrugshaveaneffectonmentalillnessWeusedrinkanddrugstogiveuspleasure,to
stopusfeelingpainorbecausewehavenothingbettertodo.Ifdrugsarepartofourlifetheywillhaveaneffectonourmentalillness.Whatthiseffectwillbedependsontheperson,thedrugandhowthedrugisused. Thesestoriesarebasedontalkingtopeopleinpsychiatrictreatment.
ThisstoryisaboutDavidandtherolethatcannabisplaysinhislifeandhisillness.
.
Outofyourheadguidesforpeoplewhousedrugsandhaveexperiencedmentalillness
Brainchemistry
Yourbrainisthemostcomplexobjectintheknownuniverse–itcontains100billionspecialcellscalledneurons.Neuronscom-municatewitheachotherbyreleasingasortof‘chemicale-mail’.
Therearemorethan80typesofthesechemicals–calledneurotransmitters.Mostillegaldrugscausethereleaseofaneurotransmittercalleddopamine.
Thisreleaseofdopamineiswhydrugsfeelpleasurable.Buttoomuchdopamineinyourbraincouldcauseproblems.Drugsusedtotreatschizophreniatypeillnessesseemtoworkbyreducingdopamine.
Thebalanceofneurotransmittersinyourbrainaffectsyourmoodandthoughtsandseemstohaveanimportantroleinmentalillness.
4
Cannabischemistry
Cannabissmokecontainsover2,000chemicals.Theonesthatinterestusarecalledcannabinoidsandaboutadozenofthesehaveaneffectonthebrain.
THC(shortfortetrahydrocannabinol)isthemainonethatgivesyouthereallyspaceyhigh.CBN(cannabinol)andCBD(cannabidiol)havemorerelaxinganddopeyeffects.
Mostdrugsaffectbetweenoneandthreeneurotransmitters,butcannabisaffectsmorethanhalfadozen,including:
Serotonin(alsoboostedbyecstasy);Dopamine(alsoraisedbycocaine);Endorphins(alsotriggeredbyheroin).
Thatiswhycannabishassuchawiderangeofeffectsonthemind:trippy,painkilling,relaxingetc.
5
Lotsofbadthingshadhappenedtome..Lotsofbadthings.
Icouldn’tthinkstraight.Itwasallgoingroundandroundinmyhead.
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WarningsignsandtriggersSomepeoplebecomeseriouslymentallyillandothers
don’t–nobodyissurewhythisis.Davidbecomesmentallyill–althoughhedoesn’tknowityet.
Thefirstsignsofmentalillnessoftenstartweeksormonths
beforeanybodynoticesandcanincludethingslikefeelinganxiousandtense,becomingwithdrawnandisolated,notgoingout,neglectingyourappearance,havingtroublesleepingetc.Ifyouarearegularcannabisuseryoumightfindyourselfusingmoreoften.Thisisnotsurprisingbecausecannabisisenjoyable,helpsusrelax,sleepandmakeslonelinessandevendaytimetellyabitmorebearable.
Thereisnoclearevidencethatcannabiscausesmentalillness(whichwouldnototherwisehaveoccurred).However,itisthoughtthatcannabiscankickstartor‘trigger’anepisodeofmentalillnesseveninpeoplewhohavesmokedcannabisforalongtimewithoutproblems.Ifyouaresmokingallthetimeitcanbedifficulttotellifsmokingweedishelpingormakingthingsworse–itmayevenbedoingbothatthesametime.
Thingsyoucando: * Learntorecogniseyourearlysignsofmentalillnessrelapse.
* Learnskillswhichcanhelpreduceyourchancesofbecomingillagain. Askthepersonwhogaveyouthisleafletaboutwarningsignsandrelapseprevention.
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Theywerewatchingmeattheprecinct.
Whisperingandwatching.
Ihadtomakesuretheydidn’tfollowmehome.
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Andreadingmymind.
ParanoiaEverycannabissmokerisfamiliarwiththatuneasy,
suspiciousfeelingthatyouarebeingwatched,talkedabout,followed,spiedonorplottedagainstwhennoneofthesethingsareactuallyhappening.Paranoiaistheunjustifiedbelieforfearthatsomebodyissecretlyouttogetyou,oftenfornoobviousreason.
Themaindrugsthatwhichcanleadtoparanoiaarestimulants(likecocaineandamphetamine)andcannabis.Paranoiaismostlikelywhenyousmokecannabisinunfamiliarplacesorwithstrangers–particularlywhenyou’restoned(andthey’renot).Ifparanoiahasbeencausedbycannabis,itwillwearoff(inanhourortwo)whenthecannabisdoes.
Theeffectsofsomedrugscanbeverysimilartosomeoftheeffectsofmentalillness.Paranoiacanbeasymptomofmentalillness.David’sparanoiaisverydisturbingforhimanddoesn’twearoffwiththecannabis.SmokingcannabismightbemakingDavid’sparanoiaworse.
Ifyoustarttofeelparanoidgosomewherequiet,whereyoufeelcomfortableandsafe.
Thingsyoucando:* Avoidgettingstonedinstrangeorunfamiliarplaces.
* Ifyouhavetogotostrangeplacestryarrivingstraight.
* Ifyoustarttofeelparanoidgosomewherewhereyoufeelsafe.
9
Iwasshitscared.
SirTrevorMcDonaldstartedtosendmewarningsaboutthem.
Theycouldreadmymind.
Ihadatransparenthead.
10
...it’sclearwhatwasonhismind.
HasyouriPodbeentalkingtoyoulately?Isyourheadsee-through?Areyourthoughtsbeingcontrolledbysomeoneelse?Areyouhavingideasthatarenotunderstoodorbelievedbymostpeople?
Thetroublewithallthebrilliantideasyouhavewhenyou’restonedisthat(a)youcan’trememberthemwhenthecannabiswearsoffand(b)theyoftenturnouttobecrapideasinthefirstplace.WhatishappeningtoDavidisnotcausedbycannabis,butcannabismightbehavinganeffect.
Ifyousmokeallthetimeit’sdifficulttotellifcannabisishelpingornot.Thereisnoharminstoppingforawhiletoseeifthingsseembetterorworse.Regularuserswillactuallyfeelproperlystonedagainiftheyhaveabreak.
Mostpeoplecanstopusingwithoutanyproblems.Butifyou’reoneofthosepeoplewhothinkitmightbedifficult,askthepersonwhogaveyouthisleafletforsomeadvice.
Thingsyoucando:* Checkoutrealityeverynowandagain.
* Thinkabouthavingabreakfromcannabis.
Secretmessagesandthoughtcontrol
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HearingvoicesHearingvoicesiscommonamongpeoplediagnosedwith
schizophreniatypeillnesses.Therearealmostasmanyexplanationsforthevoicesastherearevoices.Voicesaredifferentforeverybodywhohasthem;theycanrangefromtherelativelyfriendlytoextremelydisturbingandterrifying.
Somepeopleusecannabiswhentheyhearvoices.Somesaythevoicesbecomequieterorlessdisturbingorevengetstoned,andthereforeappearlessthreatening.Somesaycannabismakesthingsworseorthatthevoicescomebackevenlouderthenextday.Formostpeopleboththingshappen,theyfeelbetterwhenstonedandworseafterwardswhichleadsthemtosmokingmore.
Itisimportanttobehonestwithyourself.Itisnotalwayseasytojudgewhatishelpingandwhatisnot.Equally,ifcannabisishelpingitisimportanttoaskyourselfhowitishelping.
Forinstance,areyouusingcannabis(maybealongwithotherdrugslikealcohol)togetcompletelyoutofitandnumbyourselftowhat’sgoingon;orisittherelaxingandcalmingeffectsofcannabisthathelps?
Thingsyoucando:* Itisworthrememberingthatyoucangetavarietyofdifferenteffects fromcannabis.Learntogetwhatyouwantfromit. Seepage18fortips
* Askaboutotherwaysofrelaxingordealingwithstressorvoices. Askthepersonwhogaveyouthisleaflet.
13
AliensunderthefloorboardsDavidbelievesthatalienelectricianshavebuggedhis
wiring.David’sbeliefsmightbedisturbingforotherpeople,butitishisstrangebehaviourthatisnoticedandwillresultinhimbeingtakentohospital.
Strangebehaviourisoftenasignthatanillnessisgettingworse.BythetimeDavidstartsdismantlinghisbedroomlookingforaliendevices,it’sprobablytoolateforhimtodoanythingabouthisillness.
Whenyoucomeintocontactwithdoctorsandnursingstaff,theywillalmostcertainlyadviseyounottouseanydrugsotherthantheonestheyprescribetoyou.Whatyoutellthestaffaboutyourdrugusewillbetreatedinconfidence.Alotofstaffaresympathetictowardsdrugusers,butitisillegaltoallowsomeonetousedrugsonyourpremises.Soeveniftheywantedto,staffcannotallowanyonetousedrugsinahospitalorpsychiatricunit.
Youwillprobablybesearchedbeforeyouareadmittedtohospital.Youcanstillbeevicted,dischargedorarrestedbythepoliceifyouarecaughtwithcannabisorotherillegaldrugsonyou.
Thingsyoucando: * Behonestwithstaffaboutyourpastdruguse.
* Rememberthatcannabisisstillillegal.
15
16
David...Davidcanyouhearme?I’mNurseJessand
thisisDr.Bone.
PutsimplyMr.Jones...Schizophrenaformtypepsychoticsymptomaticus
AndypandyusGinganggooglyoogly.
DoctorswouldprobablycallwhatDavid’sbeenexperiencing‘psychoticsymptoms’ora‘psychosis’.SomedoctorsmightsaythatDavid’spsychosishasbeenbroughtonbyusingcannabis–theymightevensayit’scannabispsychosis.
Somepeoplewillbecomeillonceandneverbecomeillagain,whileotherswillexperiencemanyepisodesofillnessovertheirlives.Ifpsychosiskeepsrecurringoritisverysevereitcouldleadtoadiagnosisofparanoidschizophreniaorschizophreniatypeillnesses.
David’sillnesswillrequirehimtospendweeksormonthsinhospital.Hewillbegivenverypowerfuldrugscalledantipsychotics.AntipsychoticdrugswillstoporreducethesymptomsofDavid’spsychosisandhelphimcopewiththestressoflife.Antipsychoticscanhaveunpleasantsideeffects(likegainingweight)–butthesecanbecontrolled.
Cannabisreducestheeffectivenessofantipsychoticmedication.Davidwilltakelongertogetbetterandwillneedmoremedicationifhecarriesonusingcannabisorotherdrugsduringhistreatment.Cannabiscanalsomakedepressiveandanxietysymptomsworseinthelongterm.However,evenifyouareusingcannabisduringyourtreatmentitisstillbettertocarryontakingyourantipsychoticmedicine.
Thingsyoucando: * Remember,evenifyouareusingcannabisduringyourtreatment youshouldcarryontakingyourantipsychoticmedicine.
Diagnosis,treatmentandmedication
17
DifferenttypesofcannabisTherearethreemaintypesofcannabis:herbalcannabis
(grass),strongerformsofherbalcannabis(skunk)andresin(hashish).ItisthoughtthatbecauseithasaveryhighTHC*contentsmokingskunkismorelikelytobringonparanoiaandthekindofsymptomsdescribedinthisleaflet.
Smokingcannabisresin–whichhasmoreCBNandCBD–hasamorerelaxinganddopeyeffectandmaybelesslikelytocauseproblems.Somepeoplesmokeamixture,whilesomejustsmokeresinorsaveskunksmokingforweekendsorspecialoccasions.
StandardMoroccanresin(soap/slate)ischeap,butcutwithallsortsofcrap,soisroughonthelungs.Pollem(orPollen)andblackaremoreexpensive,butarebetterqualitytypesofresin.*Seepage5
Herbalcannabis Skunk Resin
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Managingcannabisuse
Asageneralrulethemorecannabisyouusethemorelikelyitisthatitwillhaveanegativeeffectonyourmentalillness.Ifyoucan’tstopusingtryandcutdownonhowmuchcannabisyousmokeandhowoftenyougetstoned.Takecontrol–tryandgetasmuchpleasureandpositiveeffectsfromcannabisasyoucan,andtoreduceasmanyofthenegativebitsasyoucan.
* Tryusingonlyintheeveningsoratweekendsetc.
* Buyasetamount(inweight)everyweek/monthandeithermakethatlastor ifyourstashrunsout,gowithoutuntilit’stimetobuymoreagain.
* Havearestfromsmokingregularly–you’llactuallyfeelstonedagainif yougiveitabreak.
* Don’tusedaily–ifyoudotryandkeepatleasttwoorthreehours betweensmokes.
* Ratherthansmokingskunkonly,trysmokingresininstead, atleastsomeofthetime.
* Don’tusefastdeliverymethods–likebongsetc.
* Avoideatingcannabis(ittakeslongertohaveaneffectbutitcanbevery strongorunpredictablewhenitstarts).
* It’sbestnottomixcannabiswithotherdrugs.
* Avoidstressfuloranxiety-causingsituationswhenyouarestoned (e.g.illicituseintoilets.)
* Cannabiscanmakeyouforgetful–remembertotakeyourmedication.
* Rememberthatcannabisisstillillegaltopossesorsupplytoothers.
19
20
Syntheticcannabis‘Syntheticcannabis’(‘spice’)is
usuallysoldinsmallbrandedpacketscontaininganordinarydriedplantthathasbeensprayedwithchemicalscalled‘syntheticcannabinoids’.
SyntheticcannabinoidsinteractwiththesameareasofthebrainasTHC,producingeffectsthataresimilartoobutcanalsobequitedifferentfromnaturalcannabis.
Somebrandsaresopotentthatanactivedoseisapinchthesizeofamatchhead.Userswhogooverthisdosehavereportedbreathingdifficulties,chestpains,racingerraticheartbeat,severerashes,vomiting,lossofbalance,anxiety,panic,seizuresandunconsciousness.Ifyouexperienceanyserioussymptoms–trytostaycalmandcallforanambulance.
Syntheticcannabinoidshavealsobeenassociatedwithhighbloodpressure,short-termmemoryloss,hypokalemia(lowpotassiumlevels),numerousnonfatalpoisonings,kidneyinjuryandasmallnumberofdeaths.
Researchershaveconcludedthatsyntheticcannabinoidsarepotentiallymoreharmfulthannaturalcannabis.
Tolerancetosyntheticcannabinoidsdevelopsquickly,withcompulsiveusecommonlyreported.Itisnotthoughtthattheycausephysicaldependence,butlikenaturalcannabissomepeoplemaybecomeanxiousaboutstoppingandmayexperiencemildwithdrawalsymptoms,suchassweating,insomniaandvividdreams.
Aswithnaturalcannabis,syntheticcannabinoidsarethoughttotriggerpsychoticsymptomsinthosepredisposedtotheillness.Therearealsoreportsofsyntheticcannabinoidscausingsevereparanoiaandsuicidalthoughts.
Nexttonothingisknownaboutlongtermuseofsyntheticcannabinoids,asquitesimplynobodyhaseverusedthemforalongtime.Itmaywellbethattheyarefarmoredetrimentaltoyourmentalhealththannaturalcannabis.
21
Itisillegaltosell‘syntheticcannabis’asa‘drug’,soitissoldas‘potpourri’or‘herbalincense’.Itsays‘Notforhumanconsumption’onthepacketasthesedrugshaveneverbeentestedonhumans.
Thechemicals(syntheticcannabinoids)thataresprayedontothedriedplants,changeovertime:asthegovernmentbanone,newer‘legal’onesareused.
Ifyouareadmittedtohospitalyouwillnotbeallowedtousesyntheticcannabisorotheranydrugsoralcohol.Nursesanddoctorscanworkwiththehospitalsecurityand/orthepolicetoensurethewardenvironmentissafeanddrugandalcoholfree.
Youwon’ttestpositivefornaturalcannabisifyousmokesyntheticcannabinoids,buttestsforsyntheticcannabisarelikelytobecomemorecommon.
Thingsyoucando: * Beawarethatsyntheticcannabinoidsareprobablymoreharmfulthannaturalcannabis.
* Don’tunderestimatepotency–startwithadosenobiggerthanamatchhead.
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StreetdrugsandyourmedicationReportedadversereactionsthatcantakeplace.
Cannabis
Alcohol
StimulantsCocaine/Amphetamine/Ecstasyetc.
Heroin/Methadone&otheropiates
Tobacco
Addeddrowsiness.
Someantipsychoticlesseffective(higherdosesmaybeneeded).
Antipsychotics Antidepressants Anxiolytics&Hypnotics
MoodStabilisers
Increasedheartrate(palpitations)withtricyclics.
Possibledelirium.Serotoninantidepressantrecommended.
Addeddrowsiness.
Paradoxicalagitation.
Nervousedginess.
Addeddrowsiness.
Possibleriseinbloodlithiumlevels(toxic).
Addeddrowsiness&lethargy.Increasedheartbeat/hypotension(lowbloodpressure).Respiratorydepression.DANGEROUS.
Addeddrowsiness,seizuresandhypotensionwithTricyclics.Serotoninantidepressantsrecommended.
Addeddrowsiness.Hypotension(lowbloodpressure),fainting.Respiratoryarrest.DANGEROUS.
RiseinbloodLithiumlevels.Dehydration/overhydration.DisruptbloodLithiumlevels.DANGEROUS.Carbamazepine&alcoholbadfortheliver.
Antipsychoticlesseffective.Stimulantlesseffective(mayleadtoahigherdoseofboth).
Disturbedheartrhythm(Arrhythmias).Serotoninantidepressantsmaycausestimulation/agitation.
Anxiolytic/hypnoticlesseffective.Oversedationwhenusedwithcocaine.
Heartproblems(Arrhythmias).Dehydrationleadingtotoxicity.Diminished‘high’couldleadtopoormedscompliance.Carbamazepineandcocainetoxicmix.
Increasedsedation.Hypotension(lowbloodpressure).Respiratorydepression(lower,stoppedbreathing).
Addeddrowsiness.Respiratorydepression(labouredorstoppedbreathing).Mayincreasebloodopiatelevels.
Addeddrowsiness.
Riskofrespiratorydepression.
Bloodopiatemayrise–dangerofO/DDANGEROUS
Carbamazepinelesseffectiveandreducedbloodopiatelevels.O/DriskifsuddencessationofCarbamazepine.Sodiumvalproatepossiblealternative.
Someantipsychoticlesseffectiveeg.clozapine&olanzapine,sohigherdosesmaybeneeded.Doseadjustmentmaybenecessaryonsmokingcessationtoavoidsideeffects/oversedation.
Antidepressantside-effectsmayworsen,somelesseffective.Higherdosesmaybeneedede.g.fluvoxamine/duloxetine.Sideeffectsmayworsenwhenstoppingsmoking.
None/littleknown/reported.
O/D=Overdose
None/littleknown/reported.
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AnticholinergicsDrugsusedtotreatanti-psychoticside-effects.
AnticholinergicsProcyclidineOrphenadrineBenzatropineTrihexyphenidyl
AntipsychoticsDrugsusedtotreatpsychosisandschizophreniatypeillness.
Antipsychotics(Typicals)ChlorpromazineTrifluoperazineHaloperidol SulpirideFlupentixolZuclopenthixolPipotiazineFluphenazine
Antipsychotics(Atypicals)RisperidoneOlanzapineQuetiapineClozapineZotepineAmisulprideAripiprazole
AntidepressantsDrugsusedtotreatdepression.
Serotonin/NewerAntidepressants
CitalopramFluvoxamineFluoxetineParoxetineVenlafaxineSertralineReboxetineDuloxetineMirtazapineAgomelatine
Tricyclic/OlderAntidepressants
AmitriptylineClomipramineDosulepinLofepramineTrazodoneMianserinImipramineNortriptylineTrimipramine
Anxiolytics&HypnoticsDrugsusedtotreatanxietyandsleepproblems.
Anxiolytics&HypnoticsDiazepam Lorazepam Temazepam Pregabalin Clonazepam BuspironeChloral HydrateZopicloneZolpidemPropranolol (Beta-blocker)
MoodStabilisersDrugsusedtotreatbipolardisorder,depressionandothermooddisorders.
MoodStabilisersLithium *Carbamazepine *Sodium ValproateSemisodium Valproate*Lamotrigine
*Alsousedinepilepsy.
Anticholinergics
Possibleanticholinergenicpsychosis.
None/littleknown/reported.
Agitation.Overstimulation.
None/littleknown/reported.
Agitation.Overstimulationpossible.
Examplesofdrugsusedtotreatpsychiatricillness
Monoamine oxidase inhibitors e.g phenelzine, tranylcypromine are rarely used due to dangerous interactions. The combination of these and opiates/stimulants is very bad.
Theseguidesarebasedupontheexperiencesofpeopleinpsychiatrictreatment.
The stories were told as part of a Ph.D. sponsored by the Manchester Mental Health & Social Care Trust and The University of Salford.
Research: Dr. Mark Holland, Michael Linnell.Text: Michael Linnell, Mark Holland. Illustrations: Michael Linnell. Special Thanks to: All the clients and staff involved in this project, Dr. Russell Newcombe, Peter McDermott, Dr. Tim Garvey (Consultant Psychiatrist, General Psychiatry and Assertive Outreach, MMHSCT), Petra Brown (Chief Pharmacist MMHSCT), Dr. Deepak Gupta, Professor Duncan Mitchell, Dr Tracey Williamson (University of Salford), Sabrina Schulte and Kerry Hilton.
NorthWestNHSInnovationAwards2007–FirstprizeNHSNationalTechnologyAwards2007–RunnerupNursingTimes,ChiefNursingOfficer’sAward2007–Finalist
To re-order go to exchangesupplies.org Published by: Exchange Supplies, 1 Great Western Industrial Centre, Dorchester, Dorset DT1 1RD. Tel. 01305 262244
code A37 | version 2.0Print date 04/2014 | Review date 04/2016
aims To provide up to date information and advice on drugs and mental illness.
audience People who use drugs and have experienced mental illness and the staff who work with them.
content Some swearing and graphic images of drug use.
funding Self-financed.