Navigating Medical Cannabis Prescribing in Mental Health Treatment - a strategy to mitigate street use cannabis.
Article Written by Dr Danny Cai
Read time: 5-6 mins
From patients self-medicating with street cannabis to clinicians exploring regulated medical cannabis, the application of medical cannabis in the mental health sphere is constantly evolving. In lock step with any novel frontier in medicine, there are challenges.
As a doctor specialising in mental health, my role isn’t merely about prescribing cannabis—it’s about navigating the complex relationships between the individuals who need support, their health picture and the applicability of the medication.
Understanding the Context: Why Patients Seek Cannabis?
It is common for me to encounter patients visiting my clinic who are already using cannabis. More often than not, they’ve turned to it as a form of self-medication—whether for anxiety, depression, or chronic pain. Up til now, they are not using it in a medical context; they’re sourcing it from the streets. In that case, my job is to ask the right questions: How much are they using? What kind of product are they getting? Most importantly, what symptoms are they treating on their own? These are effective triaging tools to ensure the best course of treatment is provided based on past use.
From the clinician's perspective, this is both a challenge and an opportunity. The challenge being that street cannabis can contain unknown or harmful substances; the opportunity is in harm reduction. If I can intervene, helping patients access regulated, quality-controlled cannabis, the education and follow-up promote better outcomes and ensure they don’t rely solely on potentially THC-dominant products from unknown sources. Keep in mind that black market products are commonly grown indoors under artificial lights to promote high potency.
In many cases where patients use street cannabis for their mental health concerns, they’re leaning heavily on high THC varieties and not considering the neuroprotective benefits of CBD, as well as terpene influence.
Treatment Protocol: A Harm-Reduction Approach
When it comes to developing an effective treatment plan for patients already using cannabis, the approach has to be gradual and measured. Many of these patients are coming to me after years of self-medicating with THC-heavy street cannabis. They might be using it to manage anxiety, bipolar disorder, or even manic episodes.
A key part of my approach is to avoid abruptly cutting patients off from THC or drastically changing their treatment. Whether it’s shifting to a CBD-dominant product or rapidly changing the method of delivery - people don’t cope well with sudden changes, and that’s especially true for those dealing with mental health conditions.
So, I take a harm reduction approach. I don’t try to eliminate THC altogether because, in reality, if I don’t help guide them, they’ll just go back to their dealer. Instead, I focus on reducing the harm by encouraging them to gradually lower their THC intake while incorporating CBD, highlighting its neuroprotective effects and the benefits of modulating the Endocannabinoid System with CBD and other minor cannabinoids.
The literature on cannabis and mental health is expanding; while we don’t have all the answers, I’ve found that CBD can play a crucial role - especially for patients with bipolar disorder or manic episodes. These are complex conditions, and cannabis isn’t a standalone treatment, but when combined with traditional psychiatric medications and care, I’ve seen it provide real benefits for many of my patients.
It’s essential to approach these patients with caution and in concert with their other healthcare practitioners. It can be possible to create a balanced plan that helps manage symptoms. Particularly when introducing CBD in situations where street cannabis has been the primary form, I’ve found working closely with my patient’s psychiatrist and other supports regularly proves beneficial.
Transitioning to Safer Consumption Methods
Another key part of harm reduction is how patients consume their cannabis. More often than not, patients with a history of recreational use or self-medication are smoking their cannabis. From a health perspective, this is far from ideal, so I encourage them to switch to safer methods.
Dry herb vaporisers allow for more precise control over the temperature and dose. Slowly transitioning patients away from smoking and towards vaporising or oral ingestion, highlighting the nuance of control they can have with alternative consumption methods, often helps guide patients towards safer options.
That said, it’s not just about reducing harm. I also want patients to understand what they’re consuming and how it’s affecting them. By switching to a vaporiser, patients can begin to experiment with temperature control, which can change the profile of the terpenes they’re inhaling. This education process is important because it helps patients feel more in control of their treatment.
A key takeaway with mental health patients and many others I’ve witnessed is when they understand the nuances of their medication; then they’re more likely to stick to the treatment plan.
Individualising Care: No One-Size-Fits-All Approach
If there’s one thing I’ve learned from working with patients and medical cannabis, it’s that there’s no one-size-fits-all approach. This is where the art of medicine comes in.
You need to assess each patient individually—how long they’ve been using cannabis, what doses they’re taking, and how it’s affecting their mental health. There’s a balance to strike between respecting individuals’s autonomy and ensuring they’re not putting themselves at further risk.
Some patients are eager to come off antidepressants once they start medical cannabis. This can be a positive goal for some, but it’s important not to rush. I always tell patients that coming off medications like antidepressants is a process. The longer they’ve been on them, the slower we need to taper them off. If they’ve been on antidepressants for five years, for example, it might take several months to come off safely.
Mental Health and Cannabis Use: Building Trust and Rapport
One of the most important aspects of treating mental health patients using cannabis is building trust - you've got to form that rapport with them and then for them to trust you before you can get to that plan and get them to be compliant with that plan.
Many of these patients come to me because they feel like they haven’t been heard by their regular healthcare providers. They may have been told to stop using cannabis without any understanding of why they started in the first place. For these patients, cannabis has been a lifeline, helping them manage symptoms that weren’t adequately addressed by traditional treatments.
As a physician and human being, I can’t dismiss their experiences. Rather, I work to build rapport and show them that I’m here to help, not to judge. With the foundation of an empathetic and solid therapeutic alliance, together, we explore what triggers their cannabis use, what benefits they feel, and what challenges they encounter.
It’s through communication and connection that we can develop a plan they’ll adhere to, one that balances harm reduction with effective symptom management.
The Power of Hope in Mental Health Recovery
The driving force of my work in the mental health space is hope. Hope that we can find solutions for patients who haven’t found relief in traditional medications. Hope that in providing them a safe alternative to street cannabis, we can reduce harm and improve their quality of life.
There are days when patients struggle, when they experience setbacks. But one of the most powerful tools I’ve found is instilling hope in my patients. Whether through a refreshed treatment plan, highlighting a positive outcome from their lifestyle choices, or simply the reassurance that I’m here to support them, even the tiniest piece of hope can help buoy patients through tough times.
In Closing
Lastly, I believe it’s important to frame cannabis correctly so that it doesn't glamorise the medication. Cannabis is not a panacea for mental health conditions; it’s a tool that, when used appropriately and in concert with other treatments, can offer real benefits.
By focusing on harm reduction and maintaining a collaborative approach with other healthcare providers, we can support patients in navigating the complexities of their mental health. The journey is not always easy, but with the right support, patients can find relief and, perhaps, a glimmer of hope for the future.
Dr. Danny Cai is an accomplished medical professional with over 20 years of experience in healthcare, holding a Fellowship with the Royal Australian College of General Practitioners (FRACGP) and an M.B.B.S. from the University of Adelaide. As Medical Director of Botaniqal and a consultant to the Australian Government, he specializes in cannabinoid medicine, plant-based therapies, and cosmetic medicine. His expertise spans multiple domains, including his role as Director of Ldlsolutions.com.au, where he pioneered Australia's first Emergency Dissolving Service for cosmetic filler complications. Dr Cai's entrepreneurial spirit is evident in his co-founding of CeBeDe Skin, Australia's first CBD skincare line, and his previous fifteen-year tenure as Medical Director/Founder of Dr Wrinkles. A respected voice in government policy and public health reforms, he actively contributes to the advancement of medical cannabis in Australia through his membership in the Australian & New Zealand College of Cannabinoid Practitioners and his advisory roles with various cannabis manufacturers and companies.
Disclaimer: This information is shared with a global readership for educational purposes only and does not constitute medical or business advice. All patient-related information has been de-identified OR fictional to protect privacy. Nothing in this article is intended to promote the use or supply of medical cannabis to members of the public.
