MentalillnessandCannabis–thestoryof

David–themanwith thetransparenthead

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OUTofYOURHEADguidesforpeoplewhousedrugsandhaveexperiencedmentalillness

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MentalillnessisareactiontolifeThejourneybetweenourbirthanddeathis

thestoryofourlife.Onthisjourneywewillmeetwithdesperation,delight,loveandloneliness.Sometimesourmindsrespondtotheeventsandtheexperiencesinourlivesinwaysthatcanbecomeextremelydisturbingforusandthosearoundus.Doctorscallthisreactiontolife‘mentalillness’.

DrugshaveaneffectonmentalillnessWeusedrinkanddrugstogiveuspleasure,to

stopusfeelingpainorbecausewehavenothingbettertodo.Ifdrugsarepartofourlifetheywillhaveaneffectonourmentalillness.Whatthiseffectwillbedependsontheperson,thedrugandhowthedrugisused. Thesestoriesarebasedontalkingtopeopleinpsychiatrictreatment.

ThisstoryisaboutDavidandtherolethatcannabisplaysinhislifeandhisillness.

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Outofyourheadguidesforpeoplewhousedrugsandhaveexperiencedmentalillness

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David Martha Jason God

Brainchemistry

Yourbrainisthemostcomplexobjectintheknownuniverse–itcontains100billionspecialcellscalledneurons.Neuronscom-municatewitheachotherbyreleasingasortof‘chemicale-mail’.

Therearemorethan80typesofthesechemicals–calledneurotransmitters.Mostillegaldrugscausethereleaseofaneurotransmittercalleddopamine.

Thisreleaseofdopamineiswhydrugsfeelpleasurable.Buttoomuchdopamineinyourbraincouldcauseproblems.Drugsusedtotreatschizophreniatypeillnessesseemtoworkbyreducingdopamine.

Thebalanceofneurotransmittersinyourbrainaffectsyourmoodandthoughtsandseemstohaveanimportantroleinmentalillness.

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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.

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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.

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Iwasshitscared.

SirTrevorMcDonaldstartedtosendmewarningsaboutthem.

Theycouldreadmymind.

Ihadatransparenthead.

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...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.

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Iknewwhatwasbehindthishadtobehiddeninthewires.

butwherewasthealiendevicehidden?

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AliensunderthefloorboardsDavidbelievesthatalienelectricianshavebuggedhis

wiring.David’sbeliefsmightbedisturbingforotherpeople,butitishisstrangebehaviourthatisnoticedandwillresultinhimbeingtakentohospital.

Strangebehaviourisoftenasignthatanillnessisgettingworse.BythetimeDavidstartsdismantlinghisbedroomlookingforaliendevices,it’sprobablytoolateforhimtodoanythingabouthisillness.

Whenyoucomeintocontactwithdoctorsandnursingstaff,theywillalmostcertainlyadviseyounottouseanydrugsotherthantheonestheyprescribetoyou.Whatyoutellthestaffaboutyourdrugusewillbetreatedinconfidence.Alotofstaffaresympathetictowardsdrugusers,butitisillegaltoallowsomeonetousedrugsonyourpremises.Soeveniftheywantedto,staffcannotallowanyonetousedrugsinahospitalorpsychiatricunit.

Youwillprobablybesearchedbeforeyouareadmittedtohospital.Youcanstillbeevicted,dischargedorarrestedbythepoliceifyouarecaughtwithcannabisorotherillegaldrugsonyou.

Thingsyoucando: * Behonestwithstaffaboutyourpastdruguse.

* Rememberthatcannabisisstillillegal.

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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

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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.

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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.

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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.