Guest: Dr. Kevin Gray - Psychiatrist
Host: Dr. Linda Austin – Psychiatrist
Dr. Linda Austin: I am Dr. Linda Austin and today I am interviewing Dr. Kevin Gray, who is a psychiatrist here at the Medical University of South Carolina. Dr Gray one of your areas of interest is in adolescent use of marijuana. What an important topic because it seems that so many kids try marijuana these days and continue using it into adulthood.
Dr. Kevin Gray: Absolutely, people will say that for a long time kids have been using marijuana and that’s true, but there has been a lot of changes since say the 60’s, 70’s when we started seeing a lot of marijuana use to what’s happening today.
Sr. Linda Austin: What changes?
Dr. Kevin Gray: Well, we are noticing - what the literature is telling us - what kids are telling us. Actually, the kids are the ones providing a literature for us is that they are starting earlier. We are starting to see use in very the early teens and we are seeing heavier use at a younger age is one of the things we see.
Dr. Linda Austin: Has the marijuana itself changed over the years?
Dr. Kevin Gray: Absolutely, just like other things in agriculture people are getting better at growing marijuana to be more potent and so I think somebody told me recently the talk of today is like the joint of the 60’s. So, meaning that we are much more potent now. So, one dose of marijuana today is equivalent of many, many doses from the 60’s.
Dr. Linda Austin: What is the upshot of that, what impact does that have then on the kid, who is smoking now relative to when I was a kid in the hippy days of the 60’s?
Dr. Kevin Gray: The short answer is, we don’t quiet know. The long answer is, these kids are more likely to become dependant on this at a stronger dose and earlier exposure they are more likely to become dependent on the substance and that something that really wasn’t thought about decades ago as people being dependent on marijuana, but we really are seeing a lot of daily use among adolescents.
Dr. Linda Austin: Let’s talk some about dependence on marijuana because what kids and adults, who are users always say is that - it is not an addictive substance. What’s your view on that and what does research show us?
Dr. Kevin Gray: Research shows us that marijuana acts in a way similar to alcohols, what I compare to in terms of - if you compare to nicotine where if any of us were given enough cigarettes we would become addicted. However, most Americans, who are exposed to alcohol and most don’t become addicted. The same is true from marijuana. See you may have a number of people exposed to marijuana, but there is subset of people for reasons we aren’t quiet clear on, but are prone to becoming addicted to it.
Dr. Linda Austin: If they become addicted to it and then have to stop very suddenly or try to stop what happens?
Dr. Kevin Gray: Well, we found that there is a withdrawal syndrome that happens with marijuana and again this is something that was doubted in the past, but that really with a great deal of research that’s been supported by repeated studies and different populations it shows that people have a similar withdrawal to what people have with cigarettes and I think most of us know about nicotine withdrawal. There is behavioral and physical symptoms that go along from a day or two to about week or so when they have the really intense symptoms of withdrawal.
Dr. Linda Austin: So, it becomes very hard for them to stop.
Dr. Kevin Gray: Yes and for some marijuana users that actually is their main drive for continuing uses to avoid withdrawal symptoms.
Dr. Linda Austin: Are there any estimates as to what percent of marijuana smokers are prone to become addicted?
Dr. Kevin Gray: Well, most of the literature that I know is on adolescents and you can extrapolate from the data from monitoring the future study, which is supported by the National Institute on Drug Abuse. They show that by seniors of high school about - nearly half of high schools senior have tried marijuana and about 5% of high school seniors smoke marijuana daily, so if you extrapolate from that about 10%, who were exposed become dependent if you would think that daily use probably does reflect dependence.
Dr. Linda Austin: So, that’s not so different from alcohol. Am I right about that?
Dr. Kevin Gray: You are absolutely right and again I think that goes against the thinking of a lot of people, who were thinking that alcohol is being addicted, but marijuana not so much.
Dr. Linda Austin: Does it tend to be the same individuals, who are prone to be addicted to alcohol, who become addicted to marijuana?
Dr. Kevin Gray: Sometimes these things cluster together, but we really don’t know enough about that.
Dr. Linda Austin: What impact psychologically does chronic marijuana use have on the individual; let’s say the kid, who smokes at least several times a week?
Dr. Kevin Gray: Sure. I think that’s a great question and I think there is really emerging information on this that is countered to what our logic has told us is that we used to typically think of marijuana use as being self medication, so we will say, ?Well the kid is feelings stressed, depressed, or anxious. So, therefore they use marijuana, but we have actually found that quite the opposite is the case is that adolescents, who begin using marijuana are prone to later developing anxiety disorders, depressive disorders, and in some cases psychosis and that’s a pretty new topic that’s a bit controversial.
Dr. Linda Austin: So, let’s imagine your apparent listening to this and you have a teenager and you know that your teenagers smokes marijuana from time to time, you may not be quite sure how much. What would you advice that parent to do what to say?
Dr. Kevin Gray: Well, that’s a tricky question and a lot of things are up to individual parenting styles, but really the bottom line is - get to know your kid. In a comfortable approachable way, you need to talk to your kid about what’s going on and you need to ? in a confrontational way, you have to sort of say as I have seen I suspected that you may be smoking marijuana and then in a approachable way, get them talking about it. You can’t really intervene unless you really know.
Dr. Linda Austin: Would you suggest taking them for treatment and what kind of treatment might be useful?
Dr. Kevin Gray: Well that depends on the amount of use, which still may be mysterious to parents. As with anything else going to the pediatrician is usually the first good way of getting evaluated for something and pediatricians are sometimes under utilized as sort of a primary place to go to begin with evaluation of substance use in adolescents, but they are kind of the people to start with.
Dr. Linda Austin: In my adults psychiatric practice I have any number of patients, who tell me that they are chronic marijuana smokers and that they do it because it calms them down and help them with chronic anxiety. What would do you say to that, do you by that?
Dr. Kevin Gray: I do by that, but I also will throw in the caveat that they may have developed worsening anxiety as a result of withdrawal from marijuana. So, instead of may be chasing the effects of marijuana; that makes sense, may sound a bit vague. What I am implying is that just like with cigarettes when people say well I need to smoke in order to calm my nerves well they didn’t - before they became dependent on nicotine they didn’t need it to calm their nerves, but that’s sort - what’s happen with turn over of brain nerve 06:38 that they have become dependent on that substance to feel non stressed or non anxious.
Dr. Linda Austin: So, in other words, they are really trying to treat withdrawal symptoms just like an alcohol might have an eye opener in the morning.
Dr. Kevin Gray: Absolutely, and we actually do see people, who have to have a bowel in the morning or have to have a warm head in the morning or have their joint before they go to class. We see even young kids, who do this.
Dr. Linda Austin: So, it’s really a pretty big problem actually. What about chronic health problems coming from marijuana smoking?
Dr. Kevin Gray: Well, that’s a great question as well. The things that we know are associated, but we can’t quite say cause and effect. We do see that the people tend to have more respiratory infections in the long term with marijuana use. We know that there are a lot for carcinogens in marijuana. We don’t quiet know the prevalence of cancer that may be caused by marijuana use, but we do know that the carcinogen were there and smoked marijuana and we know about chronic problems with motivation and chronic problems with thinking. There are some cognitive effects that can be very lasting with heavy chronic marijuana use.
Dr. Linda Austin: So, far from being just a benign drug, which so many people think it is - their really are some significant issues involved.
Dr. Kevin Gray: Yes and I think I lead into this earlier is something that fascinating to me is there is an emergent information from a number of different countries and number of different cultures of early adolescent heavy marijuana exposure, bringing out psychotic symptoms and that’s to say hallucination, delusions, and paranoia and we are trying to pin down, who is at risk for this and we don’t quite know, but we do suspect that those with the family history of psychosis such as schizophrenia or other psychotic disorders may be at a increased risk of becoming psychotic with marijuana use.
Dr. Linda Austin: So, your wrap up advice to parents on this issue would be what?
Dr. Kevin Gray: Get to know your kid and feel comfortable with getting to know your kid and its better to try to know and then intervene than to wonder what’s going on.
Dr. Linda Austin: Dr. Kevin Gray great. Thank you so much for talking with us today.
Dr. Kevin Gray: You’re very welcome, it’s my pleasure.
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