Cannabis And Couples: What Does The Research Say?

“Now that marijuana is legalized in many states for recreational purposes, I am seeing more conflict arise between couples about what it means to use marijuana and whether it should be used recreationally. There are long-standing beliefs and values about drug use in our country, and yet, I do not see legalization being addressed in the context of how it has impacted relationships and couples. It would be very helpful to hear more about this topic specifically.”

It’s difficult for couples to avoid black and white answers when considering cannabis use—pro or con. Staying in the grey area can feel uncomfortable when there are strong emotions underneath those positions, especially if there is a family history or relationship history related to substance use.

Another big problem with any discussion about cannabis is the history of government misinformation and lack of support for research. Additionally, researchers are hampered by the categorizing of cannabis as a Schedule 1 drug. The Drug Enforcement Agency (DEA) puts cannabis in the most restricted category of “high abuse potential” and “having no medical value.”

The implication for researchers is that access to federal funding and grants is difficult because the federal government Schedule 1 classification makes cannabis illegal, despite compelling research to date that clearly challenges this inappropriate classification.

Political agendas, not medical or scientific agendas, have served to hamper much needed research to better understand the potential benefits and potential harms from cannabis use. Patients and parents of children with serious health issues that could benefit greatly with a cannabis-based medicine are left trying to figure things out on their own, an unnecessary and unethical situation from the hands of policy-makers.

Despite the challenges, changes are occurring as researchers, nationally and internationally, are providing new information on risks and benefits of cannabis use. A review of current research helps with a starting point for couples to grapple with and have a conversation about cannabis.

Evolving legalization and evolving issues

I teach a graduate psychology class at Santa Clara University on addiction assessment and treatment. In the first class I typically ask the students about what they think people could get addicted to, including marijuana. The students are often split on whether people can be addicted. Even with the possibility of cannabis addiction, students are uncertain about how big of an issue it is compared to other substances.

So given the serious and pervasive issues of other substances like alcohol, the resurgence of increasing rates of overdose deaths from stimulant use, and of course the opioid crisis that has emerged over the last several decades, just how concerned should we be about cannabis?

After all, cannabis is the most commonly used “illicit” drug in the USA with an estimated 22 million users per month.

Does medical marijuana really have a legitimate place in health care, or is this a workaround, a socially acceptable, and legal maneuver with the step-wise intention of legalization?

A political movement (with enormous economic implications) has rebranded cannabis. An increasing number of states have either decriminalized or have legalized (10 states as of this writing) its use for medical and/or recreational use. Perceptions are changing. A 2013 Fox poll found that 85% of Americans support medical marijuana when prescribed by a physician.

Conflicting reports cause confusion

In my consultation sessions and workshops, the two most common questions I’m asked by couples therapists are about cannabis use: “As a clinician, when should I be concerned about marijuana use?” and “How do I deal with a couple when one partner is concerned about their partner’s marijuana use?” These actually are not simple questions to answer. There are a lot of things to consider in determining where the line blurs between safe recreational use, problematic use, legitimate medical benefit, and addictive use.

Reports on the harmful consequences include concerns that heavy and extended use of cannabis could damage the brain’s pleasure center, negatively impact cognitive functioning and learning, damage reproductive systems, present risks for dependence and addiction under some circumstances, increase anxiety and panic symptoms, and create mood alterations (also a symptom of withdrawal).

Because of the complex nature of cannabis and the current trends in cannabis legalization and accessibility, both counselors and couples are likely to feel conflicted or uncertain about whether use is problematic.

The reality is that significant strides in science are being made in uncovering and understanding the healing possibilities of cannabinoids. And there are harmful consequences that can occur as a result of use as well.

Reports on the benefits of cannabis use include reducing anxiety, evidence that cannabis can kill certain cancer cells in patients with brain cancer, help in managing chronic pain, effective in treating movement disorders, possibly useful in treating symptoms from Alzheimer’s and Parkinson’s, and reduces eye pressure from glaucoma.

Researchers do agree that both the negative and positive effects come from the body’s endocannabinoid system.

The endocannabinoid system

In the 1990s scientists discovered that our body naturally produces endocannabinoids, a system found throughout our body which activates the two endocannabinoid receptors, CB1 in the brain, and CB2, located outside the brain and throughout the body. There are more than 60 types of cannabinoids.

The psychoactive compound in cannabis, tetrahydrocannabinol (THC ), activates CB1 receptors and produces the “high” while CB2 does not. Interest in CB2 is researched for its potential therapeutic effects for a number of conditions, including acute pain, chronic pain from inflammation, relieving symptoms from multiple sclerosis and other movement disorders, numerous cancer studies, and many other conditions with promising possibilities.

Both the CB1 and CB2 mechanisms have led researchers to believe that cannabis can have great benefit and therapeutic value for a host of psychological and physiological problems. The challenge with the CB1 receptor is the unwanted psychotropic effects when used as medicine. This is where interest has turned toward cannabidiol (CBD), which is receiving a lot of attention in the medical research communities. THC is the major active ingredient in cannabis, but cannabidiol makes up about 40% of the cannabis extracts.

While CBD does not directly trigger signaling at CB1 or CB2 receptors, it is thought to alter how CB1 receptors respond to THC, dramatically counteracting the psychoactive effect of THC.

The concept of the “entourage effect” was introduced in 1988 and refers to interactions between different cannabinoids creating different effects to alleviate medical symptoms. Scientists are exploring the therapeutic value of CBD, as well as the benefit of combining CBD with THC, which serves to harness the therapeutic value of THC without the accompanying high.

In June 2018 the FDA approved for the first time a cannabis-based drug. Epidiolex is administered orally to treat two rare and severe forms of childhood epilepsy. The formulation is a highly purified CBD, so there is no resulting high, allowing the FDA to classify the drug as a Schedule V (no addiction potential and demonstrates therapeutic value).

Marinol and Nabilone are FDA approved synthetic cannabinoids used primarily to treat nausea and vomiting from chemotherapy, for anorexia from AIDS, and for chronic pain. Because they contain THC there can be withdrawal symptoms and can be addictive. Another drawback is there is no entourage effect, the synergistic reaction between cannabinoids. Without the entourage effect mediation is less effective, due to the limited number of symptom targets.