MARIJUANA CAN SEND A BRAIN TO POT

At age 17, sitting in the basement with friends smoking pot, Don
Corbeil first noticed all the cameras spying on him. Then he became
convinced a radioactive chip had been planted in his head. "I thought
I was being monitored like a lab rat," he explains.

It never occurred to him that marijuana could be messing with his
brain. Corbeil had been smoking pot since he was 14, a habit that
escalated to about 10 joints a day.

He started hearing voices and, at one point, Corbeil thought he was
the Messiah. Police found him one day talking incoherently, and
brought him to hospital, where he was eventually diagnosed with
drug-induced psychosis.

Corbeil had dabbled in other drugs, such as acid and ecstasy. But
marijuana was his mainstay.

When he went on anti-psychotic medication and off pot, the symptoms
eventually stopped. But twice he tried smoking it again, and both
times the demons sprung up. "Within 10 minutes, the voices started,"
says Corbeil, now 20, of North Bay. "It was as if people had been in a
box for a few years and then you take the lid off and they all want to
talk to you."

He slammed the lid back on the box - he swore off marijuana.

With good reason: Research in recent years has shown that marijuana
can trigger psychosis in vulnerable individuals. But who exactly is at
risk remains hazy.

Smoking marijuana is one of a messy mix of circumstances - genetics,
stress, injury, age of first use - that likely predispose someone to
psychosis.

"There seems to be a combination of risk factors. But nobody knows
which combinations can be the triggers." says Jean Addington,
psychiatry professor at the University of Calgary and president of the
International Early Psychosis Association.

Some studies suggest that youth in their early teens who become
regular users - toking a few times a week - have double the risk five
years later of paranoia, hallucinations and psychotic breaks.

While most studies have focused on cannabis and psychosis, researchers
are also investigating the relationship between marijuana and other
mental illnesses. In a survey of more than 14,000 Ontarians, Robert
Mann, senior scientist at the Centre for Addiction and Mental Health
found that people who use cannabis almost every day were twice as
likely to have anxiety or mood disorders as non-users. The study,
however, did not determine whether the drug prompted symptoms or was
used to self-medicate.

And a McGill University study on rats last year found that injecting
adolescents daily with small doses of synthetic marijuana led to
depression-like and anxiety-like behaviours in a series of tests.
Researchers also found that rats' brains were altered long-term.

"We finally understand that marijuana is not the harmless substance we
thought it was," says Dr. Leonardo Cortese, chief of psychiatry at
Windsor Regional Hospital.

No one is talking about the return of Reefer Madness, the 1930s film
about cannabis use leading to death and destruction. The vast majority
of pot smokers will not go psychotic.

But two recent developments have researchers particularly bummed about
pot.

Imaging studies now show that crucial regions of the brain are still
developing in the teen years, the very time many start smoking pot.
After alcohol, marijuana is the teen drug of choice. More than 30 per
cent of Ontario's Grade 10 students reported cannabis use in the past
year, according to CAMH.

And what they're smoking is not their hippie dad's doobie. Growers
have bred more potent pot, more than doubling the amounts of
Tetrahydrocannabinol, the psychoactive ingredient, and decreasing the
cannabidiol, a protective ingredient.

About 3 per cent of the population will experience a psychotic episode
from all causes. The rate, however, of cannabis-induced psychotic
episodes is not clear.

"We're just catching up to the effects of high-octane weed," says Dr.
James Kennedy, director of the neuroscience research department at
CAMH. "We need new follow-up studies to see its effect on the
population."

While psychosis is rare, for the kid hearing voices, it is
life-altering. Some are lucky and the symptoms stop when the drugs
stop, but for many, the voices and hallucinations recur.

Social stresses such as family problems and emotional trauma
contribute to the risk of psychosis, as do some biological factors,
such as brain injury, says Addington. A family history of serious,
persistent mental illness, particularly psychosis, ratchets up the
risk too, but the genetic markers are by no means clear cut.

Many genes may predispose someone to psychosis. Focus has been on a
variant of the catechol-O-methyltransferase (COMT) gene, which is
associated with higher levels of dopamine in the brain.

Dopamine, an important neurotransmitter, is involved in thinking
processes, mood, memory and reward-seeking behaviour. Too much
dopamine can create confused thoughts, paranoid delusions and other
psychotic symptoms, explains Kennedy.

Since smoking marijuana increases dopamine levels, people carrying
that variant COMT gene who use weed could experience levels high
enough to tip them into a danger zone.

Especially if it's particularly potent pot. It's THC, the psychoactive
ingredient, that pushes up the dopamine.

In the 1980s, the THC level in marijuana was about 3 to 4 per cent. In
the last couple of years, says Det. Don Theriault of the Toronto
Police, tests on marijuana show a 10 to 12 per cent THC level.

An estimated 20 per cent of Caucasians carry that COMT variant. That
does not neatly translate into a one-in-five risk, however. "They
could have several other genes that are protective. It gets
complicated," says Kennedy.

So what percentage is at risk of psychosis from marijuana?

Kennedy hesitates. This is not solid scientific ground.

"I'd guess 10 to 15 per cent would be at significant risk if they
smoked a lot of marijuana, almost daily, in their teen years when the
brain isn't fully developed."

It's the brains front part, crucial in judgement and social
perceptions that's still under construction in the teen years. "The
wiring, the circuits where the neurotransmitters flow and signal are
still being laid down," says Kennedy.

So does smoking pot permanently change or damage this still-maturing
brain?

We'll have that answer in two or three years, says Kennedy. Imaging
studies tracking the growth of teens' brains are looking at whether
cannabis use alters the development, or permanently damages
still-maturing brains.

It's not only teens that may be vulnerable, however.

Ana Smith didn't use marijuana regularly until her mid-20s, after she
graduated from film school. "I'd stay home in the evenings with my
cats, make tea and smoke weed," says Smith, a Vancouver resident, now
39.

Then she started smoking during the day as well, first thing in the
morning and through the afternoon, instead of writing screenplays. The
only time she didn't smoke was weekends, when she worked in a group
home. She didn't drink or do other drugs.

At first the voices in her head were pleasant. "They tricked me into
thinking I was being discovered by Hollywood. It was a beautiful world
for a couple of months."

Then they turned evil, terrifying her. Smith spent four lost days just
walking, sleeping on the streets. She finally checked herself into a
hospital and was diagnosed as a paranoid schizophrenic.

Smith has no known family history of mental illness. But a geneticist
told her she had inherited genetic frailties from both her parents.
Smith had also been under a lot of stress. "I think pot tipped me over
the edge."

After the diagnosis, Smith kept smoking pot because the voices
demanded it. She stopped two years ago and her mental health has
improved. "Now I know it's just the illness rearing its head," she
says.

Research suggests that only about 15 per cent of people who experience
a first psychotic episode do not have another, says Dr. Suzanne
Archie, clinical director of the Cleghorn Early Intervention in
Psychosis Centre in Hamilton. For a large portion of that 15 per cent,
the episode was probably due to drugs.

"It can be very tricky to figure out if it was substance-induced or if
there's an underlying psychiatric illness," says Archie.

If the patient is off drugs for six months with no psychotic symptoms,
Archie leans toward a substance-induced diagnosis.

But for the majority, those diagnosed with a psychotic illness, the
big question is: Could it have been prevented if the cannabis had been
avoided?

That's impossible to know, researchers say.

"The marijuana could cause schizophrenia to come on sooner," says
Kennedy. "If it interacts with a not fully-developed brain it could
create a more severe, a more disruptive version of
schizophrenia."

With schizophrenia, marijuana likely precedes psychosis, although some
people may smoke to ward off early symptoms.

With depression and anxiety, clinicians face a chicken-and-egg
dilemma: Did the pot help spark the symptoms, or was it used as an
attempt to self-medicate?

"These cases are difficult to tease apart," says Dr. Benjamin
Goldstein, adolescent psychiatrist at Sunnybrook Hospital. He advises
anyone feeling anxious or depressed to stay away from weed. "The
effects of pot on them swing more steeply toward the risk end."