What about medical marijuana as a treatment for bipolar disorder? Now that cannabis is legal in many states, many people want to try smoking as a primary treatment method. Realistically, even before cannabis was legalized and regulated, people touted its benefits as a treatment of all kinds of mental health issues from depression to psychosis. But is it true?

Join us as Gabe shares his own experience with marijuana use and Dr. Nicole shares the latest research surrounding living well with bipolar disorder and cannabis.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington
Dr. Nicole Washington

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: And today we’re going to talk about marijuana, weed, pot, reefer grass, dope, ganja, Mary Jane, hash herb, Aunt Mary, skunk, boom. There’s like 140 different names that I found on the Internet for cannabis. My favorite one is wacky tobacky. I want to be honest. Dr. Nicole, wacky tobacky. But we’re going to be talking about cannabis and marijuana because everybody asks me about this. People pull me aside constantly and they say to me, I want to stop taking my psychiatric medications or I want to manage my bipolar disorder and I’m going to do it with cannabis. And they ask me what I think about this. Now, it has occurred to me that if people are asking me, a dude with bipolar disorder who just happens to have a podcast and do public speaking, if they can treat bipolar disorder with marijuana, they probably ask a doctor, I’m going to go with more. My bet is you get asked about this a lot.

Dr. Nicole: I do get asked this question a lot. Can I quit my meds? Can I just use weed? Can I just use cannabis? Whatever word you want to use. And my answer is always, I’ve never had a person who has attempted to do so, who hasn’t ultimately come back for some reason. I just haven’t seen it. I haven’t seen a person who has successfully managed. But I see so many people who say, well, I stopped my meds because I tried to manage it with marijuana, but I’m still having these A, B, C, D and E problems.

Gabe: There’s a lot to discuss when we talk about managing bipolar disorder with marijuana. First, our culture has gotten to the point where there’s a lot of different types of marijuana, and that’s on the strain side. So, this is actual THC marijuana. Many different strains, many different potencies, many different types. But moving away from that, we also have something in our society called cannabis oil, which you can buy at the gas station. So, we all know that things that you buy at the gas station can treat severe and persistent mental illness because, you know, that’s why it’s at the gas station. And then even in those things we have non-THC cannabis and there just seems to be a lot of products, right? That are sold with cannabis in the title or marijuana in the title. But then when you read the little fine print, it’s like, yeah, not really.

Dr. Nicole: That is very, very true. And I do think it’s important that we tease out a couple of things. You know, that marijuana plant has hundreds and hundreds of chemicals in it. Hundreds. The main ones that we worry about are the cannabidiol. That’s the CBD, the oil that you were talking about. That’s the stuff that you can get just about anywhere, not really regulated. CBD has like 0.3% or less THC, so it very little psychoactive ability. It’s the delta nine tetrahydrocannabinol. Say that with a mouthful of stuff, right? Delta nine tetrahydrocannabinol. That’s your THC. That’s your weed. That’s what you’re buying from out of the dispensary. That’s what you’re buying from homeboy on a corner. Wherever you’re getting it from, that’s where that that’s what you’re getting. That’s where the psychoactive properties lie.

Gabe: To say it frankly, that’s what gets you high. That when people want marijuana weed, pot, Mary Jane, wacky tobacky, that’s what they’re looking for. They’re chasing that high. There’s so many directions that I could go with this. But one of the things that I want to be clear is when people talk about this, I appreciate the discussion.

Dr. Nicole: Mm-hmm.

Gabe: Right? I want there to be robust discussions about ways to treat bipolar disorder. So, I am not anti the discussion. Does marijuana, does THC, does CBD oil, do supplements, do these things help treat bipolar disorder? What I am anti is the, oh, yes. Yes, it does. Okay. What is your proof of that? Well, I just hate Big Pharma so much because all they want is your money. And I’m like, well, but is marijuana free? Well, it’s natural. Well, you know, arsenic is natural and that’ll kill you. Poison ivy is natural. Don’t rub it all over your body. It’s not medicinal in any way. There’s lots of natural things that are, in fact, bad for us.

Dr. Nicole: That’s 100% accurate. Everything that’s natural is not good for you. There are mushrooms growing that aren’t good for you if you if you eat them. So, I think we know for sure. But for some reason when it comes to cannabis, people just are so adamant that, no, this is good for me. This is from the earth. This is, this is God’s medicine. This is these are all the things, you know, I’ve heard people say, and I’ll be totally honest with you, Gabe, I’m not a like firm no person when it comes to this. Even though I can list all of the horrible things that we know can happen as a result of cannabis use, I’m still not a firm no across the board for everybody. I think it may have its place. I just don’t think we know where that place is yet. We’ve just gotten to a point in recent years where we’re really, really researching cannabis and its effects on people, and I think there’s still so much we’re going to learn about it. So, I’m not a firm no, uh. You know, I can’t say that I don’t have patients that I’m very aware, you know, smoke for certain reasons. And we’ve just decided that, okay, that that that can be a part of this, but it can’t be the whole, it can’t be the whole treatment regimen. So, I’m not a firm no. Which surprises a lot of people.

Gabe: I can see why you’re not a firm no, because if the data shows that it works, you would be 100% for it. That is what being a good doctor, a good scientist, a good researcher, and frankly, an intelligent person means. As data becomes available, we shift our thinking. There’s a lot of talk in society about being a flip-flopper or, you know, can’t hold your opinions down or my favorite one, well, they’re just all over the place. And that’s how, you know, I do think that we need to give a little pushback about this, because the genesis of science is best decision with available information. And that information is naturally going to change as we do the research. Now, unfortunately, the flip side to that is you can cherry pick any data you want.

Dr. Nicole: Uh-huh.

Gabe: You can almost make anything sound plausible.

Dr. Nicole: You’re absolutely right. You know, if people say anything with enough confidence, it’s hard not to start thinking like maybe? Maybe, maybe they do know what they’re talking about. There are tons of “experts.” You can’t see my air quotes, listeners, but “experts” out there who if you say something with enough authority, it can sound like you. You know it so well, people will believe you. And that can be very dangerous. But the other thing with like studies that you brought up and I think this is important, there are good studies, there are strong studies, there are poorly constructed studies. Right. There’s a study out of the UK where it talks about how, you know, people who are stable had more positive emotions with bipolar disorder, with cannabis use. But there were only 24 people in the study and they were all stable. So, these weren’t people like most of the patients I’m seeing who are trying to treat their mania or their depression with cannabis. These are people who were largely stable, so they felt more positive emotions. But to me, that doesn’t really equate to cannabis being helpful for treatment for bipolar disorder, because we’re talking about treatment. We’re talking about somebody in an episode.

Gabe: One of the things that I always like to point out in this studies of all psychiatric medications is that you can’t study them on suicidal people. And I’m a I believe in that. I do not want researchers rounding up a whole bunch of suicidal people and doing stuff to them. That sounds dangerous to me. But we do have to acknowledge that the purpose of psychiatric medications in many cases is to prevent suicide, to not allow people to get to that suicidal level. So, we’re testing them on people who are often already stable. The next thing that we have to look at is where do we get the participants for the study? Did they respond to an ad? Did they drive themselves there every day? Because now we’re looking at a certain socioeconomic level. We’re looking at a certain level of people who have a certain amount of time. And then next, and this is the problem again with many studies, you’re getting fussed over. That’s the best way that I could put it. Many people who are turning to alternative medications cannabis, marijuana, et cetera, aren’t being fussed over. They don’t have a Dr. Nicole. They don’t have a therapist. They may not even have a strong support system. They may not have health insurance and they may not have access to a standard pharmaceuticals. I’m going to go with that wording. And then all of a sudden, they get in this study and they’re getting fussed over. Right? They got the check-in appointment, the therapy appointment. They got the phone calls to do the questionnaire. And people suddenly care about them. We know with bipolar disorder that support is a protective factor. So, it’s going to be difficult to tease out the, especially in 24 people what amount of just being fussed over and cared about allowed them to be more stable versus the actual medication. And again, I want to state plainly this is a problem in all studies. So, it’s not surprising that it’s also a problem with, you know, studying marijuana.

Dr. Nicole: Yeah. And you can’t argue. Well, I mean, I guess you could try, but it wouldn’t make a whole lot of sense. But you can.

Gabe: I’m not going to argue anything, Dr. Nicole. I don’t.

Dr. Nicole: You probably could.

Gabe: [Laughter]

Dr. Nicole: I believe that you could argue anything, Gabe. I do. But I think that you bring up a really great point because you can’t argue that there’s a difference between someone being in a what whatever normal mood state looks like. So, whether that’s a person who has bipolar illness, who’s in a in an extended normal mood state, or that’s a person who doesn’t have bipolar disorder, who’s in a normal mood state, I think those people are going to experience very, very different things when they use versus a person who’s in an episode. Those brains are different. The chemicals are different. So, heck, sometimes the structures are different. I just think we have to make sure we’re comparing the right things and we’re comparing apples to apples and oranges to oranges and not out here comparing apples and watermelons and trying to come up with the exact same logic.

Gabe: Well, I don’t want to discourage anybody from trusting studies or trusting science. That’s not the goal at all. But as we’ve discussed before, I do think that it’s a good idea to look at them plainly and reasonably and make the best decisions for you. So, what I want to turn on is the number one reason that people tell me that they want to take this medication is because of the whole we don’t trust pharmaceutical companies talk. It’s not that they read a study somewhere and they’re relying on the science. It’s almost always word of mouth. And we don’t trust Big Pharma anyways. Those are the words that I use as we’ve already talked about with the all-natural. Right. Arsenic is natural, poison ivy is natural. Don’t take either one of those things to treat your bipolar disorder. There’s this like allure of this idea that marijuana is looking out for you, that these companies are pure and they care about you in the way that the other industries don’t. And the reason that I bring this up is because the cannabis industry is a $13.2 billion industry. That’s billion with a B. This is So when people say things like, well, you can trust them because they’re natural and they’re looking out for you, you recognize that. You’re saying that a $13.2 billion empire exists like as what? A nonprofit, as a as a public service? They’re just another giant company with frankly, better marketing. They have marketed themselves so that you believe that they’re all huggy and loving and caring, unlike those mean bastards over at Big Pharma. And that really scares me because the same reasons that you should not trust the pharmaceutical companies are the same reasons that you should not trust the marijuana industry. Because according to popular culture, anything that exists for profit is inherently evil. Marijuana exists for profit, so all of your concerns about the pharmaceutical companies should equally apply over to the medical marijuana industry.

Dr. Nicole: Absolutely. I mean, you have to question everything. I think it’s healthy to question everything. It it’s American to question everything. You should question the things that people tell you, especially if they sound too good to be true.

Gabe: And it’s important to really focus on this idea of why do we inherently trust one industry and we inherently don’t trust another industry when either, we need to be self-consistent, trust all industries, all industries love us and care about us and would never, ever, ever, ever lie. I don’t advise that, but I also don’t advise this wishy-washy approach where you decide that some industries are good and some industries are bad. I think that all industries have the potential to be good and bad. I’m not going to sit here and tell you that pharmaceutical companies don’t have things that concern me. I’m just telling you that it can’t be one or the other. The medical marijuana industry. And we’re going to we’re going to we’re going to twist in a second and get to the other marijuana industry there in a minute. But the medical marijuana industry exists for profit as well. They have the same motive to feed you misinformation as the pharmaceutical companies. So, I’m really confused by people who are like, Look, I don’t trust this industry because their motivation is profit, but I do trust this industry, even though their motivation is profit as well. But now let’s move it one down, right? I think many of us, especially if you’re 45 years old or man, I’m old, I’m 46.

Gabe: I got I got to update my rhetoric, Dr. Nicole.

Dr. Nicole: [Laughter]

Gabe: I want to do a slight, slight twist and talk about the marijuana industry that well, all of us in our mid 40s remember. See when I was diagnosed with bipolar disorder when I was 26, this this wasn’t a concern. It was a hard no. Any marijuana that I use to manage the symptoms of bipolar disorder was done illegally. I cannot be more clear on that. Any young people listening? There wasn’t always this discussion about medical marijuana. In fact, that’s why we call it medical marijuana, because medical marijuana is legal and marijuana and all those names that that I just named are the illegal version. So, when I was when I was diagnosed at 26, any marijuana that I found, I found illegally. And I want to point out that people are still buying marijuana illegally because the states that they live in, because of cost factors, because that’s just the way they’ve always done it, whatever reason. What I want to focus people’s attention on, though, is not the illegal aspect of it. We’re not even going to touch that on this podcast. That’s a that’s a that’s a different type of podcast that you can listen to.

Gabe: I want to discuss regulation. I want to be as straight as I can. I used to smoke marijuana. I did not know that I had bipolar disorder and it did provide me the relief. The relief that it provided me was escapism. It was not making me better. It was not treating bipolar disorder. But when I was high, I forgot. I forgot about the pain. But here’s the thing, it was different almost every time. Sometimes I would smoke a little bit and I’d get really high. Sometimes I’d smoke a lot and I’d feel nothing. And I was buying from largely the same people time and time again. And for anybody who’s done marijuana a lot, you always have that. Well, this is all stems and seeds. This is all stems and seeds. No, this is the good stuff. This is the good stuff. Feel it. It’s dank. It’s dank was a word when I was a kid. And but the thing is, is it was the same price every time. It was just different every time. I really want people to focus on this idea that there’s just not a lot of regulation.

Gabe: So, a lot of the things that you’re hearing out there are from people who may have been getting different, different strains, different potencies, different types, dank or no dank. And yet they’re taking it every single day to manage bipolar disorder. T that’s not good. That’s just that’s just not good at all. I mean, could you imagine if every day you just picked a pharmaceutical pill and took it and it was different every day? No, no, no. It’s all in the anti-depressant category, so therefore it’s fine. Just pick any one. We’ll just give you a different one every day. Everybody listening to the sound of my voice is like, Wait, you’re just you’re just going to grab any old antidepressant, take it one day, and that’s going to manage bipolar disorder? But if you take out antidepressant, replace it with marijuana, you’re just going to smoke any old marijuana every day and you expect to get relief from that? People are like, yes, yes, marijuana is a miracle and it works. See, again, a lot of what we’ve heard about marijuana is frankly just propaganda from people who have an alternative motive.

Dr. Nicole: The thing you do have to remember, I mean, guess I will say, if you live in a place that has dispensaries versus the person on the corner, you have to know that what that person on the corner is getting, only God knows what it might be, what it could be laced with, what they’re using to, to make it a little more special so that you will come back to them versus going to the dispensary. And it is also extremely important to know that these strains of marijuana that are out there, that people are selling just across the board, they’re very different than the marijuana that Gabe was using 20 years ago. Or guess now that 46, maybe 26 years ago.

Gabe: What are you doing to me? Don’t, don’t, don’t, don’t. Don’t be adding years.

Dr. Nicole: [Laughter]

Gabe: 20 years was right the first time. Twenty-six when I was diagnosed. Forty-six now.

Dr. Nicole: [Laughter]

Gabe: Don’t, don’t. Don’t you put that on me, Dr. Nicole.

Dr. Nicole: Maybe, you know, 20, anywhere from 20 to 26 years ago. Um, we just know that it’s very different. I mean, our parents, you know, and so we look back and we think like, wow, look at those people. They look so cool. The people in the 70’s, they were smoking. Look at Snoop Dogg. He looks so cool. Well, you know, when Snoop Dogg first started smoking weed, it is not the same weed that’s out today. The potency of what is out today is exponentially higher than what was out 20 something years ago. It’s just very different. Things evolve. Things change.

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Gabe: And we’re back talking about the use of cannabis to treat bipolar disorder. I am so glad that you brought up Snoop Dogg. Snoop, Snoop Dogg is my jam. I remember when Snoop Dogg came out with Dr. Dre, and he was he was a badass and he was high. And he did that. He did that rock back and forth thing. And nothing scared him. And he was cool. And he had he had the guns and he was from the streets and just I remember his songs and his music like I was the generation that he was marketing to. And here’s the thing. Um, it turns out that Snoop Dogg is a liar. It’s a persona he was acting. Have you seen Snoop Dogg lately? Right? He goes to hockey games, he fusses over his kids. He hangs out with Martha Stewart on cooking shows. He’s this really intelligent guy. And he’s not any of those things he portrayed to us in the 90’s. He’s it’s a persona. It’s an act. It’s part of his thing. And that’s awesome. Right. But if you’re relying on Snoop Dogg for your information on whether or not marijuana is safe, you got to remember, this is his persona. I’m not even positive that he smokes the marijuana. I kind of get the feeling that he does. But we don’t know. If that man stopped smoking marijuana right now, it would be in his best interest for his career to just pretend that he did. And I don’t fault him that at all. But what I do fault is people who get their medical information from celebrities based on their persona.

Dr. Nicole: Yeah.

Gabe: I just, it is it’s bad. It’s bad.

Dr. Nicole: So, I may have a little bit different take on that. I think that when you’re young and you may be involved in things that are not so great, you grow up in environments where that’s kind of the lifestyle and that’s what’s happening. And then you achieve a certain level of fame and when you know better, you do better. So maybe those things were 100% accurate when he was a late teen, early 20’s young man. And as he developed fame, wealth, you start to put yourself in different situations where you don’t necessarily want to lose those things, right? You learn that I can’t still do the same things I did when I was broke because, you know, I’m going to lose all this all this stuff that I have achieved, the status, the finances, the just status in the in the world. However, I think the important thing to not compare yourself to is a person who does not have bipolar disorder. I think that is where the comparison comes in. You can look at celebrities who look really cool and when they’re high and they look relaxed and chill, great. They look relaxed and chill. That has nothing to do with you because you’re you. Has nothing to do with you.

Gabe: Dr. Nicole, I love that you brought up that people change because you’re right, I don’t know anything about Snoop Dogg. But what I do know is that people are using how he behaved 20 years ago as justification for their behavior today. And marijuana has this whole romanticized mythos about it. Like apparently mania and marijuana both have the same public relations team because whenever something bad happens as a result of smoking marijuana, using drugs, etcetera, it’s always, oh, that’s too bad. But whenever something good happens, it’s, oh, it made him a better writer. It made her a better singer, it made for better plays, it made for better books. It’s like all of the goodness is why we need to gravitate toward it. And anything bad that happens is just shoved down and forgotten about. We all think about Woodstock and all of the illegal drugs that were used at Woodstock, and for some reason we still remember Woodstock is this this this magical event. And I bring that up because I wasn’t alive for Woodstock. I couldn’t go to Woodstock yet. I have fond memories of it. Why do I have fond memories of a drug-fueled music festival that happened before I was born? Because that that’s the romanticizing of things that we have. And many of us have this this just really positive feeling about something that literally happened before we were born, I think that marijuana and other illegal drugs.

Gabe: Marijuana just has all of this romance around it. It’s really just been romanticized as this amazing and good thing. But it really smacks of a conspiracy theory to me. And that’s the that’s the direction that I want to go in. Now, see, I think people with bipolar disorder, myself included, we want the quick fix. And here’s the thing that we know about conspiracy theories. There’s something that bothers the public. And it’s a really difficult challenge. And it’s really, really difficult to fix. But it turns out that the solution has been there the whole time. It’s just been hidden from us. So, if we would all just get on board with this solution, then this, this, this, this devastating and debilitating thing that’s bothering and harming and killing so many people would go away. I think that marijuana is the conspiracy theory for people with bipolar disorder. Right? Bipolar disorder is really difficult to manage. It’s really difficult to medicate. It’s difficult to learn coping skills. It takes a long time. But you know what? You’re suffering for nothing.

Dr. Nicole: Yeah.

Gabe: Marijuana will take all of this away from you if you just walk towards that direction. Does that make it harder for you to treat people with bipolar disorder when they believe that there is a magic cure that the government is preventing them from having?

Dr. Nicole: And on top of that, I think that the more we say, no, don’t use it, the more it feels like a conspiracy, because people want to believe that we know that it works and we just don’t want them to have it, or because we can’t make money off of it, because there are those people who still think that we get kickbacks from pharmaceutical companies. So, you know, you can’t make money off of me smoking weed, but you can make money if you prescribe me this pill. You know, you’re getting your kickback. And so, then you’re in the pocket of Big Pharma. It adds to the conspiracy. I think you’re 100% correct because people do get very upset. So, I think it’s important for them to understand the no. It’s just like when you have a kid and your kid says, can I, you know, do blankety blank? And you say no with no explanation. They see it as, you don’t want me to have fun. You don’t want me to live my life. You’re trying to keep me. You don’t. You don’t care about me.

Gabe: Trying to control me.

Dr. Nicole: Trying to control me. If you go the step further and just say, hey, these are my concerns. This is why I think marijuana could be very bad for you. It might give you some benefit. But these are the things I’m concerned about and why I say no, I think that helps to move the conversation along.

Gabe: I cannot agree with you more, Dr. Nicole. First off, I think that many people are just afraid to bring it up to their doctor at all. And now they are taking medications that their doctor prescribes and they’re not telling their doctors that they’re also using medical marijuana or marijuana from any place or cannabis oil or anything. They’re just not disclosing that at all, which that makes your job a lot harder. If you are prescribing somebody’s medication to manage their bipolar disorder and they’re also using marijuana and not telling you, that impacts the level of care that you can provide them, does it not?

Dr. Nicole: Absolutely. Because if you think about if you think about cannabis, you know, there are the different strains. People are all into their sativas or indicas or whatever they use or hybrids or whatever, whatever they choose. And the thing that people say about Indicas is that Indicas will have you in the couch. So, you know, those are the much more relaxing strains. But smoking too much, you’re talking about apathy, lack of motivation, slowed motor reflexes. Those things are important for me to know because if I’m asking you in a depression screen about motivation and you’re like, Yeah, I just don’t have much motivation to do anything. And I don’t know that you’re smoking all day, every day. That’s a problem because I’m treating something that I’m probably never going to be able to chase. I’m never going to be able to catch up with it. I need to know that. On the flip side, if you’re a sativa person and you like the energy it gives you and you like that boost and you want that energy and the get and go and I’m asking you and you say, Yeah, some days I just feel real energetic. Some days I’m more anxious, some days. And I don’t know that that’s in play that’s going to affect what I do. So yeah, it does make it difficult. It’s, it’s much easier if you just tell me that you’re using. I just need to know what’s happening.

Gabe: Now, I know that you can’t speak for all of the doctors. You can only speak for yourself. But what is your opinion? Your professional opinion? Do most doctors share your point of view? I know that you can’t speak for all doctors. So

Dr. Nicole: I cannot.

Gabe: You’ve got to you’ve got to take this information for what it is. But

Dr. Nicole: Yes.

Gabe: It I don’t believe that any doctor has ever picked up the phone and called the SWAT team to have somebody arrested for using marijuana as they’re leaving their office. And I know that’s a big concern and one of the reasons that people don’t disclose.

Dr. Nicole: Absolutely. I could see that we have a wide range of opinion in the medical world, in the psychiatrist world, when it comes to substances. Some people have a very deep harm reduction model approach to treatment, which is kind of where I live. I did training in a program where harm reduction was a big part of the training. Harm reduction is a big part of my practice model, which just means that, you know, I work on the harm reduction. I’m not going to tell you absolutely no, I’m not going to tell you that I won’t treat you if you use you know, I will try my best to work with you within whatever it is that we have going on. There are some doctors who won’t treat you, though. I mean, I will tell you, there are some doctors who say, well, I won’t treat your bipolar disorder if you’re using any illegal substances. There are some people who do urine drug screens on a regular basis because they want to know if someone is using something that they haven’t told them about. Some people do random drug screens. I don’t do drug screens as a typical part of my practice. Everybody is different. My general opinion is it can absolutely interfere with what I’m trying to do. But I want to work with you because when somebody is holding on to something like that so tightly, whether it’s an addiction process or they really do genuinely believe it’s helping them, I need to tease that out and take the time to work with them and maybe even use that relationship to show them some holes in their thinking.

Gabe: It really seems like what you’re saying is the worst-case scenario is the doctor won’t work with you. You’re not going to be arrested. People aren’t going to call the police. You’re not going to be thrown out of your home. You’re just not going to work with that particular doctor. And you’ll have to find a new one. Is that, am I understanding correctly?

Dr. Nicole: The only way I would see the police being called is if you were actually intoxicated during a visit and you were going to drive yourself home. And that would happen with alcohol. Because at that point she’s a danger to society. So that’s really the only way I could see the police getting involved as if there was a like public health public risk situation. I don’t know that I would imagine anybody would call the police just to say, hey, I know somebody who uses cocaine and they’re getting ready to leave my office right now. That wouldn’t happen. So really, unless you’re a danger. But so, yes, the biggest thing you have to worry about is will this person continue to see me and continue to treat me if they know that I use A, B or C?

Gabe: And I would like to point out that if your doctor doesn’t want to see you anymore because of something that you’re doing in your life, they’re not a good fit. I hate to say that it’s not much of a loss because I understand that finding a doctor can be very, very difficult and very, very challenging. But you’ve got to ask yourself this question, right? This is what you have to juxtapose it against. Do you want a doctor that only has an incomplete medical history and is making decisions without all of the knowledge? Because as Dr. Nicole has illustrated many, many times throughout this podcast series, they’re not going to do a very good job if they’re missing data. I remember on the Sexual side Effects episode where I said that many people, if they’re having a sexual side effect, they just stop taking the medication that’s causing it.

Gabe: But they don’t tell their doctor because they don’t want to have an uncomfortable conversation. But then their doctor thinks, okay, well, they’re taking this pill. So, all of the decisions are based on a pill that you’re not taking and you’re not getting good care. To wrap that all up in a nice little bow? Well, it is a problem and troublesome and difficult to find a new doctor finding a doctor that you’re on the same page with and has a complete medical history is still the goal. So, if the doctor won’t treat you because you confide in them, tell them, disclose to them that you are using marijuana, they’re not a good fit. They’re not going to make good decisions on your care if you have to hide that from them. I do agree that disclosing that and losing your doctor is a distraction. It’s a barrier to care. But I think that ultimately you will end up in a better place if you’re working with a doctor who has your complete medical history.

Dr. Nicole: That is accurate. And I will say on the other side of that, if your doctor is telling you I won’t treat you because you’re using whatever it is you’re using, I do think you owe it to that relationship because let’s face it, it is not easy to just go pick up and find somebody new. You owe it to yourself to have a conversation a little bit further with that doctor, take it further. Ask them specifically what is their problem with you doing A, B or C? There are some drugs, marijuana aside, there are some drugs that people use that they tell us about that we know can have very, very serious mental health effects. Like we know for sure. There is no question. You got to listen to their opinion. I mean, you’re going to them for a reason. If you knew everything there was to know and if you were an expert, you wouldn’t need to go see them. But you’re not. So, you know your lived experience and you know the people that you’ve talked to, but you don’t know the data, the science. You’re not an expert in this area, so you’ve gone to them for a reason. There’s probably a reason they feel the way they do. So, ask them, what is the problem? Marijuana is very iffy so much we don’t know. I live in a medical marijuana state. I pretty much assume that everybody I see has a medical marijuana card and so many of them do. 75% of people I end up seeing have a card. And honestly, if you’re going to smoke or use whatever method you choose in a medical marijuana state, you might as well have a card because there is no reason to add the legal risk to any other risks that are associated with your use. If the card is available, get the stinkin card if you qualify for it.

Gabe: As we near the end of the episode, I would be remiss. I really wanted to answer the question of, hey, does marijuana treat bipolar disorder? We’ve talked about all the reasons that people believe that it does, how it’s changed and on and on and on. But the core question of if you live with bipolar disorder and you treat that illness with marijuana, will you do better or worse? What’s your take on that?

Dr. Nicole: There is not enough information to support marijuana as a primary treatment of bipolar disorder. We just don’t have it. We don’t have it. Maybe we’ll have it five years from now. Ten years from now. So, a lot of us still fall in the no camp. The no, it’s not okay. Because we know about the psychoactive properties and we probably will. Most doctors you talk to will probably fall in the no camp. Ultimately, we just don’t have enough information to know if that’s accurate or not.

Gabe: As I’ve said many times in my career, this idea that there’s a silver bullet that will resolve all of the problems with bipolar disorder, that is not even wishful thinking. That is bipolar thinking. That’s the kind of grandiose thinking that we really need to be challenging. If there really was a magic bullet, we would use it. Doctors would use it, companies would use it. And the very fact that there isn’t, shows that as of right now, there isn’t one. That said, I do like the idea of keeping an open mind. I do like the idea of continuing the research, and I like the idea that we’re having robust discussions around it. I don’t like the idea that it’s magical and it’s being hidden from us because that’s the kind of thinking that if we were honest with ourselves, has really led us to a lot of problems. And bipolar disorder just has a way of globbing onto things and making us think that we’re better or worse or stronger or weaker. It really influences our thinking. And I really think honestly that the marijuana industry has really focused on that. Is something wrong in your life? We’re the solution and you don’t need to ask any questions because we’re all natural. And your parents have been doing it for years and it’s led to some of the greatest music and art and literature ever. And that’s a that’s a great story, but it’s false. It’s absolutely, unequivocally false. The real answer surrounding marijuana are much more nuanced. And there’s lots of tragedy in that story. There’s just a lot of tragedy that fades to the black because we all think of Woodstock as the greatest concert that we never attended.

Dr. Nicole: Uh-huh. There are very few things in life, and cannabis is no different, that are 100% bad or 100% good. There are all kinds of things that have their good qualities and their bad qualities, and really, it’s a risk-benefit conversation for any of those things, whether it’s Oreos or cannabis.

Gabe: Dr. Nicole, thank you so much for being here. I love hanging out with you. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can grab a signed copy with free swag or learn more about me just by heading over to gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych to see whatever it is I have my hand in at the moment.

Gabe: And listen, we need a favor from you. Tell your friends about this podcast. Post us on social media. Shoot an email, mention us in a support group. Hell, send a text message. Sharing the show is absolutely how we grow. We will see everybody next time on Inside Bipolar.

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