Doc, I Want Something Natural!

In an age of health gurus and influencers with the status of prophets of doom, we are flooded with messages to improve our health lifestyles, including watching what we put into our bodies.  We are admonished to avoid processed foods or foods sprayed with herbicides or pesticides, BPA-free food containers, or genetically modified foods.  As a psychiatrist, I  get requests for “something natural”.   Psychiatric medications have always been held suspect, given the public’s historical perception and stigma of who takes psychiatric medications.   In contrast to those who want something natural, there are those who want “better living through better chemistry”, a phrase coined by Peter Kramer in his 1993 book Listening to Prozac.   Upon both these categories, we can superimpose those who engage in the wishful thinking that alcohol, tobacco, or cannabis are not contributory to their mental or physical health.   There are experts of every stripe pandering whichever professional opinion you are searching for.   Whom do you believe? Surely, something natural would be most innocuous!

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Even our governmental and non-governmental health watchdog organizations, such as the FDA or CDC, are offering inconsistent opinions.   The presence of the internet in every hand makes everyone an online sleuth, capable of searching for truths and disclosures.   Consumers need to get a new kind of smart.

Consumers will need to become increasingly savvy about discerning true expertise and reviewing the available information regarding medical treatment options.  Buyer beware.

As a psychiatrist, I will often need to negotiate carefully protected beliefs or distortions about medical reality regarding psychoactive substances such as alcohol, tobacco, or cannabis.  There is a belief that anything in moderation is ok, and popular entertainment icons such as Bill Maher and Dave Chappelle regularly tell us that cannabis is not really a drug, followed by the litany of cannabis purveyors telling us that it is, after all, medical and natural!

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Regarding cannabis, the scientific evidence from around the world is irrefutable: chronic cannabis use causes the same ills as tobacco when smoked, and it also leads to cognitive loss, and a substantial increase in the risk of mood or psychotic disorders.  Botanical cannabis contains over one hundred distinct cannabinoids, of which THC (tetrahydrocannabinol) and CBD (cannabidiol) are the only ones commonly considered.  The concentration of THC has gone up from approximately 4% to over 25% in the last four decades, so users are getting loaded with the cannabinoid most implicated with mood and psychotic disorders.

Cannabis is legal and “medical” by the will of voters or industry lobbies.  Cannabis is using the Phillip-Morris playbook from the 1960’s when the tobacco industry tried to push back against the Surgeon General’s authority to require health warnings on tobacco products.   In 1960, 42% of Americans smoked tobacco (53% of men); today, we are down to 12% of the American population smoking tobacco.   In a 1969 Gallup poll, 4% of Americans reported having tried cannabis.  According to the National Institute on Drug Abuse in 2024, 42% of adults from 19 to 30 have used cannabis in the past year.  We have yet to see any government body require any warnings on cannabis products.   Chronic cannabis use will exacerbate almost any underlying psychiatric illness.   Twenty-seven percent of American and Canadian adults report having used cannabis for putative medical indications (https://jamanetwork.com/journals/jama/article-abstract/2842072); cannabis’ only medical role is stimulating appetite palliatively in the terminally ill.   Pharmaceutical CBD has been approved for rare pediatric seizures, both most users seek botancial cannabis with its cocktail of cannabinoids.

Additionally, a major Canadian population study published in 2025 in the Journal of the American Medical Association reported that whole population data for Ontario from 2006 to 2022 demonstrated an 87% difference in the diagnosis of schizophrenia between non-users and users of cannabis.  The study further noted an association between cannabis use and onset of schizophrenia tripled during the study period, coinciding with the legalization of cannabis.

Government bodies responsible for the public health have been remiss for not giving the public unwelcome data driven facts.  State and federal governments should be communicating what is in the public interest.  We need to empower math and science to construct meaningful health messages and require gurus and influencers to be liable for harmful misinformation without stating disclosures of non-expertise.   Sometimes, it is a doctor’s job to interpret reality based on known facts, even when those facts may be unpopular.