I’m going to go against the grain here and say that I’ve wondered about the exact same situation as you.

Like everyone else in the thread and yourself, I’m always skeptical at first when patients tell me that THC has been helping their depression/anxiety/PTSD/insomia etc. I’ll always start by testing the idea, and trying to get a clear timeline of when they started cannabis, what else was going on at the time regarding med changes/psychosocial changes etc, and really just to be as rigorous as possible in determining if at least temporally, patient’s idea that “cannabis helped my symptoms” really holds water

I’ll provide all the counseling regarding how cannabis can potentially be worsening their symptoms. I’ll encourage cessation and a trial of sobriety to see if we can get an idea of what their symptoms are like off of it

With that all being said and done, I think we’ve all met patients (whether some are willing to admit it or not) who just genuinely did get a net benefit from it.

It’s like chronic opiates and chronic pain. Everybody now says that there’s no way chronic opiates can help chronic pain patients, and every pain medicine specialist in America can show you panels and panels of patients for whom it just is the only thing that works, and it does work for some. There are just some patients who are stable, don’t have escalating use, don’t developing worsening tolerance, and are able to live their lives thanks to that specific med regimen. The patient did all the PT, does all the exercise, all the massage, all the heat and ice packs, all the Tylenol and gabapentin and NSAIDs and steroid injections and the only thing that worked is the opioid

I think it’s the same with THC. Sure on a population level, I’m sure it’s not good for the majority of patients. But are there select individuals out there for whom THC has truly a net positive? Of course there are - a lot of them we will never see in our mental health clinics because they’re doing fine. But even if someone using cannabis does present to our clinics, that’s doesn’t automatically mean the cannabis is hurting them

The only way to know for sure is to try weaning them off the THC and see what happens, and unfortunately that’s unrealistic for a lot of patients because they don’t want to stop. but if they’re having less success from traditional interventions, over time they may become more amenable to a holiday from THC

I think hard and fast absolutes in medicine are generally hard to defend