ENCORE: The toll of cannabis-induced psychosis
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Ten years ago, I asked my partner, Kelsey, if she would marry me. I did that despite the fact that every living member of my family who had ever been married had also gotten divorced. Forever is a Long Time is a five-part series in which I talk to those relatives about why they got divorced and why they got married. You can listen to it now on CBC's Personally. This is a CBC podcast. ♪

I'm Dr. Brian Goldman. This is White Coat Blackheart in the summer. We're replaying some of our favorite shows. This one from February 2024 earned an honorable mention for the Mindset Award in Exceptional Reporting on the Mental Health of Young People. Stick around to the end of the show. We have some important updates to this story. I was confused what to do with my life. So people told me to listen to my inner voice. And now I have schizophrenia. Laughter

That is so funny. I mean, it is so painful and so funny at the same time. And how did you feel when they laughed? I felt supported. A mic drop moment from a brave and vulnerable young man.

Hi, my name is Kalpat Sharma and I am very excited to be here today. Thank you for having me. And I am just a guy who loves people and wants to see the world become a better place.

So I'd say the stage is... Sometimes works for people, sometimes works against people. It gives some people the stage fright. For me, it boosts my confidence somehow. Was there always a stand-up comic inside you? Oh, I was always a class clown. I was... I loved making people laugh. It just...

And I didn't really care if people were laughing with me or at me. I just wanted to see my classmates, my friends, everyone around me, my family laugh. You've been through an incredibly painful series of episodes. And I want to know, how do you get to a place where you can take the worst thing that's ever happened to you and laugh about it? I guess it's about accepting yourself.

The pain. The realization that I had personally was that I didn't give it that much power. Because as soon as I let psychosis or schizophrenia take power over me, that's when I know I've lost the battle. I treat it as war when I'm dealing with psychosis. And I have to be very...

cautious about my moves that I play, the strategies that I have in mind. And it's a series of battles that will eventually make you win the war. Got an interesting view. Yeah. All the sports arenas. The war, as Culpit put it, is with his newly diagnosed schizophrenia. Your feet might be cold. I'm thinking of that while taking in the exquisite view of the Rogers Center and the CN Tower from an open-air balcony of the 33rd floor condo he shares with his brother, Rishikant.

I'm also dealing with my fear of heights and the danger I sense. This show is about Colpitt's episodes of psychosis and his frequent and heavy use of cannabis that likely triggered them. I've seen this in my other job as an ER physician. Like Colpitt, around one in five young people in Canada, some as young as 16, use cannabis every day. Some use a lot of it. That's it. That's us. Cool.

Our show today zeroes in on a risk about which you may have no idea. Colpitt certainly didn't when he started smoking cannabis heavily shortly after coming here from India to study psychology at York University. So you arrived in Canada in September 2018? Yes. And the next month cannabis was legalized. What did that mean for you? Party. Party. Yes.

That's what it meant. Like as an 18 year old, without really knowing the consequences of cannabis, when all you've heard so far is that cannabis is not harmful at all. There is, you can't die from smoking weed and you can't get addicted to it. Just all these myths, if I can, about cannabis that they were just fed into my head.

And I believe them without doing my own research about it. And I feel that is the mistake I made. Back then, Kalpat wasn't old enough to buy weed legally. So he got it from a friend. At what point were you able to go into a cannabis store and purchase as much as you wanted? That happened when I moved to Aurora. So I'd say that was 2020. And did your consumption go up at that point? Yes, it did.

I didn't know what I was smoking. I had no idea what THC meant. I just knew higher the better, which is not true at all. I would like to mention that. THC stands for tetrahydrocannabinol, the key psychoactive ingredient in cannabis. THC causes euphoria. It makes you high. Other active ingredients cause sedation and drowsiness. The issue today is how much THC is too much.

Back in the 80s, Health Canada says the cannabis available had roughly 3% THC. Today, it's routinely around 15% and can go a lot higher. So I would just go into the store and just try to get as high percentages of THC as possible. You would actually ask them for higher percentages? Yes. Why would you ask for higher percentages? What were you noticing about your experience?

I was noticing that I was getting higher for longer. I was feeling more numb per se. And I liked the feeling of being numb, which is why I was smoking weed. And you wanted to feel that way all the time?

Did you, some people feel tolerance, they experienced tolerance where the same amount of THC doesn't give them the same effect that it used to give them and so they push the dose higher and higher. Was that what it was with you? I'd say so because it was not only the percentage that was increasing, it was also the...

Health Canada used to have a warning label that said, quote, end quote.

But in 2019, they removed it, saying they did so to refresh messaging to make it more reflective of population-level guidance. Were there warning labels on the packages that you purchased? There is a small logo, if I recall, that says warning THC. But you know how what I firmly believe in, what should be done, is warning THC can potentially cause psychosis.

So that wasn't written there at all? I do not think so. One thing you'll notice with weed is they'll come up with creative names for the weed. I would just pick whatever had the funniest or a name that stuck out to me. For example? Black Widow. Black Widow. Yes. And that somehow made me think of the Marvel character. And I'm like, this is amazing. I'm a cool guy.

I'm smoking weed right now. It's bright and early. It's the start of the day, and I'm starting my day off. It's smoking some Black Widow. I'm living my life. On one occasion, a cannabis shopkeeper tried to steer Culpit away from high THC cannabis. He bought it anyway. Then came COVID, and Culpit's cannabis skyrocketed. That's when the story takes a very disturbing turn.

What was the earliest indication that you had that you were having symptoms that might be due to cannabis-induced psychosis? You didn't know what it was called at the time, but you knew you weren't thinking right. I was on my bike and I'd gone to the weed store to smoke. I smoked. I was on my way back and the chain, it came out of the bike.

I was somehow speaking to birds and they were guiding me with the way they were moving that how I should put the chain back on the bike. And somehow I managed to put the chain back on the bike. And that sort of fed into my belief that the birds helped me out. And I can speak to animals. I can speak to birds. And like this is, I have this sort of superpower, right?

And the very first time you hear a voice, it's like very, I'd say, dangerous because you think that's reality and you believe it with your heart. And because you've never known anything different. And if you're hearing voices, you just think that's your inner voice at that time. The voices Kalpit and no one else heard are called auditory hallucinations, a hallmark of psychosis.

voices that became more intrusive and more insistent. I was driving and the voices said, take it. And it was a left turn. And it was a very risky left turn that I took. I shouldn't have taken that. I listened to the voice in my head and I put my life at risk and others at risk as well. Up until this point, had you connected your marijuana use with these thoughts that were going on in your head?

Yes. My brother actually told me that it is the marijuana that's causing this, so I should probably stay away from it. And did you take his advice? I did. What happened? I mean, I stopped smoking weed, but the voices, the delusions, the paranoia, that didn't go away. It didn't go away. No. You must have been disturbed. Very. Disturbed because he was having what psychiatrists call a psychotic break.

The good thing is that unlike other patients, Kalpat took his brother's advice and sought medical help. His family doctor referred him to CAMH, the Center for Addiction and Mental Health in Toronto, where he had his first appointment. I told them everything that I was experiencing. They asked the right questions. They knew what was happening with me before I even could describe it to them. And so they just said I had psychosis and the ground slipped beneath my feet. We'll be right back.

School is almost out for the summer, and if you have kids in your life, The Current is here to help. My name is Matt Galloway, and we talk about big issues facing families, like how do you actually get kids off their phones? How can teenagers learn to manage their money? And why some parents admit that they regret even having kids. If you need to escape under your headphones from any family member this summer, we have you covered. You can find and follow The Current on your favorite podcast app. We'll talk to you soon. You're listening to White Coat Blackheart.

This week, Colpitt Sharma's episodes of psychosis and the escalating use of cannabis that triggered them. He had several huge risk factors. He's male, less than 25 years of age, heavy daily user of high-dose THC, and, as Colpitt is about to reveal, a family history of psychosis. Combined, they increased his risk. Still, it came as a shock when a caseworker at CAMH gave him the diagnosis. You were stunned?

Yes, I was shocked and just the preconceived notions that I had that I'm going to be looked at differently. I'm going to be separated from society. I'm not going to be like my parents' culpith ever again. I do know someone in my family who has experienced psychosis and that's who I thought of when I heard that I have psychosis.

I didn't really understand it well enough what was going on. It was kept a secret, which now that I think about it, it's so wrong. Had I just known what caused it, how it happened, everything, maybe I wouldn't be talking to you about psychosis. The secrecy and the stigma Colpitt talked about had another effect.

It made he and his family reluctant to start medication as recommended. They did agree to try cognitive behavioral therapy or CBT. A few months later, things got worse. That's when I went to India for a wedding. And there was just a lot of people there.

that had seen Kalpith in a different lens. Someone who's smiling all the time, who's joyful, who's playful and all of a sudden they see this dull, still guy who's

with no expressions on his face, who's just looking around and who's in his mind all the time. That disturbed me so much. And I would think that the people around me are saying the worst things to me. I'm just getting a very rude reaction. And these are people I love, like I've spent my entire life with. And it was a wedding of someone who is very, very close to me.

And just to see that I'm not being able to be myself, it was the lowest point that I faced. I would say that's when my psychosis was at peak. I didn't follow through with it, but I was close to self-harm. Despite being in bad shape, Kalpit was able to use the CBT he learned at CAMH to talk himself out of harming himself.

Back in Toronto, Kalpit started taking the antipsychotic medication Abilify. He says the voices have become less disturbing and more manageable. Still, he's got a long road ahead. So overall, what's your mental health like these days? Currently, it's not the best because of motivation.

I'm finding it very difficult to motivate myself to be present and active in work and stuff. So that is bumming me out because I feel I have the responsibility on my shoulders to do well not only for myself but for others as well. You want to be an inspiration to others? Definitely. You got your bachelor's degree in psychology? Yeah. Do you want to be a therapist? Yes. What kind?

a psychotherapist that um and i also want to be dealing with patients mainly that have experienced psychosis a friend of mine mentioned this uh to me that uh when i went to him for advice he's a therapist himself because even he has psychosis and he said that you can be a wounded healer

And that stuck out to me. You can be somebody with lived experience. And having that is inspirational to somebody who's going through a crisis. I would honestly love to do something like that. I'm so glad that you've spoken to me. And I've enjoyed speaking with you. And it was very brave of you to tell your story. Thank you. Thank you. Culpit's story is a compelling one that tracks with what I've seen as an ER physician.

By themselves, anecdotes like this one don't prove high-dose cannabis causes psychosis. Still, a growing number of studies suggest that cannabis-induced psychosis is real, and researchers are hot on the trail. My name's Daniel Myron. I'm a family physician and public health physician. I'm an investigator with the Brear Research Institute and the Ottawa Hospital Research Institute and an associate professor of the Department of Family Medicine at the University of Ottawa.

As a public health researcher, Dr. Myran uses population health data to better understand the burden of substance use, including cannabis. Dr. Daniel Myran, welcome to White Coat Blackheart. Thanks for having me on the show. You published two studies in the fall of 2023 looking at cannabis-induced psychosis. Let's hear about your research. How often are people showing up at Ontario emergency departments with cannabis-induced psychosis?

So we did a study where we said between 2014 and 2021, let's capture every emergency room visit in the province of Ontario for cannabis-induced psychosis. And we found that there was a 220% increase in these visits. And who's showing up the most? Is there a profile? Yeah, so it's more male than female.

And it's certainly, you know, individuals on the younger age spectrum. But some people will do that and not get psychosis. This is not an inevitable reaction for everybody all the time. Most people who are using cannabis, the vast, vast majority are not ending up in the emergency room with an episode of cannabis-induced psychosis.

So there is certainly an interplay of risk factors. I have heard it said that the cannabis that is available commercially for sale right now is not your grandparents' cannabis. If your frame of reference is what people were smoking in the 60s,

then you don't understand what's going on today. And I think that's what you're trying to say. Yeah, I think that if you look at the THC content, which has gone up by 10 to 20 fold since the 1960s and 80s to what's currently being sold, THC is the component of cannabis that seems to be most strongly correlated with the adverse mental health effects that can be seen and with the addiction potential. And the real concern is, is that

As this product changes, and it really is changing, it is changing quickly. It has changed since we have legalized it. Do you start to see just very different adverse health effects?

from it. Cannabis is a very under-researched substance. And a lot of the evidence base that we have where we say, hey, this is what we think it does for depression or anxiety or psychosis comes from studies that have looked at a much lower potency. Your research has also focused on an emergency room visit for cannabis-induced psychosis and how that can play out years later in a diagnosis of schizophrenia. What can you tell us about that?

Someone who's shown up in eMERGE for cannabis-induced psychosis has 240 times the risk of developing schizophrenia within three years compared to the general population. And to give you some absolute numbers, if you...

have shown up. You've never been in contact with the health system before for psychosis or schizophrenia or a drug-induced psychosis. You show up and emerge with an episode of cannabis-induced psychosis. And within the next three years, 26% of those people will be diagnosed with a schizophrenia spectrum disorder compared to 0.1% in the general population. That's kind of the average risk over a three-year period.

And who are we talking about? How old are they? Men? Are they women? Yeah. You see really interesting variations by age and sex. So for example, for men aged 14 to 24, the risk of developing schizophrenia rises to over 40% within three years. Uh, the older you, the older age groups have a lower risk. Uh, women, uh,

have a age 14 to 24, have a 20% risk of developing schizophrenia within, within three years. So, you know, half that of men, but still a really, you know, one, one in five will be diagnosed with schizophrenia. Any idea why there might be a difference? There's thoughts that there's differences in how, uh,

brain development between men and women occur and the risk of schizophrenia, you know, it's very well established that the brains in men are slower to mature and finalize. And one of the thoughts about the risks of cannabis on the development of schizophrenia is that during periods of higher neuroplasticity or when the brain is still forming, that cannabis use changes the connections.

The $64,000 question is whether high potency cannabis causes schizophrenia or unmasks schizophrenia in people already at risk. I think it's quite clear, quite strong evidence that use of cannabis will mean that someone who is going to develop schizophrenia will start having symptoms earlier in life.

So earlier onset of schizophrenia in these groups can really have very severe lifelong impacts on their level of functioning and how they do in life. The greatest area of controversy is whether or not there are individuals who in the absence of cannabis use never would have developed schizophrenia, but because they used cannabis that they do.

And people have looked at this through a variety of ways, through genetic means, brain imaging study, animal studies, neurotransmitters. And all of the evidence does seem to converge on the idea that there is some causal component, that some number of people in the absence of using cannabis would not have developed schizophrenia.

If you are predestined to develop schizophrenia, developing it three years earlier when you're just starting university could have a catastrophic impact on your ability to complete university and find a career and become established in a career. And you can legally buy cannabis at the age of 19 in most parts of Canada.

And you've got this undercurrent of people who were regular users of cannabis dating back to the 60s when it was lower potency saying it's benign. It's been around for ages. What's the fuss all about? What do you say to them? There is an argument for taking a precautionary approach here. You can say, look, we're not convinced that cannabis use actually causes schizophrenia. It seems very silly to

risk this, and that there's a pretty strong argument that youth should be using cannabis as late as they can and waiting for their brain development to be complete, which is typically thought to be around 24 or 25. I think that there's been a notion that cannabis is legal and that things that are legal are lower risk or relatively harm-free, and

And there's also conversations about how cannabis is a medicine. You know, cannabis has medical uses. And, you know, the actual medical, the evidence-based medical uses for cannabis is a very narrow set of conditions. But when you have a notion that cannabis is medicinal, it's hard to hold in your mind that it also might be harmful. Dr. Daniel Myron, thank you so much for speaking with me. Thanks for having me on the show, Dr. Golden.

I've realized being a comedian is the best thing I can do for myself while experiencing a disease like psychosis. Because instead of thinking that people will laugh at me, why not actually make them do it? Kalpat Sharma believes he has seen those harms up close. He may have a sobering diagnosis, but a clear mind and comedy are his remedies for moving on with his life. I feel that the best way to tackle stigma is by owning it.

The reason why I have no issue being on this show and talking about psychosis is because I own the fact that I have psychosis. What do you say to young people today who are experimenting with high-dose THC? Just really think about and research what it is that you're getting into. And if you can delay the use...

to a time in your life where you're more settled down. Honestly, I would tell them that even if you do decide to ignore what I'm saying, just have a support system in place right now and just inform the people around you that, hey, I'm going to try this. Things might go south, but at least I know you have my back. Just someone saying that I got your back mentally takes off so much stress and pressure off of you.

Do you feel you have a support system? Most definitely. My brother, my parents, and the support I got from CAMH. I just want to say that if someone is listening to this who has psychosis, I got your back. Some updates since we first aired this story in February 2024.

Dr. Daniel Myron's cohort study has shown that since 2015, the proportion of new cases of schizophrenia associated with cannabis use disorder has almost tripled in Ontario. In March of this year, Health Canada released new mandatory warning messages for cannabis. They include the risk of severe paranoia, psychosis and schizophrenia for users under the age of 25. Cannabis vendors have 12 months to include them on their packaging.

Kalpit Sharma says he wishes they had been in place five years ago. He has sought help for his lack of motivation. Recently, Kalpit ran a 10K race in Toronto, and he's moving forward in his post-secondary education. Kalpit is in the Master of Arts in Counseling Psychology program at Yorkville University in Vaughan. He says it's going great so far.

That's our show this week. Our email address is whitecoat at cbc.ca. If you like this episode, please give us a rating and review wherever you listen. And check out our sister podcast, The Dose, where we ask the question, what should I know about today's cannabis? White Coat Blackheart was produced this week by Jennifer Warren with help from Stephanie Dubois and Samir Chhabra. Our senior producer is Colleen Ross. Our digital producer is Ruby Buiza. And our digital writer this week is Jonathan Orr.

That's medicine from my side of the gurney. I'm Brian Goldman. See you next week.