The Politics of Side Effects: Marijuana Versus Antidepressants

Two types of drugs have been in the news in the last couple of days because of concerns about the side effects they can produce in small populations of users.  In both cases, the side effect is fairly rare, but in both cases the side effect is serious.

The first is marijuana. A new study from researchers in London suggests that the use of marijuana is associated with changes in brain activity that may be linked to the development of psychosis or schizophrenia in a small percentage of people who use that drug heavily. A second study, from Yale, suggests that the use of marijuana may worsen schizophrenic symptoms in individuals who already have such symptoms but are otherwise stable.  Some of the folks in the drug policy world have suggested that the concerns raised by these studies may berather exaggerated, but I don’t think it makes any sense to downplay the concerns about such side effects at a time when more and more people are considering using marijuana for medical purposes. If it’s a real concern, then fine. People should be aware of it.

The second type of drug that has some serious side effect concerns is antidepressants. The FDA just said this week that manufacturers of all antidepressants must put stronger warnings on their products about the risk that the drugs will encourage “suicidal thoughts and behavior” in people age 18 to 24.  These kinds of drugs already had to carry a warning about the risk of encouraging suicidal thoughts and behavior in kids and teenagers, and now there seems to be an understanding that the risks are somewhat broader than initially thought.

Two types of drugs, each one posing a risk of harm to small percentages of users, each promising benefits to
much larger percentages of users. How should they be treated? One option might be to ban them both, and indeed it wouldn’t be too difficult to take some of the standard “protect the children” rhetoric that is used in the War on Drugs and turn it against the manufacturers of antidepressants. But perhaps the use of a warning label is a more reasonable solution, in spite of our concern about preventing suicide, because we value the benefits of antidepressants.

What if marijuana was required to carry a warning label, so that individuals who already have schizophrenic symptoms would realize that the use of that drug could be problematic for them? Couldn’t the regulatory tools that we use to encourage safety around antidepressants be useful when it comes to marijuana? And given that 12 states now permit the medical use of marijuana, isn’t it time for the FDA to start developing some guidelines of this nature?