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Lessons from Genetic Counselling and a Public Education Initiative on Cannabis Use, Genetics, and Mental Illness
Krahn, T.M., Austin, J. & Uher, R. (25 May 2018). Lessons from genetic counselling and a public education initiatives on cannabis use, genetics, and mental illness. Canadian Bioethics Society 2018 annual conference. Scotiabank Theatre, Dalhousie University, Halifax, NS.
A June 2016 national poll showed that 7 in 10 Canadians are in favour of the legalization[i] of cannabis for recreational purposes, and the federal government has promised to do so by July 2018.[ii] At the same time, the Task Force on Cannabis Legalization and Regulation has advised that to "mitigate harms between the ages of 18 and 25, a period of continued brain development, governments should do all that they can to discourage and delay cannabis use." As such, relevant public education is a public health priority requiring increased investments in awareness and prevention programmes, research, and healthcare supports and services across the population.[iii]
Though cannabis use increases risk of psychiatric illness for all, the degree to which it influences vulnerability varies substantially according to one's genetic makeup: approximately one in three individuals in the general population (as carriers of a specific genotype) are seven times more susceptible to the pathological effects of cannabis.[iv],[v] Cannabis use is responsible for 14-24% of schizophrenia cases.[vi],[vii] A replicated gene-environment interaction study model suggests that 77% of these preventable cases occur within the 33% of the population who carry the aforementioned genotype.[viii],[ix] If access to genetic information combined with expert counseling and supportive programming could help dissuade even 1 out of 10 of these people from using cannabis, 4000 cases of schizophrenia in Canada could have been prevented making this a very promising public health project for reducing risk and burden of psychiatric illness.[x]
Genetic counseling is an intervention designed to help people "understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease."[xi] It is a client-centered, therapeutically oriented interaction[xii] involving bidirectional communication about aetiology of illness, and when requested, risk. Genetic counselling uses the shared understanding of aetiology of illness as a framework for helping clients to identify strategies that can be used to protect their mental health for the future.[xiii] There is a strong emphasis on uncovering[xiv] and addressing psychological issues that may be attached to pre-existing or new explanations for cause of illness (e.g. guilt, shame, stigma, fatalism),[xv],[xvi] as these issues influence behavior (e.g. treatment adherence and help seeking).[xvii]
This presentation reports on a public education initiative to bring the lessons learned about mental illness from genetic counselling experts to a wider public, including two presentations at local high schools and a Café Scientifique in Halifax Regional Municipality. The overall goal is to promote general community awareness and active citizen engagement, thereby building relevant health and ethics literacy. More specifically, the events will take as their primary focus discussions of if and how genetic test-based risk information might be ethically[xviii] and effectively provided to youth and their families to lower risk, promote resilience, quell stigma, and promote public understanding. The presentation will also report on the ensuing dialogue regarding health concerns voiced by the public and responsive messaging from genetics experts on how to foster successful public health outcomes in the wake of legalization of cannabis for recreational purposes in Canada.
1. What role does genetics and environment play in explaining how cannabis use may increase risk for mental illness?
2. What are some of the lessons learned from genetics counselling for undertaking public education in preparation for the legalization of cannabis for recreational purposes in Canada?
3. What are some health and ethics concerns as voiced by youth and the general public concerning the use of cannabis, and what are their stated information needs as well as responsive recommendations for how to deal with these concerns?
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