Podcasts
What Do I Need to Know about Marijuana?

Key Points

• Strong evidence marijuana causes psychosis
• The more marijuana you use, the greater the incidence of psychosis
• This dose-response relationship suggests causality

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• Marijuana toxicities
• Two major studies of use during pregnancy and breastfeeding show cognitive deficits in children by age 6
• New Zealand study shows regular use lowers IQ
• What is executive function?

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• Standard manufacturing conditions
• Sinsemilla and potency
• Rigorous scientific data missing
• Side-effects of marijuana
• Increase in potency parallels increase in ER admissions over time

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• Consequences of impact on executive function
• Divided attention
• Effects on respiratory and cardiovascular systems
• Chronic use changes brain structure
• Why worry about heavy metals found in some marijuana?

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• Difference between whole marijuana plant and chemicals in the plant
• “Legal” is not the same as “safe”
• Marijuana toxicities
• Do states that legalize marijuana protect consumers from unsafe, ineffective drugs?
• CBD is a mostly unregulated industry

Key Points

• Endocannabinoid system in our brain
• Acute effects, Chronic effects
• Tolerance, withdrawal
• Treatment of mj use disorders
• Marijuana may change adolescent brain structure
• Researchers CAN obtain mj people are using today
• Difference between potency and dose
• Cannot trust labels

Key Points

• National Advanced Driving Simulator
• Cannabis affects critical tracking
• Speeding is number-1 reason marijuana-impaired drivers are stopped
• Drug Recognition Experts (DREs)
• (See State Regulations to Ensure Road Safety for more on driving.)

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• More about neurotransmitters
• How marijuana fits into this picture
• Impaired judgment and motor coordination
• Long-term effects
• Do we know much about the other chemicals in marijuana?

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• THC is fat soluble – brain is one of the fattiest tissues in the body.
• In chronic, frequent users, THC comes out of the blood rapidly, but active THC that is stored in the body’s fatty tissues, including the brain, leaches out slowly and can be detected for as long as 30 days.
• What is body burden?
• Cannabinoid system can turn off both excitatory and inhibitory neurons.

Key Points

• No evidence to support this thus far
• Georgia allows CBD oil with 5% THC
• 5% THC is 50 mg per gram or per milliliter, which is one 30th of an ounce
• That’s like 20 2½ mg Marinol capsules
• A super dose that needs to be fixed
• Developing an eyedrop from THC that does not get into the blood to treat glaucoma.

Key Points

• What’s the difference between nabilone and dronabinol?
• Is marijuana safer than alcohol?
• Is Epidiolex the same as CBD sold almost everywhere?
• Where on the Internet can I find scientifically accurate information?

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• Correlation but not causality
• States with lower death rates may have implemented other programs
• Population studies don’t apply to individuals; need to look at individual patients
• Need to compare mj pain relief with standard pain relievers rather than placebo

Key Points

• Again, this is not something that has been shown.
• Science has been pre-empted by anecdotal evidence
• Education is key.
• First time in history that a drug has been approved by popular vote
• Marinol and Syndros are dronabinol (THC) approved by FDA. Clinical trials have shown what dose is needed.
• Epidiolex (CBD) is latest drug to be approved by FDA to treat rare forms of epilepsy.

Key Points

• US is not prepared for this. Huge issue and huge problem.
• In occasional users, 74% of THC comes out of the body in 30 minutes, 90% in 1.4 hours. Average time to get drivers’ blood drawn is 1.4 to 4 hours.
• Many states have zero tolerance levels such as I or 2 nanograms per milliliter.
• Establish impairment first, then take the biological sample.
• A-Ride Program (NHTSA) trains every police officer to do the field sobriety test.
• Also establish impairment via witnesses.

Key Points

• Different kinds of studies
• Open studies
• Important to have control group
• Double blind studies
• Difference between correlation and causation
• What about two studies that contradict each other?
• Importance of replication

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• Australia since 2004 has conducted random stops. Screen with oral fluid, confirm with oral fluid.
• You are not allowed to have these drugs in your body. Series of penalties. Don’t base it on impairment.
• Europe way ahead of the US in oral fluid screening.
• Germany - Doctor observes impairment, draws blood on site.
• Police officers can take the sample.
• POCT Tests (taken right where you are)
• Roadside tests. Probable cause.
• Canada DRE force.

Key Points

• Impact of marijuana industry deciding how to regulate itself
• Lack of industry standards based on science
• States don’t have capability, infrastructure, or financing to deliver regulation
• Testing lab shopping to find best “safety” results
• Hemp legalization potentially a game-changer because it opens pathway for regulation by federal agencies with knowledge of regulatory science

Key Points

• What we don’t know
• Our two legal drugs, nicotine and alcohol, are responsible for devastating morbidity and mortality.
• What might the unintended consequences be of legalizing a third addictive drug?
• Exposure to adolescents and prenatally
• Teen vaping

Key Points

• Occasional user needs lower amount of THC to get high
• Chronic frequent user needs quite a bit more to get same high
• Some evidence showing cannabis can change the proteins that surround your DNA and determine what genes are going to reproduce.
• Those changes are heritable, meaning if you use, it may affect your children.

Key Points

• Epidiolex is a very well-defined pharmaceutical preparation of CBD
• Difference between it and other CBD is like night and day.
• Difference between Epidiolex and CBD on the Internet and in stores
• What is the OTC process?
• What is biphasic activity?
• What is low bioavailability?
• Is there an entourage effect?

Key Points

• In utero drug exposure—growth, behavior, IQ, learning, memory
• Some obstetricians in Colorado are recommending marijuana to pregnant women
• Infants and toddlers are exposed if parents smoke
• Exposed via breast feeding
• Adolescents
• Whole spectrum of ways children can be exposed

Key Points

• Lay term for marijuana infused into a food stuff
• Risk that people may eat something but not know it contains marijuana, especially children
• Route of administration impacts drug effect
• CBD (Epidiolex) has been shown to be safe for use by children. FDA has issued warning letters against false medical claims for unapproved CBD products.
• Describes synthesis
• Pet peeves

Key Points

• Israel has had marijuana for medical use for a long time. Mechoulam first discovered THC in 1964.
• Not until 1988 did we discover the cannabinoid receptor.
• First International Medical Cannabis meeting
• Doctors expected patients to return to them but found patients got their advice from untrained dispensary workers. This meeting changed that.
• Israel has no recreational use at all.
• Advice for US researchers

Key Points

• ABCD Study=children ages 9 & 10
• Healthy BCD Study=infants, toddlers
• What can we learn from alcohol, tobacco marketing to kids?
• Can we learn anything from Canada?
• What about edibles?

Key Points

• Medical marijuana comes from the same plant recreational marijuana comes from
• FDA-approved drugs vs state-approved drugs
• Do medical societies endorse marijuana as medicine?
• Treatment for marijuana addiction

Key Points

• 1999 Institute of Medicine stated no medicine should be smoked and there was a critical need for research
• National Academies of Medicine looked at this again in 2017
• Unbiased look at where we are now
• Lessons learned from Colorado about marijuana-infused edibles