Episode 23: Marijuana, Cannabis, THC and CBD

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Episode Summary:

It can be confusing—THC and CBD are related but different compounds, with different effects on the body, and overseen by different regulatory policies. The use of both is increasing despite sparse information on their beneficial and harmful effects. This episode connects you to the most current knowledge and alerts you to the things any potential user of these products should know.

Episode Guest:

Gillian Schauer, Ph.D., MPH. Clinical Instructor in the Department of Health Services, University of Washington School of Public Health; Principal, Gillian Schauer Consulting.  

During This Episode We Discuss:

  • Pot, MaryJane, marijuana; whatever you call it there is much to know. Learn amazing information from a leading researcher. This episode has excellent unbiased information as current science allows, regarding the use of both good and bad.
  • The history of public policy about marijuana; recent changes and legalization.
  • THC and other medicinal compounds.
  • The endocannabinoid system. Your body has it. The receptors for the system are found throughout the body… What they do, how THC, CBD and yet other products stimulate them.
  • Risks and benefits to marijuana, synthetic THC use. We don’t know all the risks, we don’t know all the benefits. Listen and find out why.
  • The developing brain in youth and exposure.
  • Cannabis and alcohol are a dangerous combination for operating a motor vehicle or heavy machinery. 
  • Cautions for naive users, beware of initial dose of intake.
  • Effects on behavior and judgment.
  • Effects on male fertility.
  • How more study is needed regarding cancer risks, pulmonary issues, and cardiovascular risks.
  • Whys it’s challenging to research cannabis (schedule 1 substance, supplied by one institute).
  • CBD what you should know re claims that are made… Listen and learn.
  • Why youth and pregnant woman should stay away from use.

Quotes (Tweetables):

“The endocannabinoid system can regulate appetite, energy balance, stress response, pain response, mood, inflammatory response, so we have these naturally occurring molecules in the endocannabinoids that bond to these receptors and activates these systems; it’s a very important system in the body. THC acts as an alternate key to that lock and key system.” 

“The cannabis plant as we talked about is a complex plant. It has all of these compounds, more than 100. Most of the science has focused on individual compounds for individual uses, very little has focused on studying the entire plant.”

“For People naïve to cannabis, it’s very important to titrate use. Start low, go slow.”

Gillian Schauer, Ph.D.

Recommended Resources:

Episode Transcript: 

Intro (00:07):

Baseball game, day in a park with friends and family, fishing in a remote stream, work, travels, providing for loved ones, or heading out for adventures, whatever you do, whatever you enjoy, you need your health. The Original Guide to Men’s Health, as presented by the Washington State Urology Society, to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body, after all it makes better sense to retire healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine, your body, if you know you should, but haven’t yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast, as we explore men’s health with renowned experts and embark on a journey towards better health!

Dr Pelman (00:01:20):

On today’s episode of The Original Guide to Men’s Health, we’ll be exploring cannabis and cannabinoids. We’re fortunate to have an expert. Gillian Schauer has her PhD from Emory University, which she earned in 2015 in Behavioral Sciences and Health Education. Her Master of Public Health came from the University of Washington in 2010. And her bachelor’s was from Northwestern University in 2003, Dr. Schauer comes to us from the Department of University of Washington Health Sciences School of Public Health. She has been involved in tobacco prevention and policy for a decade or more in 2012, when cannabis became legalized in Colorado and then Washington State, she moved her expertise to cannabis policy around 2012. So, Dr. Schauer welcome, give us a little background in what you do. And then we’ll talk about cannabis cannabinoids and kind of educate our listeners as to what that means, and then we’ll explore some topics.

Gillian Schauer (00:02:22):

Great. Absolutely. So I had been working in tobacco prevention and control and tobacco policy for a number of years when cannabis first became legalized. And my interest in cannabis was initially on the overlap that it had with tobacco. So I know you’ve done a podcast on tobacco control and tobacco policy issues, and I was interested initially in finding out would legalization cause an increase in use of certain tobacco products. You know, what would we see happen to tobacco policy smoke-free policies, et cetera, with legalization. And it took me all of a couple of meetings with state folks in Washington and Colorado, for me to recognize that this was much than just an overlap with tobacco control and that public health really needed an ally and a voice. And so I have spent the last, I don’t know, seven years or so working largely with public health departments and state health officers and state health epidemiologist, as well as with cannabis regulators to help them think about policy, to help them figure out what data they need to collect, to understand how policies work and to help organize them so that they can share their learnings.

Gillian Schauer (00:03:26):

As you’ll hear from our dialogue today, we know very little about the health effects, both good and bad of cannabis and cannabinoids. And so in the absence of a lot of health-based knowledge policies far ahead of the science that we have, and it can be very challenging to make educated and informed decisions. So everybody needs to be sharing the lessons that we have, as much as possible. And I have tried to help facilitate that.

Dr Richard Pelman (00:03:51):

So tell us about cannabinoid system and what people think of cannabis and think of marijuana.

Gillian Schauer (00:03:58):

It goes beyond that. It does. And so I actually think we should start by talking about the plant and then I’m glad you brought up the endocannabinoid system, because it’s critically important that people understand that before we start talking about some of the health effects. So the plant itself, the cannabis plant, it’s one of the earliest cultivated plants from around the sixth century. It was kind of indigenous to south central Asia and then it spread to other parts through trade. And it was parts of the plant were actually used, not just medicinally, but also for rope and textiles. And it came to the U S in the 1600s, the Jamestown settlers actually brought cannabis with them and had a decree from the king to grow cannabis for Great Britain for United Kingdom, George Washington and Thomas Jefferson grew it as some of their central core crops.

Gillian Schauer (00:04:47):

So we had a very different relationship with it at the founding of our country. And then it was used medicinally in the end of the 1800’s at the turn of the century, some of those medicinal uses, it was largely used as a tincture got sort of caught up in the opium, the animosity towards opium, if you will. And then it also got embroiled in some, some racism. So the Mexican Revolution happened, and people started coming to the U.S. from Mexico. And most of them who were using substances were using cannabis. They weren’t using alcohol. It was more expensive at the time. And so that’s when cannabis really was rebranded as marijuana. And it was embroiled in racist rhetoric about, people coming from another country to do the United States and very quickly policies started to follow, to curtail access to it. And so, you know, most people are familiar with the Controlled Substances Act, which happened in 1970 and really scheduled marijuana as a schedule one substance, which by definition has no medical uses and a high propensity for dependence or addiction.

Gillian Schauer (00:05:53):

And then the 1980s was the War on Drugs. And it wasn’t until the mid 1990’s that we started to see states legalize medically. And even that was just dipping a toe in the water. It wasn’t until I think 2009, when the Attorney General Holder said there wouldn’t be raids on medical facilities. The Ogden Memo* came out that provided clarification and guidance to states with medical marijuana, and basically said, this isn’t going to be a focus of federal prosecution. And that’s when we started to see dispensary’s spring up. And that sort of gave way to the legalization for nonmedical purposes that we’ve had. So the cannabis plant itself has been used for a variety of reasons over the centuries. It’s been used medicinally; it’s been used for textiles. It can be grown for different purposes. There are more than a hundred cannabinoids or compounds that are part of that plant.

*https://www.justice.gov/archives/opa/blog/memorandum-selected-united-state-attorneys-investigations-and-prosecutions-state

Dr Gillian Schauer (00:06:47):

The most famous two of course are tetrahydrocannabinol or THC, and not that compound is responsible for the euphoria, the psychoactive effect. That’s the part that gets you high. Um, but there are other well-known compounds like cannabidiol or CBD. CBD does not get you high and has some potential medicinal properties just as THC. But there are many other compounds that we’re only just starting to learn about GCB. GCB is another compound in the cannabis plant. And this knowledge of the cannabis plant is very recent. It’s only been 60 or 70 years that we’ve even known that THC was a compound in the plant. The endocannabinoid system itself is a system that naturally occurs in the body. It develops in utero. * So we are all born with an endocannabinoid system, whether you’ve used marijuana or not, whether you’ve used cannabis or not, you have an endocannabinoid system.

*https://en.wikipedia.org/wiki/Cannabigerol

*Term used to describe for a process that occurs in the uterus, i.e., during fetal development.

Dr Gillian Schauer (00:07:45):

And that system, works in sort of a lock and key fashion. So your body produces natural endocannabinoids. And I should say the system was in fact named for the cannabis plant because it was discovered after THC. So that’s why endocannabinoid system sounds like it’s made for the cannabis plant, but it’s actually made for naturally occurring chemicals in the body or molecules. So we produce naturally occurring cannabinoids, endocannabinoids, and they bind to two main receptors that are found throughout the body. And the body has, many, many cannabinoid receptors, more receptors than almost any other system in the body. So the receptors that bind to these naturally occurring endocannabinoids are all over the body. They can occur in the brain, organs, tissues, glands, immune cells. And there are two main receptors CB1 and CB2 found throughout the body. And basically, they serve as almost like a link between the brain and physical responses.

Dr Gillian Schauer (00:08:49):

So, the system itself has some important functions. I’m just going to name some of them. It can regulate appetite, energy, balance, stress, response, pain, response, mood, inflammatory response. And so we have these naturally occurring molecules, endocannabinoids, that bond to these receptors to activate these different systems. So it’s a very important system in the body. Now, what we’ve learned is that THC acts as an alternative key to that lock and key system. So if you think about your naturally occurring endocannabinoids being the key and fitting into the receptor lock THC and other cannabinoids can also fit into that lock and can activate that system. And we are still learning a lot about what that activation does. Most of the knowledge so far has been with regard to THC. And what we know is that THC can mimic a naturally occurring endocannabinoid, which could have good effects.

Dr Gillian Schauer (00:09:45):

It can also disrupt the endocannabinoid system and can result in something called downregulation of receptors, where your body then produces fewer receptors to run and respond to these important functions. So there’s a lot of science left to be gleaned in terms of how THC and cannabinoids from the cannabis plant work with this naturally occurring system in the body. But that’s, you know, that’s kind of an interesting, the fact about the cannabis plant is that it does work with this naturally occurring system in the body, which might explain some of the medicinal uses for cannabinoids that we’re learning about every day.

Dr Pelman (00:10:24):

So when we explore the effect of the receptors on the body, they are stimulated naturally. I mean, they must’ve had a place in development and our systems, right? And was the expectation or the discovery of these that it was internally produced. They’re not hormones. I mean, we don’t make a cannabinoid hormone, but what, what stimulates them, or is it just in response to naturally found substances that we ingest that get converted? *

*Our body produces two predominant endocannabinoids, anandamide and 2-AG

Dr Gillian Schauer (00:10:52):

Yeah, I know less about that part. I know that they’re stimulated by having certain, you know, physical physiological reactions. So stress, for example, just the physiological action of feeling stress and producing cortisol can stimulate endocannabinoids. Yes, exactly. That’s right.

Dr Pelman (00:11:13):

We’re moving into a realm where we can bring in an exogenous substance to stimulate that.

Dr Gillian Schauer  (00:11:17):

Exactly. Well, and what’s interesting again, is that the exogenous substance being THC and cannabis, the cannabis plant and cannabinoids were discovered before the endocannabinoid system, which is why it’s named the endocannabinoid system and not something else. Okay. And just to give you a sense of how recent these discoveries are, it wasn’t until the 1990s that we knew what the two receptors were in the body that would bind to this system. So this is very recent. So the endocannabinoid system and this lock and key of the naturally occurring endocannabinoid molecules, and these receptors CB1 and CB2 impact a lot of functions, appetite, energy, balance, stress, response, pain, response, mood, and perception of things, inflammatory response. Memory is another one that’s greatly impacted by it. And we’re still understanding how individual cannabinoids can plug into that lock and key system and impact this naturally occurring functional system in our bodies.

Dr Gillian Schauer  (00:12:21):

And so we know that THC, for example, may bind to some of these receptors and mimic the natural endocannabinoids that we have in our body, but we know it may also disrupt pieces of the system. And so that’s really where the science is going now is to figure out how do these individual cannabinoids work with this naturally occurring system in our body. And in which cases, can it work with a beneficial outcome? And in which cases, might it have more of a harmful or concerning outcome, which will help, I think, contextualize some of what we don’t know around health effects.

Dr Pelman (00:12:54):

Talking about health effects, what are some of the benefits that we know that, you know, I think people have been aware that there’s been quote, “medical marijuana for glaucoma,” and some other conditions, certainly oncology patients who are on chemotherapy found a benefit back even when I was a resident.

Dr Gillian Schauer  (00:13:14):

Right? Yeah. And now that you understand the endocannabinoid cannabinoid system, you can see why there might be some benefits. I want to sort of caveat everything I’m going to say about health effects, both good and bad by saying just how little we know. And I like to, to sort of liken it to what we know about tobacco. And again, you’ve just had this podcast on tobacco control. I’d like to say, we know less about the health effects of cannabis today than we did about tobacco in 1964, when the first Surgeon General’s report on lung cancer and smoking came out. Part of the reason for that is a lot of what I’m going to share with you is by association, it’s not causal. And in science, there are certain criteria that you need to say that something is causing something else. And much of what we know particularly about the health risks of cannabis is just an association.

Dr Gillian Schauer (00:14:01):

You know, people who use cannabis seem to have higher rates of this or that, or so that’s an important caveat. And I can talk about some of the barriers to doing research, but with regard to the benefits. And I think it’s very important that when we talk about cannabis, we talk about both risks and benefits. They are both true. Some of the science is suggesting, or I should say that the largest body of science so far is suggesting, a benefit for pain relief, not for all types of pain, but for certain types of pain relief, tends to be more chronic pain. It’s not quite as effective in science so far for acute pain appetite and nausea relief, especially as you mentioned in patients with chemotherapy, and there are three FDA approved synthetic drugs that are synthetic THC that exists for those purposes, patient relief of patient reported symptoms from multiple sclerosis.

Dr Gillian Schauer  (00:14:54):

There’s a more moderate body of science around sleep, but still some science and then seizure disorders. And just last year, the FDA approved the first drug that was derived from cannabis, the plant itself, not as synthetic for use in two very rare seizure disorders, that usually begin in, in youth or adolescents. So there is a cannabidiol drug on the market called Epidiolex that is used for that. And that’s really where we have the bulk of our research. Now you’ll hear cannabis talked about for lots of other medicinal things from PTSD to glaucoma. You mentioned, for all of those other things that I didn’t mention, the body of science is not sufficient for me as a scientist to say, we know this to be true. So one more caveat to all of the science risk and benefit is that the cannabis plant, as we’ve talked about is a complex plant, and it has all of these compounds more than a hundred different compounds.

Dr Gillian Schauer  (00:15:52):

Most of the science focus has focused on studying individual compounds for individual uses and very little has focused on studying the entire plant. So people often think of medicinal cannabis as being, you know, it’s one plant and I can use it for this, but it’s probably going to shake out that it will be components or compounds of the plant are individually useful for different medical purposes. But the plant as a whole has not been studied in that way. And again, we’re still learning about a lot of things that might, have interplay with medical uses. So the cannabis plant also has terpines, which create the pungent aroma and the smell. And we’re just learning about how terpenes might interplay with cannabinoids to create different effects. So I want to be careful about making it sound like using the whole plant is what has been studied in, in these cases. It’s often been individual components of the plant.

Dr Pelman (00:16:48):

With commercialization. Of course, then there’s always, you know, it’s industry, it’s profits, it’s a lot of investment and it seems like that will help promote some of this.

Dr Gillian Schauer  (00:16:58):

I would hope so. And we can talk a lot. We can and should talk a lot more about the policy. I think, you know, people often ask me, am I pro? Am I anti? And I like to tell them that I think as a scientist, I’m doing my job. If I have people on both ends of the spectrum who are upset with me, because that tends to be where the science is right now, we don’t know all the risks. We don’t know all the benefits and it will probably be that there are some of both, I think the way we are legalizing in this country right now is a commercial model. And that can be a challenge in terms of protecting public health and safety. If you look at other big commercial enterprises, tobacco, alcohol, the big agriculture food industry, it can be an uphill battle to get messages out about public and safety.

Dr Gillian Schauer  (00:17:49):

So, well I think access to cannabinoids is critically important. I’m not sure the commercial legalization is going to in the end have been the best approach for protecting public health and safety. And it’s interesting to look to see what other countries might do. And if they will have models that we can learn from. So cannabis is now legal in Canada, and Canada has given a lot of autonomy to individual provinces. So there are some provinces that are doing some things in terms of policy that might protect public health and safety better in the long run, like state or provincially run stores, you know, plain packaging, warning labels. All of those things, you know, may have a blunting of some of the commercial effect and allow access to the product, but without the kind of appeal.

Dr Pelman (00:18:41):

So in countering various opinions about marijuana, it goes all over the board. There are people who have experimented. Utilized Harm-free. I’m sure they’re getting something from this podcast about things they didn’t know, and people who are dead set against any use of drugs. You must encounter people from both sides of the fence.

Dr Gillian Schauer  (00:19:03):

Absolutely. And I think that is one of the reasons that this is such a politically charged topic is that there do tend to be these different camps with one side being reefer madness. This is the worst thing to happen to our community. And the other side, being these very compelling and real stories of medical use, you know, the stories of kids who are using for seizure disorders. I mean, that alone, I think is what swayed Sanjay Gupta in his reporting on cannabis over the years with CNN. So, it can be hard to take both of those sides and figure out what is truth. And that’s where I have tried to look to the science and looked to a body of science, not just one or two studies that suggest something, but I think in the next decade or two, we will learn a lot about additional benefits from individual cannabinoids.

Dr Gillian Schauer  (00:19:56):

And I would expect that we will probably see, or individual cannabinoids become drugs, actual pharmaceutical drugs. And we will probably also learn a lot more about the potential harms. And my hope as a public health scientist is that we won’t look back 10 or 20 years from now and say, oh, you know, this is a horrible effect of these legalization policies that happened because we didn’t know, or we didn’t put policies in place to be smart about how the legalization is happening. So I think that’s the challenge in creating policy is how can you create policy that provides the access that public opinion shows people want? And some of the medical literature shows some people need it while doing it in a thoughtful way that protects public health and safety that doesn’t create a substance that youth are going to use in higher propensity. You know, that doesn’t create challenges for, you know, pregnant women, some of these sorts of protected classes.

Dr Pelman (00:20:54):

So let’s talk about risks. Let’s talk about, you said youth, so developing, you know, a developing person has a different physiology, different brain. So what do we know about young people? Really?

Dr Gillian Schauer  (00:21:10):

Yeah. And, you know, I should preface this by saying, we know that the brain develops into the early twenties. And as I mentioned, we know that the endocannabinoid system has receptors in the brain. So it’s natural to think that there may be some interplay there. So we know that acute use of cannabis can impair memory learning and attention. The science is not definitive now to say that those are irreversible effects, they can have long-term effects in terms of, you know, impairing memory and learning, but it’s not clear how permanent they are. We also know that using cannabis early in life and using it in heavier use patterns can change the way the brain develops. Again, the effects of that are not entirely clear. It may be that people’s brains develop a little different, but they can accomplish the same tasks, just using different parts of their brain, or it may be that it creates some deficits. We don’t have a good understanding of that. So there are these sort of cognitive development concerns around youth. And I think even folks in the cannabis industry would acknowledge that unless it’s for express medical purposes, youth should not be using cannabis. It’s not a wise decision while their brains are developing. And we don’t yet understand the full effects of what that may bring.

Dr Pelman (00:22:28):

So that is a major caution, a major warning. Yeah, at this point we wouldn’t assume that our developing youth are safe.

Dr Gillian Schauer (00:22:38):

Absolutely. And I’m talking in general as well. So we should talk in a bit about mode of consumption, but certainly there are some modes of consumption that ended up themselves would be a concern smoking it, for example, vaping, that’s kind of the youth piece of the puzzle. It impairs memory, learning, attention. It may have effects on educational attainment in the long-term. You know, we’re still learning a lot about these areas. There are some other acute effects of using cannabis. So acute meaning it can happen right after use. It can impair motor vehicle coordination and reaction time and has been shown to lead to an increase in motor vehicle crashes. This is especially true when cannabis is combined with alcohol, that’s a dangerous combination. There have been a number of limitations to the data that we have that allow us to categorize fatal crash risk.

Dr Gillian Schauer  (00:23:31):

And in brief, because we don’t have a roadside test for cannabis impairment, you have to go in and draw blood. That’s the way that it’s done. There are challenges to officers in the field of, of even knowing if somebody’s impaired by cannabis. Often, if somebody is stopped and has a blood alcohol level of 0.08 or higher, they won’t be tested for anything else to test for cannabis would mean the officer would have to take them down to the precinct, which can take a couple hours, have a phlebotomist draw blood. And by the time they draw the blood, the levels of THC in the system may have greatly decreased. We also have a poor understanding about what happens in chronic users. So chronic users may have what we know. They have a base level of THC in the blood that is much higher, and we don’t know how that impairs them similarly or differently to a naive user. All of that, to say there are a lot of challenges with understanding the implications of cannabis and driving, and we need to improve on data collection. We need to improve on our ability to do roadside testing. But the message would be that people should not consume cannabis and drive, and they should certainly not consume cannabis and alcohol and drive. And we’ll talk about motive use, but cannabis can stay in the body for, you know, after using an edible for up to five hours. So there can be challenges. 

Dr Pelman (00:24:49):

Have done a segment on the opioid receptors and morphine receptor and overdose. Can you overdose on THC or Cannabis? 

Dr Gillian Schauer (00:24:59):

No, you cannot. In the way that, that you would for an opioid, it’s not a respiratory depressant. The overdose for cannabis is another acute risk that I would bring up, which is typically acute psychosis. And, you know, people like to say there have never been any deaths from using marijuana and that may be directly true, but indirectly having these acute psychotic episodes has resulted in increases in injury risk and in some cases, death. So early on in the legalization of cannabis in Colorado, there were two pretty prominent incidences that were covered by the media. One of which was a relatively naive cannabis user who consumed cannabis, over consumed, you know, had an acute psychotic episode and jumped off a building. So in particular, for people who are naive to cannabis, it’s very important to titrate use to try to avoid these acute psychotic episodes. But that’s one of the concerning acute risks that I would be aware of.

Dr Pelman (00:26:00):

So what do we do about people who do find themselves addicted to use of THC marijuana and products of that type that are mind altering, abuse or become chronic utilizers?

Dr Gillian Schauer  (00:26:15):

Dependence can occur with cannabis. And, we’re still also learning a lot more about effective treatments, but screening and brief intervention techniques are approaches that clinicians can use to try to understand if patients that they’re seeing, even if it’s a patient who’s using for medical reasons may have some dependence issues. And then a lot of the approaches that would work for other substances, like motivational interviewing and cognitive behavioral therapy, our treatment approaches that can work for, for cannabis dependence. It’s interesting though. I think our country has a lot more to do in terms of providing treatment for people who are dependent. Other countries have tried some population-based approaches that could be interesting to try here. So for example, in Australia, I don’t know if in your tobacco podcasts, you talked about tobacco quit lines that exist 1-800 Quit Now. Anybody who wants to quit smoking or using a tobacco product can call 1-800 Quit Now and talk to a coach or a counselor and can be connected to medications.

Dr Gillian Schauer  (00:27:18):

So we don’t have any medications that work for cannabis dependence at this point. But Australia tried this idea of a helpline where people could call in and talk to somebody who had been trained in cannabis dependence, and who would help them either stop using the substance entirely or curtail their use and curtail their problematic use. And I think something like that could be much more obtainable to people than, you know, inpatient or outpatient programs, which is where a lot of our drug dependence treatment has occurred, including for cannabis and cannabis treatment has, has in the past also often been court ordered or court mandated, especially in youth. So there’s some innovative research happening now for the teen marijuana check-up is one approach to try to provide treatment in a setting that is not an outpatient, you know, residential treatment center, but a setting where people are more likely to potentially take it on the phone, et cetera, through an app. 

Dr Pelman (00:28:22):

It Seems from what I’ve heard, the potency is much stronger than it was say in the sixties or fifties. I mean, cannabis use goes way back, but it seems like it’s been bred to be more potent.

Dr Gillian Schauer  (00:28:35):

Yes, this is not your grandma’s weed. Right. That’s very true. And, you know, we’re still understanding again, the balance of the plant itself, but if you look at a graph of DEA seizures, CBD and THC have existed in a ratio in the plant and what’s happened over time is the plant has been bred to have the same level of CBD, but a much higher level of THC. And it’s thought that CBD may offset some of the effects of THC that are more negative, like the psychosis and paranoia. And so breeding plants to have very high levels of THC while not also having parallel levels of CBD may result in some of the acute health risks that we’re seeing. And we don’t understand how that, that might change some of the long-term

Dr Pelman (00:29:23):

Just before we leave that topic, a psychosis, somebody is with somebody who’s having a bad time say they were uncertain that they ingested too much. And then they started having trouble. What’s the best way to help them out?

Dr Gillian Schauer (00:29:33):

They should call the poison control hotline in their state. And every state has a poison control line and states that have legal medical and nonmedical marketplaces in particular, have folks with special training that can talk to individuals. If it’s a very severe situation, they should go to an emergency room. Certainly. But those would be the two, the two steps that I would take.

Dr Pelman (00:29:56):

Yeah. If somebody is naive, meaning they haven’t utilized before or they haven’t utilized for a long time, would you give advice, at least be with somebody initially?

Dr Gillian Schauer (00:30:06):

Yeah. And I think, you know, I, I live here in Seattle, and I go to pot shops to talk to budtenders and find out kind of what’s going on. And I think their outages start low, go slow. And the over-consumption usually happens with edibles because they have such a delay of onset. And so people might have a cookie or a gummy bear or whatever it is and say, well, I don’t feel an effect. I need to have another, and then it can catch up with them. So edibles in particular can be very hard to titrate. Now in states that have legal recreational, or I like to say nonmedical use, there’ve been some important policy gains that have made it less likely that consumers can over consume in the early days. One cookie might have been 400 doses of what somebody would need to get high.

Dr Gillian Schauer (00:30:55):

And who’s going to eat a tiny nibble of a cookie. Everybody’s going to eat the whole cookie. I don’t know anybody who could just have a small bite of a cookie and be okay with that. So what states have done now is they’ve put policies in place to have a serving size. So in most states that serving size is 10 milligrams or five milligrams of THC. So if you buy an edible, you will know that that you’re getting a serving size. And if you eat the whole cookie, it’s five or 10, it’s not 400. So that I think has helped curtail some of the over accidental over-consumption.

Dr Pelman (00:31:26):

We’ll go through some of the other health risks.

Dr Gillian Schauer (00:31:28):

In terms of acute health risk. You’ve got the impaired memory learning and attention that we talked about, the impaired motivation, motor vehicle coordination, acute psychosis and paranoia, and then altered judgment in general. And the altered judgment has been shown in studies to be associated with higher risk taking, riskier sexual behavior, riskier behaviors in terms of injury. So those are the main acute risks. long-term risks, and again this is caveated by the fact that we know very little and most of what we know is by association. There are these cognitive development risks and related outcomes that we’re only just beginning to understand. And we talked about with regard to youth, there are respiratory effects, namely acute bronchitis and namely from smoking the product. So people can have respiratory challenges breathing, basically cannabis use disorder, or increase abuse and dependence on other substances. So I think that goes without saying that if you consume cannabis, you could become dependent on it, depending on the survey source it’s between 9% and 14% or 15% of people who consume cannabis in the past month become dependent on it.

Dr Gillian Schauer (00:32:36):

And cannabis is just like any other potentially addictive drug. You can have withdrawal symptoms, you can have tolerance where you need more of the drug to feel the same effect, but that’s only fairly recently that people have understood that cannabis addiction can behave like other addictive substances. And it’s at least right now, it’s okay, a much smaller proportion of people who become addicted to cannabis than say, become addicted to tobacco. And that may not always be the case. People have not consumed cannabis in the way that they have consumed tobacco in terms of smoking two packs a day. For example, we also have not seen these high potency products before. So just like you mentioned, you know, it used to be that cannabis flower had, you know, 10, 15% THC, and now it’s 25% potentially even slightly higher than that. And we didn’t have these oils and concentrates, which can be 40%, 50% all the way up to 80 or 90% THC.

Dr Gillian Schauer (00:33:32):

And we don’t know the effects that that will have on dependence. So we could see a much more dependent population in the future. This cannabis use disorder is a longer-term effect as well as abuse or dependence on other substances. And people often ask me, is there a gateway effect? So that would mean that somebody would start using marijuana and then would move to heavier drugs. And the science does not show a clear evidence of a gateway effect. What it does show though, is that if you use cannabis, particularly if you’re a frequent or heavy user, you may become dependent on other substances that you use and you may have a harder time stopping. You said those other substances, mental health is another area where we have actually quite right, a body of research. And one of the areas that’s been researched the most is effects on schizophrenia.

Dr Gillian Schauer (00:34:17):

So again, people who initiate cannabis use at a younger age and who use in a heavier use pattern are more prone to a diagnosis of schizophrenia at an earlier age. And this tends to be true in people who’ve had family history of schizophrenia. So it’s not clear that using marijuana causes schizophrenia, but it is clear that it sort of primes the pump for people to have potentially a more severe case and an earlier your diagnosis, which is concerning to say the least. There’s also a body of research around social anxiety which can occur in higher instances. If people use marijuana and then there’s some moderate evidence around depression, can be more likely and people who use marijuana and then suicide intention and actually carrying out suicides can also be associated with marijuana use.

Dr Gillian Schauer (00:35:12):

So there’s a lot of mental health concerns that are not yet well understood from cannabis use. Cancer is something that we know for sure far less about than we should in terms of cannabis, but in terms of men’s health, there’s some very important information there. And that’s that the cancer that we know the most about is testicular cancer. And it does appear that frequent chronic use of cannabis is associated with a higher incidence of non-seminoma testicular cancer. The pathway is thought to be again through this endocannabinoid system, there are risks in the testes. And so, as I understand it, and you will know much more about this, that particular testicular cancer is one that develops often at a much younger age. And so it may be that, people, again, who are frequent users at a younger age are impacting their endocrine system.

Dr Gillian Schauer (00:36:03):

And that, you know, may be a pathway through which we’re seeing this higher incidence. Again, none of this is causal as I like to remind people, but that is the cancer that we probably know the most about. There’s a very unclear literature around lung cancer. There are some studies that show that smoking cannabis increases risk. There are others that show that it has no effect. So I’m not comfortable saying that we have any definitive information there to say that using marijuana is safe for lung cancer or harmful for lung cancer. We know that smoking anything is a risk for lung cancer. So smoking in particular is not a way that you would want to consume cannabis if you’re particularly concerned about respiratory issues, you know, or lung issues. But I think it’s interesting that we have these policies legalizing this, this plant, and we know very little about cancer.

Dr Gillian Schauer (00:36:53):

We know very little about COPT risk. We know very little about cardiovascular disease risk. What we know about cardiovascular diseases. If somebody is at risk for a heart attack, they may have a higher incidence of heart attack immediately after using cannabis, but we don’t know a lot about the long-term effects. So this is a very nascent area of research. And part of the reason that we know, so a little is that it has been challenging to research cannabis in this country, because it’s a schedule one substance in order to research with the actual plant, you need a DEA license to be a schedule one facility, which is a lot of steps to go through and process, and not everybody has the funds or ability to make that happen. And then you get your cannabis for the research study from one farm that the National Institute on Drug Abuse oversees at the University of Mississippi and their products while they, you know, are doing the best, they can, are not necessarily representative of what we’re finding in the field.

Dr Gillian Schauer (00:37:53):

So we talked about some of these high potency products. Those are not concentrates and oils. Those are not products that one would likely be able to get from this one farm that is, you know, federally sanctioned for research. So that’s been one big problem to doing research in this country is just that it’s challenging and it’s challenging to get the actual products. The other challenge is that there tends to be quite a bit of overlap between marijuana users and tobacco users. And so most data suggests that if you look at past month, marijuana, consumers, about 70 or 80% of them have also consumed tobacco products in the past month. And so teasing that apart in research can be really hard. And we know that tobacco is absolutely harmful and harms almost every part of the body. So to be able to control for that has been challenging in research, and to be able to find a population that has not used tobacco and has only used cannabis can be difficult.

Dr Gillian Schauer (00:38:50):

And then the other challenge gets us into talking about products in general, and that’s that most of the research has been done with smoked products. It’s not been done with other modes of consumption. And studies have often struggled to measure the frequency of use because it’s such a heterogeneous product. It’s not like a pack of cigarettes where you can ask somebody, how many packs of cigarettes are you using a day to quantify their consumption? You can ask people, how long are you smoking? You know, how many joints are you smoking? But there have been a lot of barriers to really quantifying how frequent people are consuming and how much they’re consuming, which are of course are important things to understanding health risks. As I briefly mentioned earlier, we also have not seen patterns of consumption like tobacco use and having a legalized marketplace could change that. So if we were to say, see a majority of cannabis users move to consuming, you know, 10, 12, 15 joints a day, we would probably see the health effects change, especially with regard to some of the, you know, respiratory and lung effects. We have not seen that yet, but it’s a new market. 

Dr Pelman (00:40:05):

So going back again, we were talking about inhaling various ways, going through water, cool, filtered, vaping, a little background about what we do know, cause I’m sure there are some people who just consume marijuana in various forms without being cigarette smokers. And we’ve done some research.

Dr Gillian Schauer (00:40:26):

Yeah. So the pathways or the modes of consumption for cannabis, you have combustion, which is usually bongs, pipes, joints, blunts, which are hollowed out cigars filled with cannabis plant, all of those combust, the substance and result in smoke. We know that smoking anything is harmful to the body, whether it’s in a water pipe or whether it’s in a you joint, for example, those are pathways that are exposing the body to chemicals that happen from combustion itself, not necessarily from the cannabis plant. And there’s some very interesting research done by Matt Springer at the University of California, San Francisco. He uses animal models. So he uses rats to get the impact of smoke. And what his research has shown is that cannabis smoke has many of the same constituents as tobacco smoke and some in higher concentrations and can have some of the same cardiovascular effects when people are, or when rats are exposed to it.

Dr Gillian Schauer (00:41:27):

What’s interesting is he tried exposing rats to smoke from a joint, but then he tried rats to use the cannabis plant without using a wrapper, smoked from the cannabis plant without using a wrapper. Smoke from the cannabis plant, without THC, without CBD. He did all sorts of variations and they all had a similar effect. And his research has really concluded that it’s a combustion effect, that it may not be necessarily an effect from the plant itself, but a combustion effect. So smoking brings with it a lot of general health risks, but that is still the predominant way that people are consuming cannabis. Now, there are a number of new ways. We’ve talked a little bit about edibles, so you can eat and drink cannabis, legalized marketplaces have all sorts of products that are, you know, edibles and beverages. The concern there in terms of health is the delay of onset and the serving size, which we talked about vaping is a mode of cannabis use that has seemed to increase in recent years.

Dr Gillian Schauer (00:42:26):

And vaping has been around for cannabis for a while. In the seventies and eighties, there was a cult following around using something called the volcano, which looks like it, its name, it’s a big volcano device and you use a bag, and it aerosolizes dried plant matter that you inhale through the bag. However, what we’ve seen in terms of vaping now are products that look a lot more like e-cigarettes and vape pens, dab pens, these are pens that don’t necessarily use the dried plant matter. They use a concentrated form of it, and that concentrated form is much higher in THC, usually. Again, instead of the plant, which is like 25% THC, it might be 40, 50, 60 up to 80% THC. So that’s a concern in terms of dependence, the concentrates are manufactured using solvents. So there can be some concerns, particularly in marketplaces that don’t have good testing about solvents that might still be present butane things that wouldn’t be healthy to consume in any form.

Dr Gillian Schauer (00:43:28):

And then we’re just learning about potential implications from flavorings and diluents that the THC is suspended in and not all of those have been tested for being aerosolized or being vaporized. So there’s a lot to learn. It’s a product class that has advanced very quickly in the marketplace without, again, a lot of the science to understand what people are consuming and the safety of aerosolizing chemicals that are put in. So the other way that people are consuming cannabis is something called dabbing. Have you heard of dabbing before? Okay. So dabbing is using an extremely concentrated form of cannabis. I don’t want to say it’s analogous to crack cocaine, but the mode of consuming, it can be similar to that. So you basically heat a metal element, very hot, and then you put a dab of this extremely concentrated, you know, THC wax on the metal element and quickly inhale it.

Dr Gillian Schauer (00:44:26):

So it’s a very quick way of aerosolizing, an extremely concentrated form. People that I’ve talked to who dab have said, oh, I used to have to, you know, smoke a joint for an hour in the morning to get as high as I want it to be. And now it’s just one or two dabs. And the dabbing rigs that exist look kind of like a bong. I wish I had a picture to show you they’re glass, but they have sort of the element, and you use a blow torch to heat it, put it on, and then inhale through this kind of glass inhaling device. So that particular mode of cannabis use has as well. A number of potential concerns. One is that people are using a blowtorch and extremely concentrated forms of cannabis that if manufactured at home, present a fire hazard. So in the state of Oregon, it’s actually a felony to manufacture these concentrates in your home because of the solvents that are used and the fire risk that it poses. The other is around dependence because it’s such a potent way of consuming cannabis that we don’t know what that will mean in terms of addiction potential.

Dr Pelman (00:45:29):

So definitely a caution to naive users, not to go to something that potent. Probably not the best choice and somebody tells you it’s great if you’re not at that level. Stay away.

Dr Gillian Schauer

 Well, I think even a bud tender in a retail marijuana outlet would advise a naive user to stay away from anything like that because it’s so potent. And then there are other ways of consuming cannabis that are generally less prevalent in the population of our country. Those would be things like oils, tinctures, you know, transdermal approaches to getting cannabis. Those are more consumed on the medical side of things. But data suggests that a majority of cannabis users are consuming for nonmedical reasons or for both medical and nonmedical. It tends to be a small, a much smaller subset. Data are pretty old in this, but in 2014 a study I was involved in suggested that it was around 10% of people were medical, only users. So certainly, tinctures and, you know, transdermal approaches and pills would be more prevalent in those populations.

Dr Pelman (00:46:40):

Let’s talk about other areas, CBD.

Dr Gillian Schauer (00:46:43):

Yes. So in December of this past year, we had a big policy change in the cannabis world. The Farm Bill that was, you know, approved by the Senate and signed by President Trump legalized hemp and all of its derivatives. And so I talked earlier about how cannabis is a diverse plant and can be grown for different purposes. Hemp is basically cannabis that has not been grown for THC that has been grown for other purposes. So by definition, a hemp plant has less than 0.3% THC. However, you can extract CBD cannabidiol from a hemp plant. So the Farm Bill effectively legalized CBD provided it comes from a plant that less than 0.3% THC, CBD and hemp or hemp derived CBD, I should say, are regulated by different agencies in the state than the agencies that typically regulate marijuana or cannabis with THC. And that has resulted in a proliferation of CBD products because they’re not regulated by the same entity.

Dr Gillian Schauer (00:47:51):

They’re usually regulated by departments of agriculture. And if the state doesn’t have a regulator, it’s the USDA who’s regulating them. And departments of agriculture have not put parameters on where you can access these products. So they are being seen in our communities at gas stations, at grocery stores, at coffee shops, CBD is, you know, it’s the new kale, right? It’s being infused in everything. And what people should know is that a majority of those products are not tested in the way that medical or retail cannabis is. They’re tested usually just for their THC content. They’re not tested for other contaminants or pesticides or, and they’re not regulated in the same way. So the packaging may have health claims that are not substantiated by science, but there’s not a regulator who’s yet come in and said, Hey, you can’t be saying this about this product.

Dr Gillian Schauer (00:48:47):

So it’s a bit of a wild wild west right now. And you know, I have personal concerns working in the policy side of things that people are getting information from grocery checkers and, you know, baristas about a product for which we know very little and a product that’s not well-regulated. So we’ll see what happens. The Food and Drug Administration has some regulatory oversight that they could take with regard to CBD under the Food Drug and Cosmetics Act. But we have not yet seen what they’re going to do on that front. What did people use it? I mean, I have been in grocery stores when it’s been recommended to people for everything from diabetes to cancer, to, you know, ailments that their pets may have. And the truth is just like I said, on the health effects, we know very little about the health effects of CBD itself and the science doesn’t substantiate a lot, most of what is being said about it.

Dr Gillian Schauer (00:49:47):

So it’s probably being used for everything. And there are only a very finite number of things that it probably should be used for. The products that are being sold. We also don’t know a lot about the dosing, how much is in there. I mean, it’s, it’s somewhat tantamount to going to a grocery store and checking out and having a acetaminophen muffin at the checkout that you’re buying or having, you know, acetaminophen in an oil. That’s not been approved by the FDA that you’re buying. It’s so poorly regulated right now. You don’t know.

Dr Pelman (00:50:19):

So the oil is applied to the skin active ingredient is absorbed through the skin.

Dr Gillian Schauer (00:50:23):

Well, so there are a number of different CBD products that I have seen out there. It is being put in food in some cases it is in tinctures. In other cases, a tincture is something that you would drink. You should not ever try to vape it. A tincture is not designed for vaping. It’s being sold in oils that you could vape and it’s being sold in topical products that you would put on your skin. And again, the science supporting medicinal uses for any of those is, is very sparse at best.

Dr Pelman (00:50:54):

What indications do we know that it seems to work in?

Dr Gillian Schauer (00:50:56):

Work? Well, we know, as I mentioned, that FDA has approved to this cannabis derived CBD or cannabidiol drug for seizure disorders for these rare seizure disorders. So that’s really where the most body of research for CBD has been. We also don’t know about all the harms from CBD and it’s not psychoactive. It doesn’t cause a euphoria or a high. And so a lot of those potential risks don’t exist for CBD. But for example, in the trials for Epidiolex, the drug that was approved for seizures, there was a significant amount of individuals who had liver issues from consuming CBD. So that’s just an example of an area that we know so little about. I wouldn’t advise anybody that I know to, to be consuming the CBD oil that is out there now for all of those concerns in terms of testing and regulation and the lack of science that we have. 

Dr Pelman (00:51:53):

I have patients come in and tell me they apply it for sore joints and arthritis, and it’s improved their function. So you know that that’s a study of one.

Dr Gillian Schauer (00:52:00):

Right? There are lots of anecdotes and the challenge. I mean, one of the challenges with the health effects in general of cannabis, good and bad is you can find one study to support anything you want to say about it. So I try to base my guidance and encourage folks that I work with to really go to the review studies, the studies of studies that gather up everything that’s known and try to pool that together to determine what we can say, you know, definitively and what the science supports. 

Dr Pelman (00:52:33):

So yeah, it’s always a challenge because these studies where you use a control and you’re studying whatever substance are expensive. Yes. And who funds it, how do you, who’s interested in funding it? I mean, somebody who’s making it, they’re selling, they don’t necessarily want a study that might show that it doesn’t do anything against placebo. So how do these get funded and who, and are there big studies that are being done?

Dr Gillian Schauer (00:52:59):

Yes, there are, the National Institute on Drug Abuse is funding a study called the Adolescent Brain and Cognitive Development Study. The ABCD study, that is a longitudinal study. So that means they will follow kids over time to understand some of the effects of cannabis from youth all the way into young adulthood. So studies like that are going to be very important because they’re not just one cross section in time. They’re looking at what happens as people grow and mature and develop. So there are an increasing number of studies looking at the health effects of cannabis. But as I mentioned, there haven’t been as many as we probably should have had because of the relationship that our country has had with this schedule. One substance reefer madness. I think that’s fair to say yes, I think that’s fair to say, but you know, it’s a new era and folks at the National Institute of Health and the National Institute on Drug Abuse in particular are working hard to get as many studies out there as possible. And there are no shortage of very talented researchers who are trying to explore these things. 

Dr Pelman (00:54:08):

Those of us of a certain age, remember reefer madness is something we saw in high school to counter enthusiasm for youth, for trying marijuana.

Dr Gillian Schauer (00:54:19):

Yeah. And I think some of that sentiment still exists. Like I said, I tend to be somewhere in the middle of this is a panacea and a cure all, and this is reefer madness. I think the science supports a position somewhere in the middle.

Dr Pelman (00:54:33):

Well, anything that we need to cover that we haven’t talked about yet?

Dr Gillian Schauer (00:54:37):

Yeah. So, who’s using cannabis. Cannabis use has for a long time been used has been the most prevalent in young adults, age 18 to 25. And about one in five young adults have used cannabis in the past month. I think one of the more concerning trends for me, because we know that health effects, what we know about health effects is that they tend to concentrate in people who are frequent users. Is that about 40% of those young adults who have used cannabis in the past month are using daily or near daily. And we have seen that, prevalence increases and that’s, unless they are real medical users, which, probably a very small subset and that can be a concerning trend to see. So young adults are the predominant users for youth. It’s about six to 7% of youth ages, 12 to 17 who use, there’s been a really interesting phenomenon in the trends of cannabis use by age.

Dr Gillian Schauer (00:55:35):

So we’ve seen that young adults have been increasing their use in the past decade. For example, however, even with legalization, we have seen a stable trend in youth use. Youth use has not increased in most states that have legalized, in some states it’s even decreased, nationally, it has stayed relatively stable as well. And so people often like to say to me, you know, well, Gillian, this must be great news. We must have great prevention programs in place, and that may be true, but this is also the healthiest generation of youth that we’ve seen in terms of substance use. Binge drinking has gone down, use of cigarettes has gone down, even use of other illicit drugs has gone down despite the opioid crisis, but yet we see this concerning trend where marijuana use has stabilized. And the only other thing that has not declined that has been tracked by some of these surveillance systems is vaping, which of course overlaps with marijuana use as well.

Dr Gillian Schauer (00:56:32):

So, vaping has increased in recent years among youth and marijuana use has been stable. So it may be that these policies that are legalizing cannabis have had an effect of not allowing marijuana use to decline in youth like it would, or like it has I should say in other substances, it’s hard to say what exactly is going on there, but I wouldn’t say that a stable trend in youth is something we should pat ourselves on the back about just yet. We also know that males tend to have a higher prevalence of use of marijuana than females and that kind of gender sex gap has existed for some time and has actually expanded in recent years. So that’s kind of the roundup of who’s using. In older adults we have seen an increase, especially with legalization, but it’s a very small proportion of the population at a population level.

Dr Gillian Schauer (00:57:26):

And those may be adults who are, you know, who used cannabis in the sixties. And, you know, then had a job and had a family and didn’t want to use something that was illicit. And now that it’s legal in their state, they may be coming back to it. Those adults should probably also be treated as naive users. Because again, this is not the cannabis that we had in the sixties and seventies. So, um, when I talked to bud tenders, that’s often something that they kind of screened for to try to advise people in terms of which products they’re using so that they don’t accidentally over consume or have one of these acute psychotic, um, paranoia episodes.

Dr Pelman (00:58:02):

So, in summary, if somebody is going to use, if they’re naive, don’t necessarily pick up what their friend who has been using a lot use some expertise, begin slow and low dose oral ingestion better than smoking.

Dr Gillian Schauer (00:58:18):

Well. So, I want to caution, I want to caution you there. And, and the truth is there’s not been a lot of work done on harm reduction. So the kinds of messages that you are wanting to give right now are totally natural to want to give, like we have a legal marketplace. People, you know, want to know what is the safest way for me to use this. And we don’t have science to support a lot of that. So the start low go slow. That I think is a pretty straightforward message that health advocates and the industry themselves would put forward. They, nobody wants somebody to have a bad experience, but in terms of saying, vaping is better than smoking or eating is better than vaping. We do not have any kind of comparative science to suggest that one is better than the other.

Dr Gillian Schauer (00:59:06):

And all of them have potential concerns. The delay of onset with eating the high concentrations and potential contaminants for vaping, the combustion for smoking. So all of them have concerns and we don’t know from the science, is one of them more concerning than another. So I think at this point, there’s no advice that I could give in that regard. I think people will get advice at the point of sale from their bud tenders in the legal marketplace, but that advice is not formed by a lot of science. Now, certainly for medicinal users, there are some ways that are much less likely to be harmful, consuming tinctures pills, et cetera. But again, these are not products that are being regulated by the FDA. And so the dosing is, you know, often unclear, the safety profile of the product may be unclear. It’s not like an FDA approved medicine, which makes it hard.

Dr Pelman (01:00:04):

Before we wrap up. We always like to let listeners know if there’s any online resources or resources that they can find to educate themselves. Anything that you’re aware of.

Dr Gillian Schauer (01:00:14):

Yeah. So first I would advise listeners, if you are in a state that has a legal recreational or non-medical program, all of the states that have, that have quite good websites from their public health department and their cannabis regulator, and those would be good places to start on a national level. You know, I’m a public health person and policy person. So I would probably recommend the National Institute on Drug Abuse website. They have a lot more about the science, if people are interested in that. And the Centers for Disease Control and Prevention has a website now here in Washington State for your listeners in the state, the Alcohol and Drug Abuse Institute at the University of Washington has an excellent website that I’ve been privileged to contribute to on occasion that is learn about marijuanawa.org learn about marijuana WAF or washington.org. And that website has a number of pages going through different potential health effects, health benefits science, it’s all science-based, and it’s a cadre of scientists that have contributed to it. And I think it’s one of the best in the country in terms of a one-stop shop for learning more about marijuana use and health effects.

Drugabuse.gov | National Institute on Drug Abuse (NIDA)

Resources for Parents & Guardians – Learn About Marijuana (learnaboutmarijuanawa.org)

Addictions, Drug & Alcohol Institute (uw.edu)

SAMHSA – Substance Abuse and Mental Health Services Administration

Dr Pelman (01:01:25):

Agree that you should stay away. Absolutely. And moderation is always good.

Dr Gillian Schauer (01:01:30):

Yes, and youth, that’s an extremely important message that youth should stay away. And I would also suggest that pregnant and breastfeeding women should be advised not to use marijuana. And I know your podcast is for men’s health, but men have partners. And to the degree that somebody has a partner who is pregnant or breastfeeding, they should be advised not to consume marijuana again, because we know the endocannabinoid system is forming in utero, and we don’t fully know the effects that cannabis can have. It’s concerning at a minimum. We know that using cannabis during pregnancy can lead to low birth weight babies, which comes with an array of concerns. And we know that THC passes through the breast milk. It’s a lipid and breast milk is a fatty substance. And so it passes through the milk to the baby. There are only a handful of well-designed studies looking at any sort of outcomes from that. So it’s a very nascent area and the precautionary principle, meaning that we know enough to know that it’s not safe and could cause harm would apply here. Excellent.

Dr Pelman (01:02:36):

Well, Dr. Gillian shower truly appreciate this. It’s been a wonderful, uh, informational session. A lot of things I think that people thought they knew about really don’t know about. So thank you.

Dr Gillian Schauer (01:02:52):

Thank you for having me. I’m happy to do it.

Dr Pelman :

This completes another podcast chapter of the Washington State Urology Societies: “The Original Guide to Men’s Health.” This is Dr. Richard Pelman reminding you to take care of yourself. The Washington State Urology Society wishes to thank all contributors, who volunteered their time and knowledge. The information presented is the opinion of the speakers. The Society also wishes to thank Sean Fox for his invaluable technical assistance, music theme “San Juan bells” written and performed by Dr. Dave Whiting, the podcast is the property of the Washington State Urology Society.  Reproduction and use without the express consent of the Society is strictly prohibited. For more information about men’s health visit wsus.org or visit your physician or care provider.

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