The Health Effects of Marijuana – Expert Q&A

hello welcome to today's webcast about marijuana thank you for joining us my name is Edie Bottomly with the Michigan Medicine Department of communication the Michigan regulation and taxation of marijuana Act also known as proposal one was passed by the voters of the state of Michigan on November the 6th 2018 it became a law on December the 6th the law allows for the personal possession and use of marijuana by persons 21 years of age or older now that recreational marijuana is legal in Michigan what should you know about its health effects that's what we have our experts here with us we'll introduce them in a moment but first a few housekeeping items you can submit questions at any time even now for our panelists to answer during the Q&A portion of today's chat questions can be submitted by commenting on this video but please know that if you do comment your your name will be visible to everybody else in the chat we're not going to mention your name on here in any way but just please know that it will be visible to others participating if you prefer more anonymous option you can also send a private message to us via Facebook if you can't stay for the whole chat or if you want to share the recording with a friend a video of the chat in its entirety will be available on our Facebook page and we'll also be loading it up to our YouTube page soon after so on to our expert we have three Michigan medicine experts here to answer your questions today if you guys could just go if we could go down the line just a short introduction from you I'm dr. Megan Mart's I'm a research fellow at the addiction Center within the Department of Psychiatry here at Michigan I primarily researched adolescent brain development in relation to substance use risk and resilience focusing on alcohol and marijuana use for example one of the studies I'm working on is a nationwide study following nine and ten year olds over the course of ten years it just started it's called the adolescent brain and cognitive development study so I'm really interested in longitudinal research and impacts of substance use on the brain and also risk factors that might preexist certain people toward that my name is Milan Han and I'm an adult pulmonologists of focusing on the lungs and much of my research actually focuses on the effects of tobacco smoke and the lung but there as you all know are lots of types of smoke so today we'll be talking about the effects of marijuana on the lungs my name is Dan claw I'm a Rheumatologist in the department of anesthesiology I lead a large paint research group called the chronic pain and fatigue Research Center and our group is very interested in the medicinal benefits of cannabis especially for the treatment of chronic pain thank you for your intro let's start with the questions I know we have a variety of different specialties a so if you can't answer the question we'll pass it along the line first question what are the physical effects of smoking marijuana anyone want to take that I'll take that on thank you so the endocannabinoid system the system within the human body that binds to the cannabinoid molecules that your own body produces is widely distributed through the human body and so most people when they think of cannabis they think of some of the side effects like getting high or getting the munchies or they think of some of the potential therapeutic benefits such as in treating pain or treating seizures which are some of the well described benefits but it turns out that the body's own internal cannabinoid system does a lot of things it affects memory it affects stress it affects sleep it affects a lot of different things and so people need to be aware that when they're taking cannabis that there are receptors within the human body that that binds to that do a whole bunch of different things and that what leads to a lot of the effects both good and bad that occur from smoking or ingesting cannabis is it a question if I go to the public drinking a couple of beers is it a question of certain people can can take more marijuana or it has different effects on people yes so marijuana well fairly rapidly like a lot of drugs like opioids or will fairly rapidly develop tolerance so that they need to take more to get the same effect that actually doesn't happen to any significant extent with alcohol you can you can up regulate the enzyme that breaks down alcohol but alcohol blood level of 0.1 Oh will make everyone somewhat impaired i level a point to all will make everyone really impaired there is no relationship at all between someone's cannabis blood level and how impaired they are because a chronic smoker can have a very high cannabis level and not be impaired at all and someone that's cannabis naive that's never smoked before could have a very low amount of THC and be quite impaired never used before using in high doses there's actually research showing that people are have increased likelihood of experiencing panic attacks or high levels anxiety a lot of times when you think of marijuana you know you think of it relaxing you but especially and young people and people using it for the first time they might actually have increased I anxiety especially in high doses the next question that we have is smoking marijuana less harmful than smoking cigarettes that one so interestingly we actually don't have quite as much long-term data on smoking marijuana as we do cigarettes it's a little bit more difficult to quantify there's a lot of ways that people might inhale marijuana whether it's a joint or a bomb or vaping now as opposed to cigarettes which are a little bit more quantifiable because patients typically get cigarettes that are the same size and they know how much of a pack they've taken and can kind of report that over time it's much more difficult to get information on marijuana particularly since it's not been legal either so have the data that we have on smoking marijuana just isn't as good so what we do know is that it irritates the lining of the lungs and can cause kind of increased mucus and a chronic cough and phlegm production so it's irritating to the airways we do know that if patience for instance smoke marijuana and tobacco it can actually make it worse or if patients have a history of asthma smoking marijuana can actually make the asthma worse there actually are also a lot of carcinogens or cancer-causing compounds in marijuana and so there are also some of the same theoretical risks to smoking marijuana as there are to smoking cigarettes with respect to development of lung cancer having said all that we don't have great long-term data for all the reasons I just mentioned on smoking marijuana – whether it definitively causes some of the same things that tobacco causes so for instance chronic obstructive pulmonary disease or emphysema or even lung cancer we just are lacking some of the that long term epidemiologic data but the theoretical risks are certainly still there it's very interesting you touched on other in inhalation devices the next question that we have it says what about using bongs vapes other inhalation devices what are the risks so for any way of smoking marijuana that results in smoke that's going to be a bit more damaging to the lungs look in general is actually damaging to the lung so whether it's cigarette or not interestingly even being exposed to wood-burning stoves some parts of the u.s. actually use for burning stoves like even that is associated with developing chronic Airways disease so in general regardless of where it's coming from smoke is bad there's a little bit less theoretical risk for things like vaping just because it doesn't generate those same burnt compounds in the smoke having said that again there are a lot of other compounds in marijuana including carcinogenic compounds that are still going to be taken up by the body so I wouldn't say at least for some of those theoretical risk that there's any necessarily completely safe way of taking inhaling marijuana that comes directly from plants thank you for that the next question that we have what risks does marijuana pose to kids and teens I can I can talk about that yeah so so what we know is that typically for all drugs of abuse alcohol marijuana that the earlier you use the more damaging effects tend to be so what really concerned about is earlier use usually we say around age 14 is typically what we define is early use but some people some kids are actually using before that in relation to brain development which is my area of focus there are certain areas of the brain particularly in the prefrontal cortex the front of frontal area of the brain that are associated with cognitive control decision-making so really important skills especially for young young people as they're you know learning and make decisions in their lives and those areas of the brain don't really fully mature until actually the mid-20s and so we are especially concerned about that in in relation to what kind of effects we are seeing in the brain and the research in our lab has found in particular effects of marijuana use and the reward areas of the brains to how people process and interpret rewards and also in terms of emotion processing so we are seeing some impacts we don't really know how how long these impacts are on the adolescent brain but again that so the studies like the adolescent brain cognitive development study the ABC study hopefully will be able to have a better understanding of the long-term impacts on a lesson brain especially if they've started using early on the next question we have this is an interesting one with regards to emotional status someone says is it fair to say that smoking marijuana is good for violent people to keep them at an even level I imagine it to in terms of emotional status in terms of call me someone now and you won't have any answer to that one pretty a tree yeah I don't think that that would necessarily be a quick fix to it I think because like you were saying you know it can have different impacts on people and especially the dosage too if you're having a very high level dosage it may not have that calming effect necessarily and if you're interacting with other substances too you may not see that that's known medicinal benefit I would say though if you if you interact with police officers or things like that they will say that they don't find that the people that are high to be nearly as problematic as the people that are drunk or using other drugs because they will be more but again having said that I don't I think any of us are advocating or recommending as a treatment no the next question follows on a little bit from from what you spoke about dr. marks with regards to the risks what should parents tell their children about marijuana use um well I think any kind of psychotropic medication you're taking you know whether it be legal illegal it does have it changes the the way the brain processes information and and it can have effects not only physical effects but psychological effects as well so I think just being aware of you know trying things early on because it can have impacts on your on your brain and I think especially at a time when you have it's a very sensitive period in terms of brain development and it's not worthwhile to to add in external substances that might have a negative impact on your brain should marijuana be used to treat aches and pains well the first threshold is you know there's a lot of things we can use to treat aches and pains that are not drugs at all there's a lot of non drug therapies that can be quite effective for treating pain exercises probably the singularly most effective therapy for treating any type of chronic pain getting better sleep reducing stress so but when we move into medications for treating pain we don't really know exactly where cannabis would lie but I do want to make the distinction between the two elements of cannabis one being CBD or cannabidiol versus THC which is the THC is the psychoactive component of cannabis there are a lot of emerging studies that CBD alone can be effective to treat pain in CBD has virtually no side effects that we know of right now it's not psychoactive it has no addictive potential it really doesn't have hardly any side effects and so if people are moving in the direction of cannabis to treat pain they should try CBD alone and then perhaps a high CBD low THC form of cannabis as the preferred constituents of cannabis that would be most likely to treat pain a lot of people right now are using the high THC forms of cannabis to treat pain and they're overshooting the dose that's effective to treat pain a low amount of THC is more effective than a high amount of THC to treat pain and what we see if people don't watch programs like this and and get medical guidance about how to use cannabis appropriately is they're going to the dispensaries which are used to catering to the recreational user they're there dispensing mainly these very high THC strains of cannabis or of the edibles or whatever and those are not at all the strains that people should be using for most of the medicinal effects of marijuana especially the analgesic or the pain relieving effects the next question we have a little bit of a different one what what about edibles what about consuming or eating marijuana is that safer than smoke no until you know what you're doing so edibles are the preferred route of administration for treating chronic illnesses like pain but the biggest problem that has happened in every state that is legalized marijuana are a big spike in emergency room visits because of people overdosing and edibles the edibles are incredibly potent and if someone that hasn't ever smoked or hasn't smoked cannabis recently or used cannabis recently takes one of these little gummy bears they will be super high for 12 to 14 hours they'll be paranoid they'll be then and in every state has seen a big jump in these emergency room visits some of which are kids because these look like gummy bears so you have to be particularly careful with the edibles around children but the other thing that people are unaware of is the edibles take around three or four hours to have their peak effects so what what the other thing we see happening with the edibles is people take a little bit of a gummy bear or a brownie or whatever and they wait about a half-hour it doesn't do anything and then they eat the rest of it and it still hasn't done anything so they take the second one and then it starts working and they get higher and higher and higher and and paranoid and delusional and and it really is scary for for someone especially that is cannabis naive to get that high because they and they really will then often up you know end up in the emergency room or hospitalized for a workup to try to figure out what's wrong with them for the whole person and it's better because yeah when you get the right dose of the edible it'll last a lot longer and when you take it orally you don't get that big increase in the THC level that makes you high so again as someone who's trying to teach people how to use this appropriately medicinally to treat pain they'll have them use edibles as their preferred route but start at a really really really low dose and go up very very slowly and be aware of how long it takes to work because this is again one of the things that we see people think that because they don't get an effect within the first 30 minutes sixty minutes that they should eat a second gummybear and therein lies the problem because it just I think regulation over what the dose would be in that gummy bear is correct again that'll be one of the good things about the new law in the state of Michigan in contrast to the old law that was supposed to be a medical marijuana law is we will have much better provisions for testing all the cannabis and labeling it so people know exactly what they're getting they know the strength they know what concentration of THC what concentration of CBD right now some of the better dispensaries in the state of Michigan are providing that information to patients but that's not in any way mandated and people don't generally know what they're getting it's really really fascinating information here what does the research show about the use of medical marijuana for pain or nausea relief I really talked about it already I think that we used to think that it was the THC component of marijuana that was really necessary for pain and now we realize that CBD might be at least as important if not more important it probably is the THC component that helps nausea the way THC works in to treat pain is it actually makes everything all sensory experiences less unpleasant than they would otherwise be but it actually is more of what we call a dissociative agent and it turns out that opioids work in much the same way is that neither opioids nor cannabinoids actually do anything to your pain they do just don't care as much about it but this is why we worry about adolescent uses when you when people start using marijuana they don't just not care about their pain they don't care about other things in life and they have a motivational syndrome so all of us that are promoting the legitimate medicinal use are really worried about adolescent exposure it's not treatment for the underlying condition per se it's some people think marijuana might cure certain things cure can and it does it just helps alleviate some of the symptoms that you have and it's important to distinguish that correct this is an interesting question to follow on from that with God's to the effect of marijuana are you seeing any academic changes with students who use recreationally in more recent research we haven't to my understanding seen big impacts on academic achievement I think that there is a cultural shift happening where in Prior decades marijuana users might have been seen as like stoners and in that kind of subculture yeah exactly and I think as it's becoming more normative to use people aren't necessarily viewing it as that way so I think that's where we're seeing that shift in academic consequences but also we recent research from monitoring the future study here at Michigan which I was a part of when I was a doctoral student did find that there has been a fairly substantial increase in college students using marijuana for the first time that they're just recently finding so it'll be interesting to track that over time if it is having an impact on college students because we are seeing a pretty big increase in first-time marijuana use among college students where we didn't see before the next question that we have this is a audience question from Facebook I'm worried about the reproductive implications for our young folks and their children to be thoughts that's a legitimate concern there are data suggesting that you know that there may very well be developmental issues associated with smoking marijuana during pregnancy so I think people should not do that or be aware that that is potentially dangerous yeah it's not in my line of research but I'm just from a personal note I I had a baby recently and I went to a class on like a birth class and you know childbearing class and the nurse was saying that no amount of marijuana is safe from her perspective I think you know in terms of alcohol use there might be a little more variability especially with breastfeeding but for my understanding I think they're not sure yet how much is safe and so they're recommending not using any marijuana when you're breastfeeding or over child okay and the next audience question is cannabis CBD or THC being used to treat epilepsy effectively yes so CBD under the brand name epidural X was approved a couple months ago to treat Gervais syndrome which is a rare childhood form of epilepsy it's thought to be more broadly effective in a lot of different types of seizure disorders but so far it's just approved for two rare types of childhood epilepsy and that product that's approved is actually derived from the marijuana plant but then they get rid of all the THC and all the other things so although it is CBD or cannabidiol more or less pure it was actually plant grown and then they get rid of all the other non CBD constituents so the so the the kids that get epidural X are getting pretty much pure CBD the next question that we have should people with chronic conditions avoid using marijuana chronic condition you have a banach lung condition I would say yes so the data does suggest that it can make loss of lung function of worse for instance if you've got chronic obstructive lung disease or if you've got asthma can definitely cause increased irritation of the Airways could lead to more flare-ups etc so I would say particularly are going to smoke it use with caution if you've got any yo the other thing which I actually forgot to mention is that marijuana actually can carry organisms so for patients that are immunocompromised there have been reports of transferring fungal infections actually by smoking marijuana there's a fungus that goes by the name s for Djilas so if you have a patient with any kind of chronic condition that impacts the immune system it does set them up for risk for this potential fungal infection it's definitely been reported so that's another group in which I would avoid smoke walking marijuana and also I there's been a number of research studies showing that people that have a family history of schizophrenia should be cautious when taking marijuana because it might bring about the onset of schizo typic symptoms earlier than if they hadn't have used marijuana so so there is a link with schizophrenia and marijuana use as well the next question that we have and this is this is a interesting one it's legal so doesn't that mean marijuana is safe there's a you know I think the personal health aspect of it you need to consider that yeah I mean is it better or worse than certain things we don't really know that I don't think there have been any deaths directly attributable to marijuana as there have been with other I mean like alcohol and and nicotine definitely see very high rates of you know deaths so see with that but we don't know that impact on you know driving and another you know they're kind of outcomes so for certain trade-offs with certain classes of drugs it's easier to make so I am often asked to talk about cannabinoids versus opioids in the context of chronic pain and that's actually pretty simple because if you go list down the list of all the problems associated with opioids and all the problems associated with cannabinoids and you look at the book benefit of both classes of drugs cannabinoids win by a longshot there's not it's not even close you again you cannot die of a cannabinoid overdose like 50,000 people in the US are dying of an opioid overdose there are good data suggesting that when states put medical marijuana laws in place that the overdose rates go down by about 20 percent and there are likewise good data that a lot of people are using cannabis legitimately to treat pain to come off of opioids and many people can successfully do that so in narrow air we're the two classes of drugs are easy to compare to each other with respect to the benefit and side-effects there's actually not a lot of data that opioids even work to treat chronic pain whereas there's more data that cannabinoids do work to treat chronic pain and the side effect profile of opioids is so much worse that it's pretty easy to make that kind of judgment but for most other things it's that all drugs when you ingest them have side-effects and toxicity and dangers and problems of marijuana about 9% of users I meet criteria for cannabis use disorder and I think almost double that number if you start in adolescence so cannabis use disorder is a real thing you know is it worse it's probably not worse than like opiate use disorder but there are some people that do become addicted to marijuana which a lot of people yeah don't think that that there is an addictive potential to that but there is so actually you know what the hook the claw you might have answered my next question is it possible to overdose or have a bad reaction to marijuana absolutely we again this will be seen in the state of Michigan when when the law is fully operationalized and people start to really use it recreationally at every state that is passed a recreational marijuana law early or legalized marijuana has seen a big increase in these emergency room admissions and things like this so you absolutely be in part because the the marijuana that's been bred and grown over the last 20 to 30 years is so high in THC content compared to again I will acknowledge I went to the University of Michigan in the 70s so so when I was smoking in the 70s I was I was purposefully trying to get high but but again the the the THC concentration of marijuana and the 70s was 120th 130th what it is right now and and that is again is the component of cannabis that we're almost all of the safety issues seem to be from the THC so we're now we've taken a drug inmate at 20 to 30 times more potent and we're exposing large numbers of people to it so yeah there's concern about that okay the next audience question to clarify does use affect the genetic formation of sperm or eggs I don't know and well any questions that you guys don't feel comfortable answering well we'll get an answer and put that in the comment section I don't think the answer is known actually I think I don't think that good work and again people the viewers should be aware that one of the big problems with cannabis is because of its still being a Schedule one drug it's really put a damper on research and until recently the NIH wasn't even allowed to fund research that could show any beneficial effects of cannabis so part of the reason that we're hemming and hanging with a lot of these questions here is that there simply hasn't been the good quality research done that needs to be done before this gets widely consumed as if people think it's safe and effective for everything that it's touted to be research because you can't for example give you know one group of pregnant women you know high doses of marijuana and you know another group low doses I mean there might be animal work that could look at that but but it's a challenging area of research yeah and you know here we have an another audience follow-up question this one is talking about research with regards to lung capacity this person says Harvard studies seem to show an expanded lung capacity with longtime users and that it's recommended for asthma depending on who grows your cannabis will determine the carcinogens put out when burned and that it's a natural inflammatory anti-bacterial and anti-fungal well interestingly at least from what I've read the slight potential increase in your total lung capacity is probably related to small Airways disease that Lin leads to air trapping and an inability to actually completely get out all of your air which actually leads to what we would actually call hyperinflation of lawns I wouldn't say it's actually increased your capacity and then you know we see that that same airway inflammation in asthma and other types of chronic lung diseases so I actually don't view that as a positive but you know there's you know as far as I know no evidence to suggest actually that it would have an anti either bacterial or antifungal effect at least in the lung and as I mentioned it actually can carry with it organisms that can lead to infections and individuals with chronic immune suppression so yes there is going to be variation depending on you know where you get your marijuana from and and how its processed but unfortunately a lot of that at least for the inhaled forms is not really standardized right now so without you know an FDA lab that's going in and checking on a on a you know a production plant regularly and checking to see if it's the same even if even if you got it from the same grower you know they could have some mold infect their plants and you wouldn't it might be different when you're from another year that's just sort of the way that's just sort of with any I think a type of farm industry but so if you don't have the regulation there's just really no way to know about concentrations contaminant whether things are the same from your deer so at least in my mind it's still a potential lung risk thank you for that and the next audience question since the law is to make marijuana regulation comparable to alcohol regulation based on that the health effects of marijuana should be gauged against those of alcohol how do the medical experts view the health issues for marijuana based on those two alcohol I deem alcohol far worse for teens and young adults especially if it's compared to a daily or weekly use with the medical experts agree or disagree I think it depends I think if you're if you're taking a very high dose of marijuana especially the different trends in marijuana like dabbing for example which is a really super-concentrated marijuana very high levels of THC so if you're consuming very high levels of THC on a daily basis I mean it's hard to to really compare in some ways they are kind of like apples and oranges but and I think another thing with young adults and adolescents is they're not typically using one drug or the other there's a lot of co use using together and I think as people get older especially with marijuana users they tend to just and you'll see people that are like oh I don't touch alcohol but you know I smoke marijuana everyday but typically in younger people they are using different drugs and so there might be some interaction effects with using drugs together which could be a potential problem next question from the audience what effects damage does marijuana smoking have on the heart as well as the lungs acutely some of some of the only deaths that have been perhaps attributed to cannabis ingestion there there is right after smoking there's an acute cardiovascular increase in blood pressure and heart rate and there are a couple case reports where this probably triggered a myocardial infarction or a heart attack in someone so it did with the acute administration especially someone that isn't used to it it'll put their blood pressure up with their heart rate up in that if you have a pre-existing coronary artery disease that could be problematic I don't think in general we think of the heart being an organ that is otherwise adversely affected with chronic administration but in acute the administration that's well known to occur okay and the next audience question can anyone speak to your opinion of marijuana impact pregnancy in the first trimester bad idea but yeah this one the next question that we have dr. call this I think this goes back to a question that we've that you fielded a while ago I don't want to drive while hi how long does it take for the effects of marijuana to leave my body so this is a really big problem that hasn't in any way been solved as sort of the legal issues of impairment because there right now in most states if you have I'm a detectable level you can be charged as with driving under the influence and you could have smoked you could be a chronic smoker that's last smoked thirty days ago but if you get in an accident where if someone was killed in an accident and because you were in the accident you're going to get a urine drug screen you you can and in some cases people are charged criminally even though there isn't evidence that there was impairment from the cannabis at that time we we still what we should be doing but we don't do is is police should really be doing roadside impairment tests because other than for alcohol there aren't any any other drugs that you can accurately say that the level corresponds to a certain amount of impairment but there's a ton of prescription drugs that people are taking and driving a people are taking opioids and driving I don't want them driving that they're they're very impaired but that's not illegal that's right now unless again unless you can be charged with driving under impaired and someone but in general we're not doing wide urine drug screens and everyone that's in a motor vehicle accident to see all the different drugs they may have in their system very interesting the next question what are the effects of mixing marijuana with alcohol tobacco or prescription drugs well with mixing alcohol I was in a meeting with colleagues and they were talking about some of their research and they were calling it green outs which are like black outs with alcohol and that people that were using alcohol and then marijuana they might have a higher likelihood of greening out so I don't know if it's something about the you know certain people are more likely to experience blackouts and others so maybe there's some association with green outs too this isn't really my area of research but that was just something that came up in a conversation and again with with I think younger people as their brains are developing you know these different neuro toxic substances in combination tend to have more cumulative effects than than in isolation because they're interacting with different areas of the brain and different receptors and so typically women are using more substances together it's more problematic the only thing we can say I think was some certainty about the combination and I'm not trying to be pro cannabis in this regard but other drugs of abuse like alcohol opioids benzodiazepines all work in the brain stem to dig decrease your respiratory drive to your breathing drive and the there's a high rate of overdose from all of those drugs and from combinations of all of those drugs and a lot of the famous overdose deaths the the actors or people it was Co administration of opioids with alcohol with benzodiazepines in' and so those three classes of drugs are known to be a deadly combination cannabis doesn't add again i'm not advocating throwing that in the mix but if you're going to be doing poly drug use that would be the one that would be the safest of a bunch of unsafe things because of the fact that it's not going to cause the there the respiratory suppression and the overdose that that and again did that people have honed in on the opioid epidemic appropriately so but there's still a tremendous number of overdose deaths from benzodiazepines alone from the combination of alcohol plus benzodiazepines and and again that is one of the only places where I think we can clearly say the Cannabis wouldn't have the same safety issues doctor hum here's a question for you can secondhand marijuana smoke affect non-smokers including children don't have great data on that I mean we don't have great data on secondhand tobacco smoke so now let's extend that one more if we look at I guess tobacco smoke is an example again I mentioned smoke in general it's not great even you know having kids around wood burning stoves is not great for their lungs particularly for instance they have asthma but can't ultimately increase risk for chronic lung conditions so if I was to guess and to extrapolate I would say it's not great to have small children around any kind of smoke regardless of the source but the kind of you know medical literature we have on it it's just I mean it's not something a lot of parents are going to report and so it's just very difficult data to try to collect thank you for that we have another audience question are there comparable studies between chronic marijuana use and a lack of hitting your REM cycle causing a full night sleep to feel like almost no sleep at all I mean I haven't say this directly I have but I have been interested this I've tried to look at this in our data we haven't been able to do it yet but I in talking about how we would set up this kind of study it's interesting because I think there are if you go and dispensary there are certain strains of marijuana where they advertise that it will help your sleep some people might just say oh marijuana helps me sleep better but we don't know what the effects are you know how it may not oh is a be a beneficial thing for your sleep so so I think you know it's a little bit mix in terms of how it does impact your sleep is it you know we've been talking about two specific cannabinoids THC and CBD that are in cannabis but there are of them and 78 of them we don't know hardly anything about so when when we here so there are there are three different strains of cannabis indica sativa and ruderalis and and what you'll hear from the recreational users is that the indica is more sedating and the sativas more activating keeps people awake and and if that is true that probably was more true in the past before all the inbreeding breeding of strains and everything but when that you used to be more true it was probably some of those 78 other minor cannabinoids that were having those effects that we don't know hardly anything about and so that's why it's so hard to understand because it THC would be directly somewhat sedating and a lot of people that use medicinal marijuana for pain will primarily take it at night and find at least it by self-report that it helps them get to sleep and it helps them stay to sleep but I'm not aware that there have been good like sleep studies showing that that's high quality deep the kind of sleep that we're trying to get people to have and you know after after today's Facebook like we can also talk to our sleep experts like dr. chair gonna see if any have any input on that as well the next question from the audience does cannabis affect the parts of the brain stem that control main body functions no again there are no cannabinoid receptors in the brain stem this is why they don't it doesn't cause the respiratory problems that it does so that that's one of the only good things about I shouldn't say the whole brain stem the rain stem is big but there are there but again the there are no cannabinoid receptors in the respiratory drive center is for a lot of the areas of the brain stem are totally devoid of cannabinoid receptors where they might they have a lot of opioid receptors a lot of other drugs that are affected so and the next question that we have is with regards to k2 spice synthetic marijuana synthetic cannabinoids how harmful are they quite they really should be put you know that they're called synthetic cannabinoids because they if you in in assays they'll bind to the cannabinoid receptor but they are so different what we've been talking about that I think people should really put them in an entirely different a lot of issues with those drugs no therapeutic benefit of those drugs so I really think those should be put over to the side as just bad and distinct from yeah very distinct from marijuana is that I think we're sort of doing cannabis a bit of a disservice by calling those drugs synthetic cannabinoids then the next question that we have if any of you can speak to this can the essential oils of the cannabis plant such as RSO cure conditions such as Crohn's and cancer this is another big problem with cannabis is the route of administration so people are taking cannabis in all sorts of different ways they're using it as a topical they're using it in tinctures they're using oils they're using edibles and what we do know about cannabis is that it's very poorly absorbed it's in very poorly bioavailable so if you put it on your skin and you don't put something else with it like alcohol or something that's going to drive it through your skin it won't really have any known topical effects even though a ton of people are using topical CBD and in products same with the oral routes we're recommending an oral route of administration but one of the big problems with cannabis is there's tremendous differences in bioavailability and only on the average person if they take a gummy bear or orally cannabis product only about 10% of that will get absorbed and the other 90% will just pass through but if they take that same gummy bear with a fatty meal 30% will get absorbed so this is a big problem with the edibles is that a the amount of an edible that you get will be highly dependent on when you eat a fatty meal or if you eat a fatty meal much more will get absorbed if you eat it with a fatty meal or if you eat a fatty meal right after and that that's a big difference in especially with THC a two fold or a three fold difference in THC concentration is the difference between maybe the amount that would cause good pain control an amount that would you ooh hi and paranoia there's not a big wide therapeutic window for THC there's a fairly narrow range that would give a therapeutic effect without a toxic effect okay and the next question is with regards to does marijuana use lead to other drug use I think people refer to that as the the Gateway hypothesis and typically we find that that is not necessarily the case that it there's nothing necessarily about marijuana that makes people want to try heavier drugs per se I think the argument maybe stems from being around marijuana users like the social context but I think the research points that it isn't necessarily something about marijuana that leads to other heavier drug use the next question this is one I feel like we touched on with you dr. hunt I knew dr. Koh but if we could touch on it one more time how is eating and drinking foods that contain marijuana such as edibles different from smoking it will be somewhat less predictable what the effect will be depending on what else you eat and drink that they're you know even though orally available prescription drugs that we have THC analogues that that are now approved in the United States for treating aids induced anorexia and for post chemotherapy nausea and vomiting those drugs are very poorly bioavailable they that's just a known fact and they and those drugs would have all the same problems as a gummy bear is that if you take that drug with a fatty meal two to three times as much of it will get absorbed so that that's still a bit a problem and there's a lot of drug companies that work on drug delivery systems that are trying to figure out a way to put either CBD or THC or both into a drug and make it more predictable absorption so you know that if someone takes that pill that they're always going to absorb 20% are always going to and then you know what the the therapy effect in the in the the toxicity will be relative dose absorbed is more reliable when it's smelled yes it is more reliable when it's mostly catch-22 right so you're gonna get a less reliable dose with the oral administration but there's the risk to the lungs from the smoke any other carcinogens with smoking so yeah I don't even think it's I wouldn't even put it that way because I think we're right we're strongly recommending against the only time that I would say someone that's trying to use it medicinally should vape that smoke is when they first are trying a little bit of it to try to see like what kind of a gummy bear they might want it but putting their toe in but no foot for chronic administration yeah III don't be even vaping I think it's going to cause a lot of the same people are using a chronically it would be far better tincture soils edibles that you're you're then you're not having any respiratory issues no anything no so it looks like we've gone through all our questions all our audience questions but I want to make sure we get everything out of today so I want to go down the line and ask you do you think there's anything we missed that you'd like to talk about and what is a takeaway that each of you would want our audience to take away from today's session yeah I think in relation to the adolescent brain and marijuana use just what we tend to see as the earlier heavier use is more problematic so delaying use much the way we have you know delayed alcohol use to age 21 you know pushing back the age of first use is really important from what we found in the literature so yeah just delay and delay in youth yeah so I mean we talked about I don't you know we are lacking some of the data long-term data although you know the interesting thing is that with respect to the lungs the tobacco companies have been arguing for years that we didn't have data that conclusively linked cigarettes with with lung cancer and things like that so you know I think just from a respiratory health standpoint there's just no safe kind of smoke it you know regardless of what the compounds are but marijuana in particular we know it does irritate the airways we know that it can make other respiratory conditions worse you know we talked about the the potential for infections carrying infections and patients with chronic immune conditions one thing I didn't mention there actually is some other the datas again none of the marijuana date is great but there are some reports and I've actually seen this which is why I tend to believe it I there are some case reports where marijuana and smoking marijuana can lead to bola in the lungs or even holes in the lungs and I actually saw this in a patient several years ago MIT is the hospital young gentleman no other really risk factors to have a whole new lung other than he'd been smoking joints and so if that has that is another kind of rare side effect that has been reported I'm not aware of any data suggests that marijuana is good for the lungs and I think of otherwise at least from a lung health perspective it just represents risk not only to the individual who may be smoking but also as was touched on I think just in general the concept of exposing others to secondhand smoke is also always at least from a theoretical standpoint and concern so not all cannabinoids are created equal did people should be aware that there's a lot of stuff in cannabis the two main one CBD and THC I'm extremely optimistic about the therapeutic potential of CBD and I think that's still being explored and way I'll bet we find a lot of important uses for CBD I'm cautiously optimistic that low amounts of THC in the right settings can be helpful but what we're seeing is that if people don't watch programs like this or don't get some kind of medical advice and they just go to a dispensary they're going to get the high THC forms that are probably not of any medicinal benefit for anything and are going to have a lot of again side effects now if someone's a recreational user and they're trying to get hide and so be it but I think we're trying to give a perspective of how people might use this more from a medicinal standpoint or be the if they're using a recreational at least be aware of some of the potential side effects associated with it and and again a word we're not seeing in part I think because very few US physicians have had any training in any of this so they're not getting the the normal sources of information for a patient are not available so what you're saying is let's reconvene in five years another face picked oh it's in two years because this is moving this field is moving very rapidly yeah yeah it's so that's very interesting too yes yeah well you know I appreciate all your expertise I appreciate you fielding all this at this hugely wide variety of questions thank you for the questions from our audience if you've just tuned in if you tuned in halfway this will be on our Facebook page and we'll also be putting it up on the Michigan medicine YouTube channel as well so dr. marks dr. Han dr. Corr thank you so much and thank you to everybody who who was a viewer


  1. Notice that the Illuminati controlled news media will NOT expose the harmful effects of alcohol because the Vatican banks, are big owners of the alcohol factories, here in the U.S.A. and the U.K. and they wont speak against the tobacco industry either, . or sodomites, who are unnatural, demon possessed, as the sodomites are dieing of AIDS and the queer"S are not paying for their hospital stays, . then die, . so I will smoke my POT here in Mobile Alabama, . F – -k the sodomite Catholic Church, all drunks, or sodomites, . roll TIDE, . roll, F – – k all FED"S who are Pro Muslim, . anti white working tax payer, . as they are for the NEW WORLD ORDER / YOU TUBE, and I enjoy U.T. and worship JESUS CHRIST. !

  2. if a stupid kid starts smoking weed at 13-14ish and stays addicted and becomes a routine weed smoker before adult hood then that will risk his brain from fully developing. You pretty know who did drugs at a young age and was hooked on it at a young age by talking to them. Its like they arent all there.

  3. There are people with significant levels of dementia. What about uncontrolled epilepsy can kill themselves and others. Drugs like Ropinarole for RLS have adverse effects that can impair driving. Anything causing drowsiness and etc.

  4. Pisses me off that most states won’t allow to purchase a firearm if u smoke marijuana (both medical and recreational) it’s marijuana for God sakes, it’s not a drug like cocaine or crystal meth or flakka that fucks up ur body and make u crazy and kill people

  5. I’d said it before and I’ll say it again:
    I’d rather be a stoner than a drunk any time, anywhere

  6. Where are the experts? And I dislike brits. I thought we chased them out of America.

  7. I just wasted my 53:44…marijuana has no death cause in respect of alcohol and ciggret…and next time please do better research before explaining anything about marijuana…

  8. Retard.. Just say "PUT SOME CBD IN YOUR JOINT" also 1 gummy 12hrs blazed.. I don't smoke weed anymore, but I want to buy one of these gummies 😂🤣😂

  9. Lortabs.. oxycodone.. sleeping pills.. and whatever cut back pills you doctors get are way better😂🤣 and dude must drink all the time.. alcohol "you always get drunk on the same dose" I know some drunks that will prove that WRONG😂

  10. Marijuana makes people lazy and careless also it shocks brain nerves and kills millions of veins in brains that it makes person stupid also it makes men's to be under maturity as to be microbial to man eggs as it gives side effects to manhood , it effects the compassion of romantic heightened and singles to lasting sex cause as stamina > it edits man muscular and mandates man disorder us vulnerable { Gay habits } experience.

  11. These people got all of their knowledge about marijuana from a Christian magazine article written in 1957!
    I've never seen so much ignorance about marijuana in one place at one time!
    I think that the guy on the right is not only ignorant but also a liar!
    25 minutes in and I'm checking out, I just can't stand this anymore!

  12. I ate 15 brownies once and I had a ball of course it was some reg I don't know what you talking about Willis

  13. 3:25 being high and getting munchies is great idk how you could think that’s a negative

  14. i never heard marijuana kill the people….i live in nepal and here are many old people using marijuna that prope use of 80%people use marijuna over age 80…..they all use age 15…..

  15. I am writing this before I watch video I am 56 and I first smoked weed at age 12. I am a chronic smoker of the chronic. 😂😂😂😂. So. As I sit and evaluate my personal experience. I'm left with a very shocking truth. At lest for me. The long term effects of cannabis usage for me has resulted in a lot of happiness that I would repeat with no afterthought. Thank you Mother Earth. For me it has been life long medicine. On a side note. I been diagnosed with childhood PTSD. Truth. ⚡️

  16. Listen, i dont know everything. But is it not sketchy that when you search for the effects of weed all that comes up are government websites (.gov), which are the same people who made weed illegal in the first place and aren’t making money off of it.

  17. What has this 1 hour of non-conclusive bull shit said?

  18. No one on the panel knew of a death attributed to Cannabis. Because of the THC level being extracted and being introduced into edibles it has brought psychotic episodes in people. Here in Colorado we have people getting high and being aggressive and violent to people walking along the 16th Street Mall. People have stopped shopping downtown because this tends to increase during the summer months. As for a death, a man ate an edible in Castle Rock (15 miles south of Denver), became disoriented and paranoid. His wife called the police for help and was killed by her husband while waiting for police to arrive. I guess that counts as a cannabis related death. This death can be verified, look it up.

  19. So u tryna say because society accepts it now it means ur no longer lazy but when it wasn't accepted ppl who were stoners were seen as lazy so only because society sees it as not lazy means they're now not lazy

  20. mumbling

  21. how about you try and smoke some ganja and shut the fuck up:)

  22. I got depressed smoke some weed blue dream if ur curious and i feel fine now i just dont abuse im not addicited i just do it randomly

  23. Obviously not a reliable source of information the ignorance is evident.
    One must have a background in the subject otherwise it is a debate of assumptions.

  24. As a new user of marijuana (age 46) I came here to be educated on the pros & cons of this plant. Half way into the video its clear to see that these people are either not sufficiently familiar with the obvious benefits or are intentionally distorting the message to discourage non users and those on the fence. Better use of time to say you're too much of a coward to sign off on the use of marijuana for fear of backlash from your colleagues and grant writers. I'll seek my education elsewhere.

  25. The legalisation of marijuana will herald a huge increase in the factory farming of the crop.
    Marijuana is prey to a wide variety of pests and diseases, which are controlled with various poisons.
    Growth is promoted with various hormones and fertilisers.
    This is what most people are smoking.
    Negative effects are always blamed on the marijuana – the wider picture is never discussed.
    This leads me to believe that the "health issue" is of no interest to the government.
    It would be much safer to encourage people to grow their own, but how would the government make any money from this booming new economy?

  26. Marijuana changed my life. It started as a great thing for me. It was fun and became a social thing for me. I then began smoking almost daily. I never overdid it though and usually smoked once before bed and it helped me sleep great. Then I started seeing negative effects. I began getting heart palpitations, sharp pains in my chest and neck. Coronary artery spasms, shortness of breath, feelings of fullness in the chest, weakness, light headed and Lots of scary pains. I got a lot of tests done and I was found to be good health. But there’s no denying the severity of these symptoms… One doctor has the theory that the weed made me develop a severe anxiety disorder… Since I quit, I feel better and am still in the process of figuring out what’s the matter with me. But my heart has never been the same. Exercise is hard and scary at times. … Marijuana is a good thing, but don’t pretend it’s a miracle drug with no negative affects… There are risks in the unknown as I found out.

  27. All the people commenting on their long term use and how it has not had negative impacts should know that brains are different, strains are different and reactions are different. I work with people who are addicted and have had their life negatively impacted legally, physically and mentally. It's not the cure all people make it out to be, especially when smoking.

  28. I have been smoking cannabis for 19 years and smoke 5 grams a day on average I believe that all the negative affects I have are no worse than petrol fumes or inhaling any smoke in general

  29. marijuana helps me when i use it medically which i do for my anxiety and my ptsd but once i start smoking to get high i dont do as well productively with stuff i need to do in my life marijauna can be great if not abused to just be high i smoke a joint im still here not stoned more relaxed less chance of having anxiety or ptsd driven attacks still functional abd productive but if i smoke 2 or 3 joints ill be too high to be productive in a usefull way weeds not a bad thing it can be good and it can definatelly be abused

  30. Is smoking viper with marijuana is healthy can i get lung cancer

  31. Hey guys, i stated at 14 im 30 now and im ok,my son is 10 n despite my advice his mom drank smoked weed n took e but he is fine. However long term depression is common in my friends. Hope this helps the research.

  32. Suff is more better then alcohol and tobacco

  33. just smoke a joint and you will realize this video is not necessary

  34. The research for these marijuana use would be so difficult and all the answers of these questions can not be verified as long as there is these CHR that prevents studies that uses humans.

  35. I have known a few people that use cannabis for years. They have eventually ended up with mental illnesses. This drug should not be used for recreation it gives you high blood pressure, heart problems, impairment blackouts, sleepless nights, low self esteem, hallucinations. For young people it causes poor brain development, no goals or focus, personality change, slow reactions, irrational thinking, anxiety, emotional.
    I rather have a glass of red wine instead.

  36. Incredible. Not one question about brain damage associated with any ADULT recreational use (either light or heavy).

  37. What is the (DNA) and (Nurons) of cannabis and Marijuana?

  38. Dont waste your time reading the comments, or the video to be honest. Just smoke a joint instead.

  39. The guy with glasses sounds like Jeff goldblum

  40. Marijuana should of been kept illegal in other countries (lets hope it stays this way in uk) as it does produce psychotic symptoms in a lot of people, especially the stronger strains. Keep it illegal as far too many kids are ending up with mental health problems because of it! Smoking it is not good for you as any form of smoking is bad on the body. Maybe oils for medicinal use but it needs more research and NEEDS to be controlled.

  41. Pot rules

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