ISPP 2015

Career Opportunities in Pharmacy
The Health Effects of Marijuana – Expert Q&A


– Hello, welcome to today’s
webchat about marijuana. Thank you for joining us. My name is Ed Bottomley
with the Michigan Medicine Department of Communication. The Michigan Regulation
and Taxation of Marijuana, also known as Proposal 1,
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 why 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 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 a 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 we could go down the line, just a short introduction from you all? – Okay, I’m Dr. Meghan Martz. I’m a research fellow
at the Addiction Center within the Department of
Psychiatry here at Michigan. I primarily research
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 10-year-olds over the course of 10 years. It just started; it’s
called the Adolescent Brain and Cognitive Development Study. So I’m really interested
in longitudinal research, impacts of substance use on the brain, and also risk factors that might preexist certain people toward that. – My name is Meilan Han and
I’m an adult pulmonologist so focusing on the lungs. Much of my research actually
focuses on the effects of tobacco smoke and the
lung, but as you all know there are lots of types of
smoke, so today we’ll be talking about the effects of
marijuana on the lungs. – My name is Dan Clauw,
I’m a rheumatologist in the Department of Anesthesiology. I lead a large pain 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 all for your intro. Let’s start with the questions. I know we have a variety of
different specialties here 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 wanna take that? – I’ll take that, Ed. – Thank you. – 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 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’s 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 pub and drink a couple of beers, is it a
question of certain people can take more marijuana or it has
different effects on people? – Yes, so marijuana,
people will fairly rapidly, like a lot of drugs like
opioids, 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 upregulate the enzyme
that breaks down alcohol, but an alcohol blood level
of .10 will make everyone somewhat impaired, and a level of .20 will make everyone really impaired. There is no relationship at all between someone’s cannabis blood level
and how impaired they are. ‘Cause 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. – [Ed] See, that’s fascinating. – And relating to someone
who has never used it before using at high doses, there’s
actually been research showing that people have
increased likelihood of experiencing panic attacks
or high levels of anxiety. A lot of times when you think of marijuana you think of it relaxing
you, but especially in young people and people
using it for the first time, they might actually
have increased anxiety, especially in high doses. – Fascinating. The next question that we
have, is smoking marijuana less harmful than smoking cigarettes? – I’ll take 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 bong, 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 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 patients, 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 to
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 that long-term epidemiologic data, but
the theoretical research certainly is still there. – That’s very interesting. You touched on other inhalation devices. The next question that we
have, it says what about using bongs, vapes,
other inhalation devices? What are the risks there? – So for any way of smoking
marijuana that results in smoke, that’s gonna be a bit more
damaging to the lungs. Smoke in general is actually
damaging to the lungs, whether it’s a cigarette
or not, interestingly, even being exposed to wood-burning stoves. Some parts of the US actually
use wood-burning stoves a lot. 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 risks
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 risk does marijuana pose to kids and teens? – Yeah, I can talk about that. Yeah, so what we know is that typically for all drugs of abuse,
alcohol, marijuana, that the earlier you
use, the more damaging the effects tend to be. So what we’re really concerned
about is earlier use. Usually we say around age 14 is typically what we define as 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 frontal area of the
brain, that are associated with cognitive control, decision making, so really important skills,
especially for young people as they’re learning and making
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 relation to what kind of effects
we’re seeing in the brain. And the research in our lab
has found, in particular, effects of marijuana use in
the reward areas of the brain so 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 long these impacts are on the adolescent
brain, but again, studies like the Adolescent Brain
Cognitive Development Study, the ABCD Study, hopefully
will be able to have a better understanding
of the long-term impacts on the adolescent brain, especially if they’ve started using early on. – Great. 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 in terms of emotional status, in terms of calming someone
down, does anyone have any thoughts into that one? It’s probably a tricky one. – Yeah, I don’t think that
that would necessarily be a quick fix to it. I think because like you were saying, 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. – I don’t think any of
us would feel comfortable saying that that’s a
known medicinal benefit. I would say, though, if you
interact with police officers or things like that, they will say that they don’t find 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 think any of us are advocating or recommending it as a treatment, no. – The next question follows
on a little bit from what you spoke about, Dr. Martz,
with regards to the risks. What should parents tell their
children about marijuana use? – Well I think any kind
of psychotropic medication you’re taking, whether
it be legal, illegal, it changes the way the
brain processes information and it can have effects,
not only physical effects, but psychological effects as well. So I think just being
aware of trying things early on, because it can
have impacts on your brain. And I think, especially the
time when it’s a very sensitive period in terms of brain development, and it’s not worthwhile to
add in external substances that might have a negative
impact on your brain. – Thank you for that. The next question,
should marijuana be used to treat aches and pains? – Well, the first threshold is 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. Exercise is probably the
singularly most effective therapy for treating any type of chronic pain, getting better sleep, reducing stress. So when we move into
medications for treating pain we don’t really know exactly
where cannabis would lie, but I do wanna make
the distinction between the two elements of cannabis,
one being CBD or cannabidiol, versus THC; THC is the
psychoactive component of cannabis. There are a lot of emerging
studies that CBD alone can be effective to treat pain. And 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 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 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. – Thank you for that. The next question we have, a
little bit of a different one, what about edibles? What about consuming or eating marijuana? Is that safer than smoking? – 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 has legalized
marijuana are a big spike in emergency room visits because of people overdosing on the 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, and every state has seen a big jump in these emergency room
visits, some of which are kids ’cause 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 effect, so 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 paranoid and delusional. And it really is scary
for someone especially that is cannabis naive to get that high, and they really will, then,
often end up in the emergency room or hospitalized for a workup to try to figure out
what’s wrong with them. – It is probably better for the lungs, if we only care about, but
maybe not for the whole person. – And it’s better because
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, I’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, ’cause 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 to 60 minutes, that they should eat a second gummy bear, and therein lies the
problem because it just … – Well, there’s really no,
at least in many states, I think, regulation over what the dose would be in that gummy bear, is there? – 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 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. – This is 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. We used to think that
is was the THC component of marijuana that was 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 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. You just don’t care as much about it. But this is why we worry
about adolescent use is 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 amotivational syndrome. So all of us that are promoting
the legitimate medicinal use are really worried about adolescent exposure.
– And I think it’s important to point out that it’s not a treatment for the
underlying condition, per se. Some people think marijuana
might cure certain things, and it just helps alleviate
some of the symptoms that you have, and it’s
important to distinguish that. – [Dan] Correct. – This is an interesting
question to follow on from that with regards 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 stoners and
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, 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 an 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 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 just from a personal
note, I had a baby recently and I went to a class, a birth
class and child-rearing class and the nurse was saying
that no amount of marijuana is safe from her perspective. I think in terms of alcohol use, there might be a little more variability, especially with breastfeeding,
but from 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 with 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 EPIDIOLEX, was approved a couple
of months ago to treat Dravet 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 kids that get EPIDIOLEX are
getting pretty much pure CBD. – Okay, the next question
that we have, should people with chronic conditions
avoid using marijuana? – I guess it depends on
the chronic condition. If you have a chronic lung
condition I would say yes. So the data does suggest that it can make loss of lung function worse,
for instance, if you’ve got chronic obstructive lung
disease or if you’ve got asthma, it can definitely cause
increased irritation of the airways, could lead
to more flair-ups, etc. So I would say,
particularly if you’re gonna smoke it, use with caution. Oh the other interesting thing,
which I 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 a fungus that goes
by the name Aspergillus. 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 smoking marijuana. – And also 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 schizotypic symptoms
earlier than if they hadn’t have used marijuana, so there
is a link with schizophrenia and marijuana use as well. – Yeah, that was the next question, so thank you.
– Oh, okay. – The next question that we have, and this is an interesting
one, it’s legal, so doesn’t that mean marijuana is safe? – Well, you could say the same thing about cigarettes, alcohol. – [Ed] Lots and lots of things. – I think the personal health aspect of it you need to consider. Yeah, 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 alcohol and nicotine,
definitely see very high rates of death associated with that. But we don’t know the impact on driving and other kind of outcomes. – For certain tradeoffs
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 down the list of all the problems
associated with opioids and all the problems
associated with cannabinoids and you look at the benefit
of both classes of drugs, cannabinoids win by a long shot. It’s not even close. 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% 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 areas where
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,
all drugs when you ingest them have side effects and toxicity,
and dangers, and problems. – And there is an addictive
potential of marijuana. About 9% of users 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. It’s probably not worse
than opioid use disorder but there are some people
that do become addicted to marijuana, which a
lot of people don’t think that there is an addictive
potential to that, but there is. – Fantastic, you answered my next question.
– Oh, my gosh! – So, oh actually, you know what? Dr. Clauw, you might have
answered my next question. Is it possible to overdose or have a bad reaction to marijuana? – Absolutely. Again, this will be seen
in the State of Michigan when the law is fully
operationalized and people start to really use it recreationally. Every state that has passed
a recreational marijuana law or legalized marijuana
has seen a big increase in these emergency room
admissions and things like this. So absolutely, in part
because 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 when I was smoking in the ’70s I was purposefully
trying to get high. But again, the THC
concentration of marijuana in the ’70s was 1/20th,
1/30th what it is right now. And that, again, is the
component of cannabis where almost all of the safety issues seem to be from the THC,
so we’ve taken a drug and made it 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? Is there anyone who can talk on this? – [Dan] I don’t know. – Any questions that you
guys don’t feel comfortable answering, we’ll get
an answer and put that in the comments section. – I don’t think the
answer is no, actually. And again, people, viewers should be aware that one of the big problems with cannabis is because of its still
being a Schedule 1 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 hawing
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. – And it’s challenging to
do that kind of research because you can’t, for
example, give one group of pregnant women high doses of marijuana and the other group low doses. There might be animal work
that could look at that but it’s a challenging area of research. – Yeah, and here we have 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, antibacterial,
and antifungal. – 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 then 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 the lungs. I wouldn’t say it’s actually
increased your capacity. And then we see that
same airway inflammation in asthma and other types
of chronic lung diseases. So I actually don’t
view that as a positive. There’s, 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 in individuals with
chronic immune suppression. So yes, there is gonna
be variation depending on where you get your marijuana from and how it’s processed, but unfortunately a lot of that, at least
for the inhaled forms, is not really standardized right now. So without an FDA lab
that’s going in and checking on a production plant regularly and checking to see if it’s the same. Even if you got it from the same grower, they could have some
mold infect their plants and it might be different
one year from another year. That’s just sort of with any, I think, type of farm industry,
so if you don’t have the regulation there’s
just really no way to know about concentrations, contaminants, whether things are the
same from year to year. 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 of alcohol? I deem alcohol far worse
for teens and young adults, especially if it’s compared
to daily or weekly use. Would the medical experts
agree or disagree? – I think it depends. I think 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, it’s
hard to really compare. In some ways they are kind
of like apples and oranges. 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, you’ll see people that are
like, oh, I won’t touch alcohol but I smoke marijuana every day. 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. – Okay, next question from the audience, what effects/damage does marijuana smoking have on the heart as well as the lungs? Can anyone speak to this? – [Meilan] I’m actually
not aware of anything. – Acutely, some of the
only deaths that have been perhaps attributed to cannabis ingestion, right after smoking there
is an acute cardiovascular increase in blood pressure and heart rate. And there are a couple of case reports where this probably triggered
a myocardial infarction or a heart attack in someone. So with the acute administration,
especially someone that isn’t used to it, it’ll put their blood pressure up, put
their heart rate up. And then if you have preexisting
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 administration that’s well known to occur. – Okay, and the next audience question, can anyone speak to your
opinion of marijuana in pregnancy in the first trimester? – [Dan] Bad idea. – This one, the next
question that we have, Dr. Clauw, I think this
goes back to a question that you fielded a while ago. I don’t want to drive while high. 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 is sort of the
legal issues of impairment because right now in
most states if you have a detectable level, you can be charged with driving under the influence, and you could be a chronic
smoker that’s last smoked 30 days ago, but if you get in an accident where someone was killed in an accident and because you were in the accident you’re gonna get a urine drug screen, 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. What we should be doing, but we don’t do, is police should really be
doing roadside impairment tests because, other than for alcohol, there aren’t 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. People are taking opioids and driving. I don’t want them driving. They’re very impaired. But that’s not illegal right now again unless you can be
charged with driving impaired. But in general, we’re not
doing wide urine drug screens on 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 greenouts, which are like blackouts with alcohol, and that people that were using alcohol and then marijuana, they might have higher likelihood of greening out. So I don’t know if it’s
sometimes about certain people are more likely to experience
blackouts than others. Maybe there is some association
with greenouts, too. This isn’t really my area of
research, but that was just something that came up in a conversation. And again with, I think, younger people as their brains are
developing, these different neurotoxic substances in combination tend to have more cumulative
effects than in isolation because they’re interacting
with different areas of the brain and on different receptors, so typically when they’re
using more substances together it’s more problematic. – Yeah, the only thing
we can say, I think, with 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 brainstem to decrease your respiratory
drive, your breathing drive. And 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 actors or people,
it was co-administration of opioids with alcohol,
with benzodiazepines, 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 gonna be doing polydrug 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 gonna cause the respiratory suppression
and the overdose. And again, people have homed
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 again, that is one of the only places where I think we can
clearly say that cannabis wouldn’t have the same safety issues. – Thank you for that. Dr. Han, here’s a question for you. Can secondhand marijuana
smoke affect nonsmokers including children? – We just don’t have great data on that. 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 as an example, again, I had mentioned smoke
in general’s not great. Even having kids around
wood-burning stoves is not great for their
lungs, particularly, for instance, if they have
asthma, but can ultimately increase their 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 medical literature we have on it, it’s just not
something a lot of parents are gonna 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’s sleep to feel
like almost no sleep at all? It doesn’t matter if we talk. – Well, I haven’t studied this directly. But I have been interested in this. I’ve tried to look at this in our data. We haven’t been able to do it yet, but in talking about how we
would set up this kind of study it’s interesting ’cause
I think if you go into the 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. It may not always be a
beneficial thing for your sleep. So I think it’s a little
bit mixed in terms of how it does impact your sleep. – Let me just say
something, though, is that we’ve been talking about
two specific cannabinoids, THC and CBD, that are in cannabis,
but there are 80 of them. And 78 of them, we don’t
know hardly anything about, so there are three different
strains of cannabis, indica, sativa, and ruderalis. And what you’ll hear from
the recreational users is that the indica is more sedating and the sativa’s more
activating, keeps people awake. And if that is true, that
probably was more true in the past before all the inbreeding of strains and everything. But when that 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 I think it’s so hard to understand. ‘Cause 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 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 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
today’s Facebook live, we can also talk to our sleep
experts like Dr. Chavin, and see if they have any
input on that as well. Next question from the audience, does cannabis affect the
parts of the brainstem that control main body functions? – No. Again, there are no cannabinoid
receptors in the brainstem. This is why it doesn’t cause
the respiratory problems that it does, so that’s
one of the only good things about, I shouldn’t say
the whole brainstem. The brainstem is big. But again, there are no
cannabinoid receptors in the respiratory drive center. A lot of the areas of the
brainstem are totally devoid of cannabinoid receptors where they have a lot of opioid receptors,
a lot of other drugs that are affected. – And the next question
that we have is with regards to K2, Spice, synthetic marijuana, synthetic cannabinoids,
how harmful are they? – Quite. They’re called synthetic cannabinoids because in assays they’ll bind
to the cannabinoid receptor but they are so different than
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. – [Meghan] And distinct. – And distinct, yeah, very
distinct from marijuana. 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, and I don’t know 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 and 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 gonna
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 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 the average person, if they take a gummy bear
or oral 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
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’s a big difference,
especially with THC, a twofold or a threefold
difference in THC concentration is the difference between maybe the amount that would cause good pain control and the amount that would
give you high 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 gateway hypothesis. And typically, we find that that is not necessarily the case. That 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.
Han, and you, Dr. Clauw. 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. Even the orally available
prescription drugs that we have, the THC analogs 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. That’s just a known fact, 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’s still a big 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 gonna absorb 20% and then you know what
the therapeutic effect and the toxicity will be. – Do you think that the
relative dose absorbed is more reliable when it’s smoked? – Yes, it is more
reliable when it’s smoked. – That’s a bit of a 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 and the other
carcinogens with smoking. – Yeah, I wouldn’t even put it that way ’cause I think 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 start trying a little bit of it to try to
see what kind of a gummy bear they might want by putting
their toe in, but for chronic administration.
– Nobody yet. – Even vaping I think is gonna cause a lot of the same
– Yeah, I agree, there’s other compounds.
– Right, yeah, and it’s just far better, if people
are using it chronically, it would be far better, tinctures, oils, edibles, then you’re not having any respiratory issues.
– Right. – ‘Cause that doesn’t necessarily filter out all the bad things. – [Dan] No, it doesn’t
filter anything out. – [Meghan] Exactly. – So it looks like we’ve gotten
through all our questions, all our audience questions,
but I want to make sure we get everything out today,
so I wanna go down the line and ask you, do you think
there’s anything we’ve missed that you’d like to talk
about, and what is a takeaway that each of you would
want our audience to know to take away from today’s session? If I could start with you, Dr. Martz. – Yeah, I think in relation
to the adolescent brain and marijuana use, just
what we tend to see is that earlier, heavier
use is more problematic, so delaying use, much the way
we have delayed alcohol use to age 21, pushing back
the age of first use is really important from what
we’ve found in the literature. So, yeah, just delay and delaying youth. – So we talked about it. We are lacking some of
the data, long-term data although 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 lung cancer and things like that, so I think just from a respiratory health
standpoint, there’s just no safe kind of smoke, 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. We talked about the
potential for infections, carrying infections in patients with chronic immune conditions. One thing I didn’t mention;
there actually is some other data, again, none of the
marijuana data is great, but there are some reports,
and I’ve actually seen this, which is why I tend to believe it, there are some case
reports where marijuana and smoking marijuana can
lead to bullae in the lungs or even holes in the lungs. And I actually saw this in
a patient several years ago. Admitted to the hospital,
a young gentleman, no other really risk factors
to have a hole in the lung other than he’d been smoking joints. And so that is another
kind of rare side effect that has been reported. I’m not aware of any data
to suggest that marijuana is good for the lungs,
and I think otherwise, at least from a lung
health perspective it just represents risks, 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 always, at least from a theoretical
standpoint, a concern. – So not all cannabinoids
are created equal. The people should be aware
that there’s a lot of stuff in cannabis, the two
main ones, CBD and THC. I’m extremely optimistic about
the therapeutic potential of CBD and I think that’s
still being explored. 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 won’t watch programs like this or don’t get
some kind of medical advice, and they just go to a
dispensary, they’re gonna get the high-THC forms that are probably not of any medicinal benefit for anything, and are gonna have a lot
of, again, side effects. Now if someone’s a recreational user and they’re trying to
get high, then so be it. But I think we’re trying
to give a perspective of how people might use this more from a medicinal standpoint. If they’re using it
recreationally, at least be aware of some of the potential side
effects associated with it. And again, we’re not
seeing, in part I think, because very few US physicians
have had any training in any of this, so the
normal sources of information for a patient are not available. – So what you’re saying is,
let’s reconvene in five years. – In two years because this
field is moving very rapidly. – So that’s very interesting, too. – Yeah, yeah. – Well I appreciate all your expertise. I appreciate you fielding all 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. Martz, Dr. Han, Dr.
Clauw, thank you so much. And thank you to everybody
who was a viewer.

100 thoughts on “The Health Effects of Marijuana – Expert Q&A

  1. None of them are advocating the use of weed because of a few minor side effects. Instead they’re advocating hard core pills that fuck up your head and are not natural at all. Mainly because the pharmaceutical companies pay their bills

  2. I smoke weed 6 years. And no body tell me. Is drugs worst drug nothing good about it I just enjoy my fast year. Rest 5 years it was addiction and everyday I was thinking to quit but it was hard paranoid. Fear. Restless. Sleepless.

  3. From their perspective Marijuana is dangerous and shouldn't be consumed in any form and has no medicinal value. Clearly they haven't tried Marijuana.

  4. Just looking at American society since legalizing drugs gives you all the proof you need. Brain damaged libtards who would gladly give up their freedoms to sit around and smoke pot. Way to go on dumbing down society…Easy pickins for the New World Order dummies.

  5. They should talk about the long affect of taking xanax, somas, percs, adderal, volume and ect..thats the real danger.

  6. ..not a toker between them and they sit there discussing the effects of smokin cannabis..🤔 U gota be stoned to watch this word salad of delusion..oh yh, I am! 😅

  7. #1, any carcinogen kills the human cell, #2, tar and oils that residual from smoking ANYTHING, in the case cannabis, BLOCK, capillaries, blood vessels, arteries, heart tissue, and lung tissue, killing the endothelium, which is the largest secreting tissue within the cardiovascular, this tissue is responsible for creating nitric oxide within the cardiovascular, when damaged, it will no longer creat nitric oxide, and WILL cause death eventually in the human consuming or smoking ANYTHING.

  8. So, she started talking about marijuana on lungs but she didnt say any shit abou the cigarrettes … WTF? ARE YOU ACTUALLY TRYING TO SAY CIGARRETTES ARE BETTER THAN WEED? …. wtf am I watching.. Im out of this motherfucker. dislike .

  9. I had to take all kinds of prescribed painkillers for my back and they do more damage to me than weed. I had a joint and my back massively lowered in pain. My painkillers would make me constipated, sick, dizzy and would give me headaches. All Pills are bad for your insides. Yet weed does know where near the amount of damage and is still illegal in the uk

  10. I have been a user for fifty years and at 66 I breath much better using an ounce of medicinal quality a month than he 1/4 lb of Mexican Schwag I consumed per month for decades. I do the Win Hof breathing method every morning and hold my breath for 2:30 to 3:00 minutes. It effects me in a positive way and that is why I continue to consume it. I take no pain medication or alcohol at all now but I did for twenty years. It keeps me moving and living despite major damage from Ankylosing Spondylitis. I am as far from cannabis naive as a human can get.

  11. I appreciate what you are trying to do with this video, however I think you should have made a distinction between medicinal use and recreational. A lot of the question and answers were waning between the two which causes a lot of confusion. An introduction should be made about the plant and the differences between recreational and medicinal. The issue, based on the main points of this Q&A, is lack of concise, clear information of users.. not the plant itself!

  12. And there's no increase in college students using cannabis, its just that more students now admit to it due to the

  13. Sorry, this is a terrible video! I gave it a chance, there is some good information in there, but there is so many confusing messages in this discussion. I am a cannabis expert and I came out confused!

  14. I far prefer smoking marijuana and hemp mixed together in smaller doses! Edibles are so much harder to control the amount and don't provide that immediate relief for my tourettes muscle spasms.

  15. 25:20 This is proof that the government doesn't give a shit about it's people… Texas needs to legalize already, there is no progress in the slightest here. When I was in montana I had a medical marijuana card and got it for my tourrettes, but when I moved to texas, I had to go back to supporting the "black market!!!"

  16. I wouldn't have eddabiles because they are varied from user to user THC when it losese it's carbon molecule has a even more psychoactive effect on the brain

  17. I wouldn't say that THC is a dissociative persay because every THC molecule is naturally different and there are three different categories of strains of marijuana you guys are forgetting about but other than the three categories there are different kinds of molecules produced by every strain of marijuana not all THC molecules do the exact same thing

  18. I wouldn't smoke THC consume THC or promote THC usage while pregnant the psychoactive effect on the brain of the baby is much I would smoke loss percentages of THC or consume low percentages of THC with high percentages of CBD for chronic pain and nausea

  19. Let me stop you right there lady about cultures living on marijuana and bacteria I would not smoke marijuana and stay away from it if you have chronic arthritis and take medication for it and have a low immune system you will get sick you will get ammonia and you will die if you cannot shake hands of someone who sneezed I do not suggest you smoke marijuana

  20. Like I said hi THC content lady produces schizophrenia specifically the strains that have high THC levels are sativa

  21. You can't overdose on marijuana because the cannabinoid system is hooked up to your body through your spinal column

  22. I'm addicted to marijuana and it's not that big of a problem I believe there are other problems bigger in the world and I don't find my marijuana use that bad

  23. Lovely Video! Forgive me for chiming in, I would appreciate your thoughts. Have you thought about – Mackorny Marijuana Paradise Blueprint (do a search on google)? It is a smashing one off product for giving up smoking weed minus the headache. Ive heard some incredible things about it and my cousin at very last got astronomical results with it.

  24. Rick Simpson cured his own cancer with HIGH THC CANNABIS EXTRACT…….. ACCORDING TO HIM THE THC IS THE CANCER KILLER!

  25. Marijuana has many health benefits when I had seizures for 14 years marijuana helped my
    seizures decrease from many a week to a few a month. I had brain surgery for my seizures and it worked but all I can say is it really did help me and I still Vape for other health problems better than taking a methadone or oxycodone but everybody is opt to there own opinion. Lets ban alcohol would save thousands of lives a year

  26. if you smoke weed everyday, you are a victim and will pay a high price eventually. ( and i dont mean $$) i feel sorry for kids in legal states. Terrible for school too. Decrriminalize DO NOT legalize. They only legalize to make money and try to save the states budget. they could care less about health

  27. I wanna know how do some use marijuana for anxiety and what type of thc is used for antianxiety? Also how do you not get anxiety from smoking thc? I'd really like to know. Let's be grown ups we all have smoked at least once some more than a couple times but I can't anymore I used to get panic attacks plse share someone? Never smoke and drive no matter how experienced you are seriously IDC if it's legal.

  28. It hampers our ability to process water. Even if that was the only negative thing about it, isn t that enough. I ve used it 50 yrs, I could write a book about what I ve found, the only positive effect I can think of is it s ability to do what doing shrooms does. It canchange your life forever, yet as a habit not a ritual, it s poison kinda like garlic and oinions

  29. MI Represent do we know how to vote or what?! I'm up north 906 wake n baking as we speak 🌟 burst and mint 🍪 that 🔥 the new law saved me $160 to Lansing as the recreational laws are pretty much the same as medicinal laws in our great state, however I do keep my expired card on me just because…

  30. I've smoked marijuana virtually everyday since I was 16 years old except at certain times on probation. I used to smoke a 1/4 oz or more a day when I was younger, i developed severe anxiety in my 20s and now require my prescribed valium and/or gabapentin along with my marijuana to fully enjoy the experience, but on the upside the marijuana heightens the effects of the medications. I 💘 smoking 🌳 and plan to smoke it til i die, the lady who says it causes cancer is full of shit marijuana is known to cure cancer.
    Edit: I'm 32 and to answer tbe guys question, marijuana immediately calms me down if im angry because it changes the way I think.

  31. The smell is awful. It really sends a negative message when you get a whiff of it. The same way smelling someone that wreaks of alcohol. It’s not a good look.

  32. Ha! That's exactly how I felt about my massive pain when i fucked up my back. I didn't CARE about it as much. It relaxed me. It loosened my attitude about my current predicament and I cared less about the pain. Weird lol. But it worked! It worked for psychological well being while dealing with pain, and ultimately that's what matters.

  33. amazing interview. and imo, weed kinda fucks with REM sleep, to be honest, even though i don't want to admit it! for instance i've been an everyday smoker for quite a long period of time, and it seemed like at nights i did not dream at all. and when i stopped smoking, 2 weeks to a month in i started noticing that i remember my dreams a lot more vividly and i it seems for me that i have more of them, so i guess my REM sleep has gotten better even though i miss my marijuana high! heh, thank you guys

  34. you have many people who have smoked for 5-50 years you can 100% study them. though the NIDA has only allowed research on cannabis to promote bad things about it… they don't accept nor fund researching the good things cannabis can aid.

  35. Those women know nothing and don’t like weed. They need a joint. Weed chills people alcohol makes people unpredictable

  36. I think Cannabis is one of the safest drugs out there. Having said that, I also thunk it's like any drug, it effects people differently and should be used responsibly. I don't believe it's a magical cure all with absolute zero negative side effects.

  37. I'm 22 now and I have smoked joint for the first time 4 days ago I'm having problem to diffrentiate between reality and imaginations. what should I do. Is these can be the symptoms of Schezophrenia

  38. many people have been using medical cannabis to treat certain conditions and illnesses that they have. depending on the product, it should give them great health benefits.

    https://fsdpharmabuy.com/explaining-medical-cannabis/

  39. Um these people are basing it off external research . They need to try it to understand . They are looking at it in ways and using comparision to other lab created drugs. How about sativa vs indica vs hybrid ?

  40. Bullshit that psychologist has never smoke weed. If that’s the case they all need to smoke a joint and do some real research.

  41. I have some questions to ask. Iv had 3 back surgerys 1) fusion, 2) cage put in, 3) remove my of fusion. It was doing more harm then good. And now my surgeon is telling me I have bad hips and needing a hip replacement. Iv been investigating medicinal marijuana and seeing the pros and cons for people with chronic pain and arthitis. Would medicinal marijuana be a good route to take?

  42. They say theres not alot of research but thats long past. Theres thousands of years of research. Only in the end of the 60s with the war on drugs cannabis was banned and taken out of pharmacies. Because of usa's politics and influences in europe mostle here also the same. But now its legal in many european countries again. The plant has 10 aminoacids and is considered a "superfood" plus antioxidants than in cases can even cure cancer., It is the best and one of the only medicines currently for MS and neurological pain just to name some. Cannabis flowers and extracts are used medically for many years documented both in Spain Switzerland and Netherlands. There isnt an excuse to not be educated about this if u call yourseves experts

  43. People with die sease should smoke medical or street it's a great natural pain relief it also helps sick people with a appetite. Main key keeps stress down which is what really kills.

  44. I smoked marijuana for 15 years and I been smoking tobacco for a year and a half… since I started smoking tobacco I can barley breathe LOL HAHAHAHAHAHA

  45. while doctors precribe legal meth to kids in first grade and prescribe kids all sorts of ** up stuff HAHAHAHAHAHA DRUG PUSHERS BIG PHARMA

  46. One true fact is it aggravates mental health issues, and in the long run makes depression worse, and takes away motivation (willingness to do anything)

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