What the Top Marijuana Experts Say About Today's Weed - BRIGID Magazine

Wednesday, June 27, 2018

What the Top Marijuana Experts Say About Today's Weed

Image: Seth Doyle
A few months ago, I interviewed Mark Robinson, town manager in the state of Maine, and two leading experts in neuroscience and addictions — Dr. Yasmin Hurd of the Icahn School of Medicine and Dr. Jodi Gilman of Harvard School of Medicine. We discussed some concerns and suggestions regarding society's newfound love affair with weed.

Medicinal marijuana and recreational marijuana are both discussed, as well as the key differences between THC and CBD.

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Kristen: Recreational marijuana is currently legal in eight states, and Canada is also moving in the direction of legalization. For this episode I want to look at the potential risks associated with high potency cannabis products in particular.

And to give you a background on the motivation for making this particular episode: In September 2017 I wrote an article for Genetic Literacy Project about marijuana and some of the epigenetic effects that can result from marijuana use. Marijuana enthusiasts were not pleased with me for writing my article, and they definitely let me know.

In October, about a month after the article came out, I was contacted via email by Mark Robinson, a town manager in the state of Maine. He was eager to put me in touch with some experts working in neuroscience, addictions, and medicine. This episode is the result of our exchanges over the past few months, along with interviews I conducted with Dr. Yasmin Hurd and Dr. Jodi Gilman.

There's a Danger Here That We're Not Talking About


Mark: Hello Kristen.

Kristen: Hi Mark. How are you?

Mark: I'm well. Thank you for your call. Well, you know, this is an interesting time we live in, and I appreciated your story very much. When the people of Maine voted last November to legalize, they voted for the marijuana they knew — totally unaware of the product lines that'll be coming out, with the high potency stuff. This is what I latched onto as a concern.

Honestly, I'm getting nowhere. No matter how many ways, how many different approaches I take, how I try to articulate the message that this is something you need to pay attention to, folks, you need to be concerned about. Can't get the local media, can't get the local medical communities, public safety communities. They're all kind of sitting on their hands, waiting to see what's going to happen. And primarily because elected leadership is so focused on the regulatory aspect of it and the amount of money they can make from it.

So I'm looking at this purely from a concern for cognitive health of the general public, and impact. Very few people know about what you wrote about. Dr. Hurd is highly respected internationally for her work, not only among the neuroscience community, but also the international cannabis communities. She would be the ideal person to really highlight and focus on the evidence-based medical research that exists that can highlight every point of your story that shows that there's a danger here that we're not talking about, that we need to be focused about.

Dr. Hurd: My Name is Yasmin Hurd. I'm a neuroscientist at the Icahn School of Medicine at Mount Sinai in New York, and I'm the director of the Addiction Institute here.

Kristen: How did you begin studying the effects of cannabis?

Dr. Hurd: I began because I was interested in understanding whether or not developmental cannabis [use] could impact adult behaviour on a neurobiological level, because we were all interested in the so-called "gateway hypothesis". And we wanted to evaluate it irrespective of parents, where you were raised, your friends, and just to see whether or not studies that had shown on an epidemiological level that people with substance use disorders in adulthood — such as with heroin or cocaine — they frequently had early exposure to marijuana, or even other drugs like nicotine or alcohol. But we were particularly interested in cannabis.

The High Potency Stuff, It's Not Your Parents' Weed


Mark: In Maine, had they passed the simple law of growing goof, like the Vermont approach: You can grow, consume, carry, give a certain amount — that's fine. The stuff you're growing, the content of the THC in the stuff you're growing doesn't compare to what the laboratories are producing.

The black market's gonna produce whatever the black market wants and there'll always be a demand in the black market for this high potency stuff. Probably the fastest growing product line in Colorado right now would be the high potency stuff. It's the vaping, it's the smokeless, odourless opportunities to consume high potency cannabis. My concern has been from the moment I heard about what was coming last March is the human impact, from in the womb to age 30.

If you're my age — I'm 52 — you're gonna do this stuff, okay, whatever. You do it. Your brain's fully developed, toward whatever end, whatever impact that has on you, that's your choice. I'm concerned about our youth, I'm concerned about babies. It changes the neurological pathways in your brain. People don't know that.

Dr. Yasmin Hurd
Image: Wikipedia
Dr. Hurd: You know, it's fascinating that what people thought about when we all considered the legalization of marijuana, I think many people thought about it as the marijuana that people had in the past, where it's like four percent THC. And even that many people were not necessarily happy about. But then with legalization came unrestricted amounts of THC. They did start experimenting with very high concentrations of THC, which took it beyond what the original plant on the street that people used to consume had.

So now it can even have, in regular marijuana, like 25 percent THC, and then dab, this concentrated form of THC can even get up to 80 percent THC. That amount of THC, you've seen now, can induce psychosis, it can induce physiological issues like tachycardia, it absolutely has a lot more psychotropic effect than a regular marijuana joint.

Kristen: The two main cannabinoids in marijuana are THC, which is short for tetrahydrocannabinol, and CBD, which is cannabidiol. THC is responsible for the high. CBD is not psychoactive. It's mainly responsible for the medical benefits that you hear about. It opposes the effects of THC and interacts with the immune system. High potency THC cannabis products often have the CBD reduced or removed altogether.

Marijuana Nowadays: It's a Different Drug That We're Dealing With


Mark: There's another person I'd like to engage you with, and that is Dr. Jodi Gilman. She's from the Harvard School of Addiction Medicine.

Dr. Gilman: My name is Jodi Gilman. I'm an assistant professor at Harvard Medical School and Massachusetts General Hospital, and my background is in neuroscience.

We know — and this isn't an opinion, this is a scientific fact — that cannabis has gotten much, much stronger in recent years, so that the content of THC, which is the psychoactive compound in marijuana, has increased from one to two percent in the 1960s — that's probably what our parents were smoking — to 25 percent or 50 percent or even 80 percent in some of the oils now. And because the potency is so much higher, it's a different drug that we're dealing with.

We know that, with these higher potency marijuana strains, they put people at greater risk for adverse outcomes.

Kristen: I saw a video where it seems like there's different companies that are almost competing with each other to see how pure they can get their THC products. And these products have zero CBD, which kind of counteracts the effects of THC, right?

Dr. Gilman: Yeah, this is a problem with any kind of commercialization. You've seen it with the tobacco industry, you've seen it with the alcohol industry. When you're trying to commercialize a product, you're trying to sell it, and you will get competition for the one that can get you the highest, the one that can be the purest, where it's not necessarily mom-and-pop stores that are growing plants anymore. These can be highly sophisticated techniques to get the most potent cannabis possible.

This Isn't About Taking People's Rights Away


Mark: Everyone is in such a rush to legalize, because they want the money. They're not thinking about the longterm impacts. And this isn't about taking people's rights away, if they want to grow and consume cannabis. This is about one component of a growing industry that poses a threat to everyone's wellbeing.

Kristen: With chronic THC exposure, neuron connections involved in memory are gradually lost. Brain imaging studies show that regular THC users have smaller hippocampi. The hippocampus is involved in forming, storing, and processing memory.

There's also been research done on IQ levels. Most people gain IQ points from middle school, then to high school, and then into adulthood, but these individuals who used cannabis regularly did not. They went the other direction, up to an eight point IQ drop over that period of time, and never gained it back. Those who use cannabis regularly in adolescence are less likely to finish university, and they're more likely to struggle with careers and significant job interruption.

The Epigenetic Effects of Marijuana That Can Be Passed On to Children


Could you outline some of the epigenetic effects of marijuana?

Dr. Hurd: Epigenetics is the process by which there are marks that are put on our DNA that changes how genes are turned on and off. So, you inherit the DNA sequence from your parents and that can't change. However, the conformation of your DNA — that is, the structure of your DNA — can change by marks that are a response to the environment. Whatever different types of environment that are significant enough puts a mark on the DNA that's maintained for a long time. It changes how your genes are turned on and off.

And we have seen that THC has very specific effects in how it puts [epigenetic] tags onto the DNA, or takes off certain epigenetic marks from the DNA that would control the regulation of certain genes. Where those genes are, the functional relevance of those genes are, of course, important. For example, we see epigenetic differences in the cortex, especially the prefrontal cortex — important for decision making, goal-directed behaviour, and so on. Epigenetic modifications there are highly related to functional synaptic plasticity — so the actual functional ways in which [brain] cells communicate with each other.

The epigenetic mechanisms are definitely significantly altered and they're altered for a very long time. That's how epigenetic mechanisms allow for longterm perturbation of DNA, where you don't need the change in the DNA sequence. Epigenetic marks allow for those longterm effects, so that's why you can see developmental effects [of marijuana] lasting into adulthood.

Kristen: Have you also seen those effects lasting into further generations?

Dr. Hurd: Yes. We've been studying the effects of prenatal and adolescent THC exposure, and wanted to see whether the effects we were seeing into adulthood, whether or not they might even persist into the next generation. And I actually didn't think that they would. It was just to cross that out as a potential. Indeed we see that — in the next generation and further generations — that, for example, in adolescent exposure to THC, you can see impacts on behaviour and on epigenetic marks in the brains of their offspring and future generations.

It's really fascinating and has taken us down a new path of research, that definitely we've seen these cross-generational effects of marijuana — or at least I should say of THC. We've studied other cannabinoids and we looked at transgenerational effects of, for example, cannabidiol, CBD. We have looked at cannabidiol in regard to vulnerability for drug intake and, in contrast to THC, we see that CBD actually inhibits heroin-seeking behaviour.

Having More CBD Would Be Beneficial


Kristen: In theory, would some of the problems go away if cannabis products could increase the levels of CBD?

Dr. Hurd: That's something that needs to be tested, but at least for some behaviours and some vulnerabilities that we see associated with THC, indeed having more CBD would be beneficial. Or having mainly CBD would be beneficial.

And we've also began studies in human heroin-dependent people and we see that CBD, just like in our animal models, does decrease craving. So it's a very important cannabinoid, and it just emphasizes the complexity of marijuana and, in terms of medical marijuana, that we have to be very careful about what we're talking about when we are making these very broad statements. It's critical to have research to understand what components of the marijuana plant might have detrimental effects, and especially THC that's made to be 25 percent and, as I said, even 80 percent, as in dab. That on the brain is very detrimental.

But other cannabinoids, like cannabidiol, appear to have beneficial effects. Some of the studies in children with epilepsy have also shown cannabidiol to be beneficial for some people, and it is going to come down to be which particular groups of people might benefit from THC for perhaps some aspects of pain, cannabidiol also for pain and also for treating addiction. There's a lot that needs to be studied.

Ten Percent of Cannabis Users Develop Cannabis Addiction


Kristen: Dr. Gilman, how did you become interested in studying the effects of marijuana on the brain?

Dr. Jodi Gilman speaks on stage during Blunt Talk
Image: Bryan Bedder
Dr. Gilman: I became interested in studying the effects of drugs on the brain that are widely used, so I'm very interested in the effects of particularly alcohol and cannabis on the brain, because these are the two most commonly used substances outside of tobacco, and yet they do have potential for addiction among some people.

So some people will drink socially throughout their whole lives and will be totally fine, and some people will develop alcoholism, and the same is true for cannabis. There's sort of this myth out there that cannabis is not addictive, but the truth is almost 10 percent of people who do use cannabis will develop a cannabis addiction.

I'm very interested in understanding why some people become addicted while others don't, of the population who will try a substance initially.

Cannabis Use and Brain Changes


Kristen: Your recent research was focusing on the altered neural processing when it comes to peer influence in young adult marijuana users. Can you talk more about that?

Dr. Gilman: For decades we've known that one of the risk factors for substance use is susceptibility to peer influence. Peer influence is not always a bad thing; it depends on who your peers are. So your peers can encourage you to do more prosocial activities — they can encourage you to study more or play sports, but they can also encourage you to do things that are not advantageous, such as risky behaviours like drug use.

I wanted to see what was going on in the brain, so we designed an experiment where we had people in the MRI scanner and they were doing a social influence task, and we were looking at people who use marijuana recreationally and people who do not. And what we found was that, among the people who use marijuana, when they received peer influence — and it was an experimental design where they had imaginary peers that were giving them advice in the scanner — their reward centres of the brain showed higher activation than those who did not use cannabis, which we thought was interesting.

So perhaps being susceptible to peer influence could be considered a neural risk factor for substance use. There are risk factors for addiction, and we know about these risk factors, and they can be people coming from impoverished environments, people with a history of trauma, of maltreatment, and things like that. There are definite risk factors for developing addictions that are common to all drugs of abuse.

However, we cannot always predict who will become addicted to a drug and who cannot. There are plenty of people who don't have risk factors for addiction, but still will develop an addiction. So we're not very good at telling you, "You can use cannabis recreationally and you will never develop an addiction because you're from a good background."

We can't say that yet. There's a lot of biological mechanisms that we don't quite understand.

Kristen: I also read that you were a bit concerned about the way that the media depicted your 2014 research on cannabis use and brain changes.

Dr. Gilman: Yeah.

Kristen: It seemed that many articles did what they do well, and that's jump to conclusions that cannabis is directly causing the changes. Can you tell me if you're any closer to being able to make those causal claims?

Dr. Gilman: This is a problem with the media interpreting scientific results across the board, but when it comes to something that's highly politicized, like the legalization of marijuana, it's an even bigger problem, that there is a lot of sensationalism in the media. You see this with diet studies all the time, or cancer studies, that "This causes cancer!" and the truth is that the article found an association.

An association between cannabis use and structural changes in the brain does not mean that the cannabis is causing changes in the brain, but we can say there's a relationship between cannabis use and these brain changes. To really understand the causal nature, there's two ways to do it. One is with animal studies — so you can take a rat and you can expose a rat or a mouse to the THC, and you have another rat that's unexposed, and you can look at the differences between the two. And you can look at before they were exposed and after, and you can see changes.

In human studies, we can't really randomize people to use cannabis or not use cannabis, because it's unethical. You can do longitudinal studies where you can get people at age eight or nine or 10 before they would have the chance to start using cannabis, and you can follow them over time, and you can see who naturally ends up choosing to use cannabis and who doesn't. And you can look at these longitudinal scans, and there's a lot of studies out there that are doing this now. There's a big push by the National Institute on Drug Abuse to do a large longitudinal study of 10,000 middle school students, and follow them over 10 years. This study has recently been funded, but there are no results yet.

I would like to say that even that doesn't completely establish causation, because there could be something different about people that pre-exists the cannabis use. Let's say you have certain structures of the brain that aren't functioning at their best, and that could in some ways cause people to seek out addictive substances. Who knows. So, there are risk factors and there are consequences, and disentangling them is really hard.

The Mixed Messages About Medical and Recreational Marijuana


Mark: I'm not against legalization. There are known, proven medicinal benefits of cannabis, and I don't want that to get lost or done away with.

Dr. Gilman: I think there's some mixed messages about medical marijuana and recreational marijuana, and they tend to occur in one single conversation. What we know is that there may be beneficial elements to CBD in cannabis, and these CBDs need to be better studied to figure out to which disorders they might be beneficial for. But I think that just because they may be good for some people in certain conditions doesn't negate the fact that there can still be negative effects among people who don't have these disorders.

We've seen this with the opioid crisis. Opiates are medicine. They're medicine for people who are in pain, and they can work very well for some people, but they are very easily abused. I'm not comparing cannabis to opiates, in that we know that opiates are far more addictive and the rates of addiction are higher, but I hope we can take some of the lessons that we've learned from the opiate epidemic and not make the same mistakes with cannabis.

Kristen: It's interesting that people are talking about marijuana as if it can do no wrong, as if it's this great herb, but it's ironic I think that a lot of things that people are smoking and taking are these high THC products. They actually lack the CBD, which has most of the medicinal properties, if I'm understanding correctly.

Dr. Gilman: That's right. So the stories that you hear — there was a big special on, I forget what network, where they were talking about the wonders of medical marijuana for childhood epilepsy patients. Those were CBD oils. These kids weren't smoking joints and getting high. These were CBD oils. That's what I mean about how the conversation is getting tangled, and I think there should really be a distinction between a CBD oil and smoking a joint. It's just not the same thing.

Kristen: While we were talking it made me think of something. I think it was in Colorado, this young man a couple years ago, he was using high potency products — I think it was the dabbing wax that he was using. He ended up committing suicide, and before that he had had no problems with depression, and all of a sudden it seemed like, it correlated. He started dabbing, and then just sort of slipped into this really, really extreme depression. I'm wondering if you're seeing more of that?

Dr. Gilman: I think the thing to remember — and we don't want hysteria, we don't want to say cannabis caused this person to commit suicide — but I think the thing to remember is that these are psychoactive compounds. These are psychoactive compounds that affect the brain, and they will affect the brain in all different ways. And this person, it could have happened anyway, but he clearly had vulnerabilities that may have been exacerbated by high potency marijuana.

Marc Bullard
Image: 9news.com
Kristen: His name was Marc Bullard. He was 23 years old. In April 2016, he killed himself. In his diary he wrote about a deep depression that had come on rapidly. He also wrote about the fact that he felt he was dabbing too much.

According to Leafly, dabs are concentrated doses of cannabis that are made by extracting THC and other cannabinoids using a solvent like butane or carbon dioxide, resulting in sticky oils, also commonly referred to as wax, shatter, butter, and butane hash oil, or BHO. These dabs are heated on a hot surface, usually on a nail, and then inhaled through a dab rig. Smoking dabs as a method of consumption [of cannabis] has been around for at least a decade, but the advent of more advanced extraction methods have led to a flood of cannabis concentrates that have boosted dabbing's popularity.

And one of the frightening combinations I read about is that there's something called mook — it's the combination of tobacco and weed. Mook creates quite an intense high. This can lead to a very quick addiction. It's also led to seizures and just some really scary stuff.

Back to Marc Bullard.

His death certificate states the contributing factor of his death as the use of concentrated marijuana products. His autopsy report revealed very high levels of active THC. Before his suicide, he had not shown any signs of depression. His family had no idea.

Beware the Charlatans of the Cannabis Industry


Dr. Hurd, ideally what would you like to see happen in regards to cannabis regulation?

Dr. Hurd: That's a challenging question, because in a way — what's the saying? "The barn door is already open." The issue that I think that states that have not legalized yet, and for the federal government to consider when it does legalize the medicinal use of cannabinoids, is that it has to be regulated in terms of the dose, of the concentrations of THC that are used for recreational use. I think for medicinal purposes, research is needed to see what dose range will be effective for certain symptoms.

But for recreational use, just having extremely high concentrations of THC, I'm not sure I see beneficial effects there. Also regulations for the formulations — you see even children being able to get a hold of products that look like candy — I think that that's something that needs to be regulated more, for child protection.

I think that people should think about it. I think we're naive if we think that there's any panacea for marijuana or any drug, including pharmaceutical drugs. Every pharmaceutical drug goes through tests to see whether or not there are adverse effects, and there are always adverse effects, but that's why they're documented. And so your physician can know what dose to prescribe for particular symptoms and tell you what side effects to expect. I think we should have exactly the same type of information to be able to give to the public when it comes to cannabinoids.

Absolutely many will turn out, no doubt, to have important medicinal value that we need to inform physicians and inform the public about.

Kristen: I feel like the public is really being misled these days with the idea that marijuana is safer than alcohol and cigarettes, and any other drug.

Dr. Hurd: I don't know where people got the thought that marijuana is safer than alcohol and safer than nicotine. They're all the same. Just because nicotine and alcohol are legal substances does not mean they do not have detrimental effects.

I don't want us to be naive about the health risk that goes with all drugs. Every drug has a health risk. I want people to understand that you just have to know what the health risks are, you have to know why you're using a particular agent, and there's a huge difference between recreational use and medicinal use.

And I do think that marijuana and the cannabinoids could have medicinal value, and those studies need to be conducted in a way that people should not be able to just say that their product is medicinal unless they prove it. I think that they're deceiving the public when they just use this blanket statement of "medicinal marijuana". They have not proven that.

When people make it seem that there is nothing at all that marijuana does to you, that is a falsehood, because you wouldn't be smoking the weed if it didn't give some psychoactive component to your brain, for those taking it recreationally. For medicinal use, clinically no one will approve a smoking route of administration, so it is about having the right formulations that can be used clinically to help the thousands of people I think can benefit from medicinal cannabinoids.

I just want people to be as diligent with investigating marijuana as they are for any drug. And any company that tries to sell them the snake oil that, "This will cure everything," then you know something is wrong, because no drug exists that can cure everything. None. Before you put something in your body, also know that there are a lot of people selling cannabidiol online, where the product is not safe, because it has pesticides, it's not even the concentration of THC that they're trying to sell. So know that there are a number of people trying to use the public today who is a little bit enamoured — we are a little enamoured with the prospect of marijuana — and they're charlatans.

You really want to make sure that you investigate the companies and who is really producing a product that is of medicinal value.

People Are Going to Experiment, Abstinence Education Doesn't Work


Kristen: If you had a message for all American teenagers regarding marijuana use, what would it be?

Dr. Gilman: I think that the conversation about cannabis use should be similar to the conversation about sex education. Abstinence only education doesn't work. We know that people are going to have sex, so we encourage them to do it as safely as possible.

So when it comes to cannabis, I mean "Just say no" doesn't work. People are going to experiment, people are going to try things, but we know that there are certain things that lead to negative outcomes. One is the frequency of use, so people who use more frequently have more adverse outcomes. Daily users will have the worst outcomes, generally. The other risk factor is potency, so if you're going to use a product — a low THC product is not going to have the adverse effects that a high THC product would have.

And then finally, something that's really interesting is that there's a lot of evidence that the age at which you use is very important in the chance of having an adverse outcome. So I would say wait, if you can. Wait to use cannabis until your brain has already undergone a vulnerable period of development in adolescence.

There's been a lot of research looking at users before the age of 16 versus after the age of 16, and the ones who use [cannabis] before the age of 16 have worse outcomes. However, there's nothing magic about 16. I think the brain's developing up to the age of 21 or 26 or 30. If you can wait longer, then wait longer. I don't necessarily see a pressing need to use cannabis. People like to experiment and people are always going to experiment, but if they can wait longer they'll make more responsible decisions, and their brain won't be in as vulnerable of a state.

The Pseudo-Medicalization of Marijuana Puts Babies and Children At Risk


Kristen: One individual that Mark Robinson really wanted me to speak with was Dr. Steven Simerville. Dr. Simerville is incredibly busy — so much so that I wasn't able to set up an interview with him in time for the release of this episode.

Dr. Simerville is a doctor of pediatrics at St. Mary-Corwin Medical Center in Pueblo, Colorado. In a presentation he gave in October 2016, he stated that seven to 10 percent of babies are being born every month testing positive for THC. He stated information from the 1970s and what they knew about THC in babies back then. It was associated with decreased school performance and difficulties with spatial reasoning, problem-solving, and short-term memory. In the 1970s, we already knew that these children were less likely to finish high school, and they were more likely to experience academic underperformance.

He says that what we do know now is that teenagers who smoke marijuana acquire the same difficulties. Babies who are exposed to THC in the womb have a high chance of preventable brain injury, according to Dr. Simerville. He asked the question, "Why are mothers smoking while pregnant? Why are they using cannabis in the first place?" Dr. Simerville points to the pseudo-medicalization of marijuana as part of cannabis marketing [as the culprit].

Mark: You know, I'm just out here looking at this — it's like watching the train wreck in slow motion. You know what's going to happen, you know bad things are going to happen from this. You don't want to sound like Chicken Little. But do they really know the impact?

Anyone who's under the age of 30, or have family members or have kids, they're going to be exposed to this with regularity. They just need to know what they're doing to themselves.

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You can listen to this interview at Humans of Earth on SoundCloud.

by Kristen Hovet

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