What Do I Need to Know about Marijuana?: Recent Episodes

National Families in Action

This is a podcast series produced by National Families in Action which conducted interviews with members of our Science Advisory Board.

Key Points

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

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

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

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio.

Key Points

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

Next Up? Dr. Huestes on Israel’s Experience & Advice for Researchers

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

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

Next Up? Dr. Compton on More on Executive Function: What is the ABCD Study?

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes.

Key Points

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

Next Up? Dr. Huestis on Marijuana Edibles

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

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

Next Up? Dr. Vandrey on Marijuana Edibles, CBD & What is Synthesis?

Mahmoud A. Elsohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse.

Key Points

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

Next Up? Dr. Huestis on How Marijuana Affects Kids

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of National Families in Action and Smart Approaches to Marijuana. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

Occasional user needs lower amount of THC to get high
Chronic frequent user needs quite a bit more to get the same high
Some evidence showing cannabis can change the proteins that surround your DNA and determine what genes are going to reproduce.

Next Up? Dr. ElSohly on Is Marijuana the Same as Epidiolex?

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio.

Key Points

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

Next Up? Dr. Huestis on Marijuana Tolerance

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes.

Key Points

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

Next Up? Dr. Compton on Predicting Future Marijuana Problems

Michael Kuhar, PhD, chairs National Families in Action’s Science Advisory Board and recruited the scientists who serve on it. He is Candler Professor of Neuropharmacology at Emory University. Among many things, Dr. Kuhar discovered the mechanism by which cocaine causes addiction. He wrote The Addicted Brain and teaches an online Coursera course of the same name, which at any given time is visited by some 300,000 people.

Key Points

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

Next Up? Dr. Vandrey on Can States Regulate Medical Marijuana Like FDA Can?

Mahmoud Elsohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse.

Key Points

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

Next Up? Dr. Kuhar on Understanding Marijuana Studies

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes.

Key Points

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

Next Up? Dr. ElSohly on Can Marijuana Cure Brain Cancer?

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio.

Key Points

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

Next Up? Dr. Vandrey on Marijuana and Opioids

Dr. Mahmoud Elsohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse.

Key Points

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

Next Up? Dr. Compton on What are Epidiolex, Marinol, Cesamet, and Syndros?

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

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

Next Up? Dr. ElSohly on Does Marijuana Reduce Opioid Use, Deaths?

Michael Kuhar, PhD, chairs National Families in Action’s Science Advisory Board and recruited the scientists who serve on it. He is Candler Professor of Neuropharmacology at Emory University. Among many things, Dr. Kuhar discovered the mechanism by which cocaine causes addiction. He wrote The Addicted Brain and teaches an online Coursera course of the same name, which at any given time is visited by some 300,000 people.

Key Points

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

Next Up? Dr. Huestis on Chronic, Frequent Marijuana Use

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes.

Key Points

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

Next Up? Dr. Kuhar on How Marijuana Works in the Brain

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio.

Key Points

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

Next Up: Dr. Vandrey on What Does Marijuana Do to My Brain

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

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

Next Up: Dr. Compton on If Marijuana is Medicine, How Can It Hurt Me?

Mahmoud A. ElSohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project, which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse.

Key Points

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

Next Up: Dr. Huestis on More on Executive Function

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

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

Next Up: Dr. ElSohly on What's Involved in Growing Research-Grade Marijuana

Michael Kuhar, PhD, chairs National Families in Action’s Science Advisory Board and recruited the scientists who serve on it. He is Candler Professor of Neuropharmacology at Emory University. Among many things, Dr. Kuhar discovered the mechanism by which cocaine causes addiction. He wrote The Addicted Brain and teaches an online Coursera course of the same name, which has been visited by some 300,000 people.

Key Points

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

Next Up: Dr. Huestis on Safe and Effective Medicines

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa. Here she explains how other nations do a better job of ensuring road safety than the US.

Key Points

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

Next Up: Dr. Kuhar on Medical Marijuana

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse, but remains highly active in the field. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances.

Key Points

US is not prepared for driving with marijuana on board. Huge issue and huge problem.
In occasional users, 74% of THC comes out of the body in 30 minutes, 90% in 1.4 hours. Average time to get drivers’ blood drawn is 1.4 to 4 hours.
Many states have zero tolerance levels such as 1 or 2 nanograms per milliliter.
Establish impairment first, then take the biological sample.
A-Ride Program (NHTSA) trains every police officer to do the field sobriety test.
Also can establish impairment via witnesses.

Next Up: Dr. Huestis on How Other Nations Ensure Road Safety

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse, but she remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Board of National Families in Action. Here she relates what she and her team learned from studying how marijuana affects driving.

Key Points

National Advanced Driving Simulator
Cannabis affects critical tracking
Speeding is number-1 reason marijuana-impaired drivers are stopped
Drug Recognition Experts (DREs)

Next Up: Dr. Huestis on State Regulations to Ensure Road Safety