(upbeat music) - Welcome to Science Pub, a monthly series exploring the fascinating scientific world around us.

I'm your host, Nancy Coddington, Director of Science Content for WSKG Public Media.

This season of Science Pub, we have a great lineup of speakers and topics ranging from forensic genealogy to exploring the science behind love and relationships.

Tonight's talk is cannabis and women's health featuring Dr. Jan Roberts.

With rising rates of women using cannabis to treat medical conditions, it begs the question, is cannabis a legitimate treatment for women's health issues, or is it a medical trend?

Tonight, Dr. Jan Roberts, a licensed clinical social worker, educator, and entrepreneur will discuss the risks and benefits of cannabis-based medications for treatments of conditions such as menopause, fibroids, and endometriosis.

Dr. Roberts will discuss the science behind the endocannabinoid system and how its potential can be harnessed to treat common medical issues facing women today.

We're also exploring the risks and rewards behind this brief frontier of plant medicine.

Jan Roberts is a clinician and entrepreneur based in New York City.

She is the founder of the Cannabinoid Institute and teaches at NYU Silver School of Social Work, where she also serves as the faculty advisor for NYU's CannaHealth Student Group.

Additionally, Dr. Roberts is the founder of the Center for Empowering Women, an integrated clinical practice dedicated to helping women of all ages live their best lives through mind and body approaches.

On top of her clinical work, Dr. Roberts teaches physicians all over the globe about cannabis, the endocannabinoid system, and how to incorporate holistic models of healing into patient treatment plans.

Welcome, Dr. Roberts.

- Thank you so much, Nancy, for having me tonight.

- We are so excited that you are here tonight, and I'm really interested in our topic that you're gonna be talking about.

Before we dive in and get started, Dr. Roberts, what first attracted you towards women's health and cannabis?

- Well, you know, it really started from my own journey.

Most of us who are in this space, especially as clinicians, we have heard anecdotal evidence, but especially as a clinician that works with addictions and trauma, I had always been trained that cannabis was a pathological substance and a substance that could only create problems for people.

However, many years ago, I had had shingles and it was in my face and in my eye and a friend of mine recommended that I try an edible.

And at the time, my physician had actually prescribed some medication for me to handle the nerve pain.

I was in a great deal of pain, couldn't work, couldn't walk without pain.

And after trying the edible, I was kind of overwhelmed.

I could work, I could think, I could walk.

My recovery just seemed to get a lot better, and it really inspired this journey for me to understand the science, because at that time, I thought all of the legalization efforts towards medical cannabis were really geared towards ending the prohibition on cannabis.

Little did I really understand what the scientific benefit was, and that essentially just started this huge journey into cannabinoids and cannabis-based medicines and really social justice issues.

And when we talk about diversity and inclusion, we really need to be talking about women's health.

So as a clinician and as a practice owner, it really just sparked a huge interest for me in this space.

- Yeah.

I really like how your own journey has kind of led you into this.

How long have you been working in this area?

- It's been about eight years.

Actually, it's funny because in my field, there was a lot of hesitation for me personally to get into this because the last thing I would ever wanna do would be to encourage something or to educate about something that could create problems for people.

So for me, my approach has always been about the science, always been about objectivity, and also really trying to teach people how to use substances in a way that they can self-regulate and not create problems in their lives.

And so as the sturdiest kind of started, I've done a lot of research at NYU, looking at clinicians' knowledge and attitudes around cannabis and around medical cannabis.

I've been very fortunate in my career to teach physicians all over the world and South America, Central America, here in North America, Asia, just very fortunate for the experiences that I've had.

And I noticed that there's this huge gap between what's happening in clinical research and what patients are being taught and what patients kind of the advice out there.

And having been in the cannabis space, my concern is that we need to have products that are really based on science and not based on just anecdotes.

So there are a lot of great researchers out there who are really trying to kind of explore how cannabis, the endocannabinoid system really impact human functioning.

- Oh, this is great.

So let's go ahead.

Let's get into this.

If you wanna go ahead and share your screen and we can start right in.

- Well, as you know, I founded with a few business partners, The Cannabinoid Institute, and we have set up educational programs for physicians, nurses, pharmacists, and mental health clinicians.

And so I just wanna do a little shout out because for us, it's really about helping clinicians to understand what the science is saying, because frankly, there's a lot of bad clinical practices out there.

My own patients have experienced feeling stigmatized by their clinicians.

My patients have experienced clinicians making medical decisions based on not having the science and the most recent data out there, and that's something that's so important in this space.

So tonight, what we're gonna talk about is really about the underlying mechanisms that help cannabis work.

We're gonna talk about the endocannabinoid system and then we're gonna kind of get into what cannabis is and then the different women's health conditions.

I'll kind of go through some of that and how cannabis and the endocannabinoid system can actually impact that.

We'll also get into some, we'll talk a little bit about research and the constraints there, as well as dosing and the methods of consumption, and of course the risk.

You can't talk about cannabis without talking about the risk versus rewards.

And so hopefully, tonight, the audience will walk away with a lot more knowledge.

So just to kind of start here.

When we talk about cannabis and women's health, it's so important for us to really kind of pay attention to what the industry and what healthcare has looked at traditionally.

So Forbes Magazine actually said that about 4% of all funding for product development and research worldwide actually goes towards women's health conditions.

And for us being 50 to 51% of the population, it's a little scary.

And so we need to recognize that there is this inherent bias in research about studying sex-related differences.

But this is a very important piece, because as we go forward with this conversation tonight, you'll understand why that matters because men and women tend to have very different kinds of experiences with the endocannabinoid system.

So some sex differences do exist.

Another thing is that we find that when women talk about their experiences, oftentimes, and this is the sociologist coming out in me, oftentimes, they feel very negated by the healthcare system.

And so often I know in my past practice and current practice is that they're often pathologized for talking about things like pain or different conditions that they have.

And it's unfortunate but it's fairly common that patients often feel stigmatized by their providers or feel like they're being told it's in their head if they express certain kinds of problems that they're experiencing.

So there has been this tendency to negate women's experiences, to psychosomaticize women's experiences, and this is where as the research is unfolding around our physiology and we'll talk more about this later, it really sets up this interesting kind of opportunity for us to really start to be more inclusive of women in healthcare.

In addition, cannabis has been used for thousands of years, and this is a product, I call it a product, it's a plant essentially that has been used throughout Asia, the US, South America.

It's had this huge kind of migration across the world and has actually demonstrated health reasons.

Here in the US, it was part of the US pharmacopeia before it was outlawed.

And so this has been a medicine that has been used for centuries to treat issues such as pain, such as menstrual cramps, we've seen it being used to rheumatism, you know, all sorts of health conditions it's been used.

And while I don't like to always rely on anecdotal evidence, there has to be something to it if people have used this continually for years.

And in fact, it's fascinating, even now, the four reasons that people, whether you're in a medical state or an adult rec state, which is adult recreational state, you know, the reasons that people use cannabis are really around sleep, reducing anxiety, controlling pain, and reducing stress.

So for me as a clinician, those are therapeutic reasons.

And so there is some validity to kind of this medicine being used in a way.

Unfortunately, due to propaganda, due to a whole matter of issues that I love to talk about and I don't necessarily have to talk about it now, but we've come to really stigmatize this plant to be something that it really isn't intended to be.

So why does cannabis work?

Well, tonight, I want you to understand something.

Cannabis works only because of this one physiological system that we have in our bodies.

And this system is in all animals.

It's in humans, the only animals it's not in are insects, but it's called the endocannabinoid system.

I know it's a really long name, but the ECS, I'll call it the ECS, it's essentially a system that's within all of us that's comprised of receptors, ligans, enzymes, and all of these things kind of work together and they're completely independent of the plan.

It is a physiological system that exists in all of us.

And essentially what it does is helps regulate our functions and pretty much regulates most functions that we all have.

We have these two receptors that exist in all of us.

So we have what we call the CB1 receptor and the CB2 receptor.

And the CB1 receptors are primarily found in the brain and the central nervous system, and I'll get into how phytocannabinoids impact this in a moment, but we also have CB2 receptors.

So the CB1 receptors are these receptors that really kind of help regulate our neuro-transmitters, they help regulate a lot of physical functions, even the sex hormones that are released.

They really do kind of help regulate people's physiology.

So think of the human being and the endocannabinoid system kind of as a microcosm of that.

It is always searching to kind of create homeostasis in the body.

So what does that mean?

Its job is to kind of repair itself so that we can all function healthily.

And so it's constantly working by producing endocannabinoids, our body is.

Our endogenous cannabinoids is what they're called, and those endogenous cannabinoids can actually attach to the receptors.

So we have CB1 receptors that really primarily focus on the brain.

We have CB2 receptors that really work a lot with our immune system.

They work to reduce inflammation and they're found throughout our body as well.

What's interesting here though, is that we do know, like I said earlier, that there are sex differences among our receptors.

So for example, males tend to have more receptors, CB1 receptors in the cortex of the brain.

And we also know, especially when it comes to women's health, that the uterus is the organ that has more receptors than any other organ in the body.

And so there's something to be said about these receptors.

There is this chemical reaction that takes place that brings people into homeostasis or into health, and the ECS is really that function that allows that.

But when we talk about the ECS, it's important to understand that there are specific roles around this endocannabinoid system.

And the main functions of the endocannabinoid system are to, we call it like eat, sleep, relax, protect, and forget.

So what does that mean?

Well, we know that for eating, we see that the ECS has a direct impact on appetite.

So there used to be this joke about people who smoked a lot of cannabis, that they tended to just sit on the couch and eat a lot of Doritos or whatever they eat.

But ironically, they found that and through research that they actually tend to be, heavy cannabis users tend to be more lean.

Now I am not saying to use it as a diet.

I'm just saying that there is some kind of role that the ECS has, an appetite, metabolism, and even energy balance.

So the ECS is really impacting the way that we kind of want to eat and the functions that go along with that.

In addition, we know that the ECS is indicated with sleep functions.

It actually helps us keep our circadian rhythm.

It influences REM sleep in different stages of sleep.

We know that it also promotes the relaxation.

And so it mitigates kind of our mood, our physiology to help the organism to kind of relax itself.

In addition, it's a protectant.

The ECS functions as a neuroprotectant.

It actually helps with immune functioning.

This is why for example, CBD is kind of known to impact the immune system in a positive way.

It's cytoprotective.

The ECS is responsible for again, this metabolic regulation, but also neuroprotection.

And then it's indicated in forgetting as well.

The ECS is absolutely involved in how our brain processes information and memory functioning.

And so it allows you to have memory extinction.

And the reason that this is so important for us to understand is that when we start to talk about how cannabis as comprised of many different cannabinoids, that why they actually, this plant actually works for so many different kinds of issues.

- Dr. Roberts, I just wanna ask a quick question before you move on.

So you had talked about how males, they have more endocannabinoid receptors in the cortex of their brain versus women who have more in their uterus.

Does that make a difference with the information that you're sharing right now?

Do men tend to have more lean towards more eating, more food, or does it relax them more?

And women might lean a little bit more towards something else, as far as the role that you were just showing?

- That's a great question.

So what we know really isn't what we're looking for, and this is such an emerging field.

You need to understand that the ECS was actually kind of discovered in the late 1980s, and it wasn't, like the receptors weren't even used in research until the 1990s.

The reason this is so important is that while we all have an ECS, there are certain things that actually impact whether or not our endocannabinoid system is functioning properly, stress being the number one reason that disregulates the endocannabinoid system.

So I say that because we need to understand that the endocannabinoid system, our goal here is to have healthy functioning, right?

Unfortunately, we know that in our modern times with all sorts of stress that we all experience, and especially like even during the pandemic, there is this impact on our functioning of the endocannabinoid system.

And so we call it a dysregulated endocannabinoid system, and that's where we start to see health conditions pop up.

So for example, neurodegenerative disorders like Parkinson's, Alzheimer's, those have actually been viewed through the lens of the ECS, and they found that typically, people are experiencing these problems have kind of dysregulated endocannabinoid systems.

Now the endocannabinoid system is constantly fluctuating.

Our chemicals are constantly fluctuating throughout our body.

And there was some incredible research from Matt Hill in Canada, and I believe it was Mount Sinai here, looking at first responders from 911.

And they found that an endocannabinoid that is naturally produced in our bodies, so there are two types.

One is called 2-AG and one is called anandamide.

Both of those are naturally occurring endocannabinoids that exist, and they found that people who had PTSD actually had an impact on their 2-AG levels.

So they found that their 2-AG levels were actually, if they were elevated, they were actually protecting people from developing PTSD.

And so it's a really fascinating field 'cause we're starting to see research focus on conditions such as mood disorders, such as physiological conditions like we're gonna talk about tonight, and they're focusing on these things now from the level of the endocannabinoid system.

And what that means is that now we're getting pharmaceuticals getting into the game who are really interested in targeting the ECS for potential remediation to kind of keep people from developing these conditions.

- Great.

That's really fascinating.

So what happens with a person?

So let's say a woman who has had a hysterectomy?

So she has a lot of an organ, right, that holds the most receptor.

- Oh yes.

That is the magic question that I ask all the time.

That absolutely is, especially as it's so common.

And frankly, the research hasn't caught up here, and this is one of the reasons why this topic is so important because we don't have the research out there focusing on women's health conditions and looking at the ECS as a novel target to treat these conditions.

And so most of the conditions we're gonna talk about tonight really are about women's reproductives, you know, their conditions, they're about hormone influence conditions that we have.

And so when we start to consider, well, whether or not someone should get a hysterectomy, what is the effect of her having this organ that basically has most of the receptors in her body removed and the science isn't there yet.

I've spoken to researchers about this because this is a passionate area of mine, and I'm hopeful that we can start forcing the conversation and start really encouraging, and hopefully, with diversity, equity, and inclusion initiatives, we can start to see more funding going towards women health, women's health issues.

- Yeah, I would certainly hope so because it's really disturbing that only 4% of the worldwide and research goes towards women's health.

- And the reason that I find this, so I'm so passionate about this, Nancy, is that if we don't start having these conversations, we're gonna keep being in the dark about this.

And I'm someone who's had a hysterectomy and I know the effects that that's had on me.

And if we can actually use science to practice better medicine, we need to.

And so we need to be having these conversations.

I'm always struck by physicians who really don't understand the physiology behind cannabis-based medicines.

And the reason I say that is, if physicians really do not understand this and understand what cannabis is and what it is not, because there's a lot of information out there that is not supported by the science, then we're gonna keep having physicians making poor medical decisions for consumers.

- Yeah, and that's really, that's very, very important.

- It is.

Thanks.

So as we get into kind of some of these other issues, if we can, yeah, perfect.

You know, I kind of alluded to this earlier.

So when we talk about cannabinoids, I wanna make sure that we have the right nomenclature.

So all of us, naturally, we produce these endocannabinoids.

And so endocannabinoids are these molecules that attach to the receptors and help our bodies function.

So back to those areas where the endocannabinoid system impacts us, if we have a dysregulated or if for some reason, our stress levels are so high and we're not naturally producing these endocannabinoids, the question becomes, can we supplement for these cannabinoids?

And that's where cannabis comes in.

So cannabis is a phytocannabinoid.

I'll talk a little bit more about the cannabis plant in the moment, but I just wanted to let you all know, this is why cannabis works on so many different conditions.

It's because it is a phytocannabinoid.

And we also have synthetic cannabinoids that are created in the lab that really aren't based on the plant.

They are synthetic molecules.

They have been used.

Unfortunately, they don't tend to show the same type of effect as a full spectrum phytocannabinoid does.

And so that's very important here because not all cannabinoids are created equally.

And when you look at phytocannabinoids versus synthetic cannabinoids, the research continually shows that phytocannabinoids are actually safer.

They have less risks to the person using it.

They tend to actually provide better benefit to the patient using it.

And so it's important for consumers to understand that if it's a synthetic cannabinoid, so like, think about K2 or spice.

Those are examples of synthetic cannabinoids.

And if you know what the history of those two substances are, it can absolutely create psychosis.

I've seen that with my own patients.

It can create a whole host of problems.

So it seems that the more natural way is better if you need to supplement yourself.

So this comes up to why is this so important in women's health?

Well, again, like I said, not a lot of research has been put into women's health, and we know that there are some sex differences as it relates to cannabinoid receptors.

We also know that stress levels impact our ability to create new endogenous cannabinoids.

And so it's important for us to really have this understanding.

So we haven't done a lot of research on the impact on women, but we're starting to see a little tide on that.

But we see, like you had mentioned earlier that we have these high concentrations of cannabinoids of endocannabinoids and receptors that are in the uterus and the women's reproductive system.

So what does that mean?

Well, that means basically, any condition that is impacted by our sex hormones, whether it's estrogen or another sex hormone, it's going to be affected by your endocannabinoid system.

We also know that the endocannabinoid system and these cannabinoids that are created and our expression of the receptors, they fluctuate throughout the entire menstrual cycle of a female.

And the reason that's important is that means it has impact on reproduction, it has impact on someone's ability to menstruate, and some of these other conditions that are associated with women of either childbearing or post child-bearing years, it's impacted as well.

And so when I talk about the endocannabinoid system, I'm looking at this from a whole life cycle.

And one of the things that's very important for me is that we talk about women throughout their life cycle.

We talk about starting with puberty and ending with menopause.

Well, women go on after menopause as well.

And so it's important for us to really be inclusive of women of all ages as we talk about the endocannabinoid system and cannabis.

In fact, we also know that one of the largest populations of people using cannabis right now are actually older women.

And it's a fascinating kind of it's just it's absolutely fascinating to me.

So right now, I kind of wanted to talk a little bit about menopause, you know?

So can cannabis help with menopause?

And the absolute answer is yes.

When we think about menopause, we think about a time, and I like the term, frankly, reverse puberty or puberty in reverse because essentially, what we're seeing are hormones that are naturally shifting our ability to ovulate ends, our ability to have children ends at this time, and it's a really interesting transition for a lot of women.

Many women experience pain during sex and that's related to the vaginal tissue thinning out and lack of lubrication.

Many of us have hot flashes.

In fact, I'm having one right now as we speak, you know?

And so they have issues with insomnia, brain fog, mood instability, decreased libido, all of these fun things that we experience.

The reason that this is so important to talk about is that we know that women are absolutely using this plant.

Like I said, there are phytocannabinoids in the cannabis plant.

Those phytocannabinoids, in fact, there are over 120 phytocannabinoids that we find in the plant.

There are also other molecules like terpenes, which are the fragrances that you might smell from the plant, and each terpene has a differing effect on one's physiology.

And so these different cannabinoids attach to different receptors.

So for example, THC is a phytocannabinoid in the cannabis plant that is used to treat pain.

It works really well.

It attaches to the CB1 receptor that's found in the brain and the central nervous system.

It absolutely while most people think of it as the chemical that gets you high in an intoxicated shoe, which it does, it doesn't necessarily mean that you have to take a dosage that would actually give you that effect.

But we know that many people use THC to control pain.

In addition, we also know that THCs impacts hot flashes as well.

And like I said, when you get into the functions of the endocannabinoid system, when we're talking about hormone regulation, when we're talking about pain, when we're talking about metabolism, all of these things are playing out for women in their menopause years.

And so we know that insomnia is, like I said earlier, that's one of the reasons, one of the top four reasons why people use cannabis-based products.

In addition, mood instability, we know that people's moods are impacted through cannabinoids.

So for example, THC is often viewed as kind of an antidepressant.

I'm not saying it's an antidepressant medication.

We just know that it has that kind of effect in animal studies.

We know that even humans report that they actually feel more activated when they use THC.

We also know that CBD reduces inflammation as well, and that attaches to the CB2 receptors.

So when we're getting into mood, when we're getting into decrease libido, we know that these cannabinoids influence that.

There's been a lot of research looking at sexual pleasure and cannabis, and I'll talk a little bit about that later, and brain fog as well.

While cannabis absolutely can impact memory if it's used consistently and at a high dosage, when we're talking about medical cannabis use, it's not necessarily to get to a point of intoxication.

Many people use it at micro doses as well.

So we know that there was this really interesting study that came out of the VA, actually, looking at former veterans, and it was done in 2019, I believe, and they looked at how many women actually used cannabis.

And what they found was about half the women who reported having menopausal symptoms were actually using cannabis to work with their menopause.

I know for most women, they're referred if they have a lot of symptoms, they're either treated with SSRIs for the mood component or they might be given hormone replacement therapy.

And so oftentimes, not all women can tolerate those medications.

I know for me, my physician really didn't want me to be on hormone replacement therapy.

My sister had had breast cancer.

So that was a huge issue.

And so we know that these cannabinoids start to kind of influence women in a way to kind of help regulate.

So this research found that half the women reported using cannabis successfully to control some of these problems.

We know that out of that study, and this was in Northern California, that 27% used it for insomnia and 69% used it for vaginal issues as well.

And so 54% of the respondents actually used it for their hot flashes.

So we're seeing this trend, especially with the acceptance of cannabis, to be able to use these types of products, and I'll get in into a moment about the different types of products and why you would use one over the other.

But what we're finding is that this one plant is starting to take the place of multiple medications that would traditionally be used for that.

- Dr. Roberts, before we move on, I do have a couple of questions.

So if you had a partial hysterectomy where you have kept your ovaries, does cannabis help with some of these symptoms that you might be and experiencing?

- Absolutely.

Absolutely.

Remember menopause is really about the hormone changes that are taking place.

So even with or without the uterus, you're so going through hormonal shifts.

So there are a lot of different systems really trying to kind of re-regulate themselves through menopause.

And so it's not so much if the uterus is intact, it's just really, and it's not even, I hate to say it, it's not even whether or not the ovaries are intact.

It's just how can we reduce these symptoms?

And so while there is very, very little research, in fact, almost none looking at menopause and the endocannabinoid system, we're really hoping that researchers will start targeting that.

We know that people are using cannabis, but if we could really look at the ECS's impact in this stage of life for women, we might be able to unlock some of the mysteries, but also to create interventions that are gonna be able to help women and reduce the risks of hormone replacement therapy or other issues that they might have.

- Yeah.

Thank you.

That led me kind of right in there.

So if you are not doing hormone replacement therapy, how would cannabis help relieve some of those issues?

You know, is there a science that has spoken to that?

- You bring up a great point.

Again, a lot of people really aren't looking at women's health issues, and for many reasons, research has been limited on human subjects.

So most of the research that's out there is primarily based on animal models.

And so again, we're not really rats in a cage, but we have this opportunity to learn from the animals what's going on.

What we do know is that we have a lot of self-reports from women who have gone through this, who have actually talked about how it's led to symptom reduction.

The problem is, is we don't have randomized control trials because cannabis is federally illegal.

That puts a huge stop on doing certain types of research projects.

It's very hard for researchers.

This is why research in other countries is actually proliferated, and the US has lagged behind because countries like Israel, Spain, you know, even I'm thinking even in Columbia, they were doing some research that you wouldn't be able to do here in the US.

Recently, they've just started talking about allowing research randomized control trials and that's the gold standard for any kind of clinical research involving humans.

They've just talked about literally this week about CBD and allowing that to become used.

And so we really have, unfortunately, a lot of constraints to doing great research to look at how this impacts humans.

And so it's concerning.

It absolutely is.

No physician in the US can actually prescribe cannabis.

I wanna be very clear about that.

It is illegal for any physician in the US right now to prescribe cannabis.

They can only recommend.

And even then there are concerns around licensure, et cetera.

I educate about cannabis.

I don't recommend just because we're talking about people's licenses.

And federally, it is still illegal.

And so there are huge constraints because of prohibition that impact our ability to do research and then couple that with the lack of funding for women's health issues.

We're lagging way behind.

- Yeah, so it sounds like with all of that, it really has diminished any research to have longterm effects, to know if there's any longterm effects of women using cannabis in this method.

- And it's such a new field.

Let's be real.

It's an incredible time to be in this space, because the science is changing daily.

And this is such a new field that we're just now understanding the role that cannabis has like in Parkinson's and neurodegenerative disorders.

There have been research looking at the endocannabinoid system and obesity.

There is really emerging research around many different types of conditions, including fibromyalgia, migraines, not just pain, but yes, definitely with pain.

But again, unfortunately, due to societal priorities, some people's societal priorities, women's health kind of gets further down on the list.

And especially when you get to older women's health, you're further down on the list.

- Yeah, absolutely.

How would you know if trials were taking place?

I mean, it would have to be federally approved before any kind of trials would be taking place, right?

- Absolutely.

Absolutely.

It always astonishes me that we're so much more supportive of trials for psychedelics than we are for cannabis.

I still don't quite understand that, and that's okay, I guess.

But the FDA, they are clearing houses that post all clinical trials.

Unfortunately, they're very limited.

Oftentimes, if there are clinical trials that might be with synthetic cannabinoids, but that's again, not really the same thing.

And so right now, you can go online, you can Google it, clinical trials, cannabis, and you're probably not gonna find too many.

There are some really great stuff looking at trauma and PTSD.

Like I said, Matt Hill at Canada, they did an incredible work looking at PTSD, memory extinction, and endogenous cannabinoids, and found that link there.

But we're talking about half the population tonight where a lot of funding and a lot of interest isn't there.

And unfortunately, what that's done and especially to a market where it's federally illegal, but you have each state with their own individual laws, if they do have laws on the books to protect cannabis, whether it's medical or recreational, every state has different requirements, different ways of manufacturing and growing the plant, producing the products.

You can't cross state lines.

If you have a medical card in one state, chances are you cannot go to another state and it won't be reciprocated.

And so we have these disparate laws out there that exists that really don't help the patient be able to access medicine in an appropriate way.

It wasn't frankly until like I said, my own personal experience, did I become really interested in this?

And it's funny because my family, they all thought I was crazy getting into this, but they've also come around to understand that this actually is very beneficial.

My own mother, who's 80 years old, used it after her hip surgery and wasn't intoxicated at all.

She just microdosed with CBD and THC and didn't have to take pain medication after her doctor, literally, I'm not lying when I say this, he prescribed her 60 OxyContin after her release from the hospital.

Not one did she have to take because we used, we microdosed or she microdosed and used a one-to-one and it helped tremendously.

And so that's the message we're trying to get out here, is that not all users abuse, and that cannabinoids, if they're used appropriately, really can impact health conditions in a great way.

- Yeah, absolutely.

Thank you.

And a couple more comments have come up.

So I just wanna just swing back on this again.

Without this being federally legal, it makes it very difficult, one for to have any federal money like National Science Foundation money come towards any kind of research, but also for big pharma companies to start looking at having research, investing that time and money.

I mean, is that correct?

- Well, actually, I'm gonna say a little note about that last point, and the reason is is they're getting into the game.

In the last month, there've been two pharma companies announcing purchase of large multi-state operators that they're really interested in looking and exploring the endocannabinoid system as a targeted point.

My concern, and this is what we start to see is that with pharmaceutical companies coming into the field, they tend to look more towards synthetic cannabinoids.

And frankly, when you look at how full spectrum plant medicine works, we see actually better outcomes.

And it's fascinating because within the cannabis plant, there's this thing called the entourage effect.

So I might be able to isolate THC.

I might be able to isolate CBD or CBN or CBG, all these other cannabinoids, but those cannabinoids together actually provide a totally different effect than they do separate.

And so there's this really unique phenomenon in cannabis medicine where we know that this entourage effect really is impactful.

This is why we see, especially with the elderly, a lot of people using this plant instead of the multiple medicines that they're on.

I know of assisted living facilities that have actually started to explore this for their patients and educate their patients around this or their residents around this because why would I wanna take a benzodiazepine to reduce my anxiety when A, you take it for two weeks and you can easily become physically addicted and dependent on it?

And if you miss a dose of a benzodiazepine, whether it's Klonopin, Ativan, Xanax, you run the risk of withdrawal and seizures and even possibly death.

It's highly addictive.

And so we see people wanting to be on a more natural regimen that's not gonna have the side effects that these prescribed pharmaceuticals do.

So when you get into issues like benzos, when you get into issues like pain, I know my own father, God bless him, he had rheumatoid arthritis and this is a medication that has been shown to actually, that cannabis has been shown to be a positive and reducing inflammation as well as pain.

And we know the ECS is involved in rheumatoid arthritis.

However, my father became dependent on opioids because that's what was prescribed to him years ago.

And unfortunately, he didn't live to see this part of my professional career 'cause I really feel like he would have benefited greatly from it, because when someone takes an opioid, it absolutely changes their brain chemistry where they really kind of become the shell of the person that they were before.

And so not only do you have these physiological issues that come up with opioid use.

If you could have a plant that doesn't really have that addictive component to it, doesn't affect your respiration, and can truly mitigate the pain and inflammation, it just seems like this one plant does so many things and it does it because of the different phytocannabinoids in it and the different receptors that they attach to and the functions of these receptors.

- Well, thank you.

I think you're gonna get into this, but there's some questions about dosing and THC and CBD.

So I think we can talk about that, right?

- Yeah, let's just talk all about that.

No, we can talk about it now, 'cause I think it's so important.

And let me just say this.

I talked about menopause.

I wanna talk real quickly before that, before we get into dosing, and before we get the methods of consumptions about these other conditions that exist, because I really think it's important that people understand.

So for example, we see it with vaginismus.

It's a condition where the vagina contracts and has a hard time with sexual intercourse.

Oftentimes, it's the result of trauma.

So you're talking about a condition that affects a significant, almost up to 20% of the population.

And this condition is so detrimental to people.

And what we found is that actually cannabis helps women who have this condition because it relaxes them naturally, and it can be used to help with creation or we call it dilation where they learn and are able to dilate the vagina because the vagina is essentially a muscle wall that contracts and doesn't allow penetration of anything, whether it's a tampon or a penis.

And so we know these kinds of conditions that exist are impacted by cannabis.

Endometriosis is one that's huge.

And this is where I get very concerned for women, because there are products out there that women are taking that are really geared towards treating pain and gynecological pain.

And the concern I have is that some of these products aren't based on science, and if we don't have science driving this as an industry, we're going to be in trouble.

And the reason I bring this up is that THC, for example, is a cannabinoid that while it's very effective with pain, it actually has been demonstrated to create scar tissue proliferation.

And if you have endometriosis, which is a condition of scar tissue in the fallopian tubes, the last thing you want to do is to jeopardize that and create more scar tissue growth.

So it's very important for the consumer to have really great education around this because unfortunately, the physicians aren't getting it.

And only 12% of medical schools actually teach about cannabis and teach about the endocannabinoid system.

So physicians are graduating, not really understanding the physiological functions that are driving this.

And so we need to make sure that women are not using products that absolutely could be creating more problems for themselves.

And so this is where the passion comes from.

And then when you get into other issues like menstrual cramps or vulvodynia, cannabis has been shown to impact that as well.

But I wanna get into product types, 'cause this is what is interesting here.

Most people, when they think about cannabis, they're thinking about smoking a joint or smoking flower, and that's not necessarily the case.

And again, not all use is abuse, and you can absolutely microdose cannabis, and that's really the most effective way, 'cause what we're looking at, this is a medication that if you take too little, you're not supplementing the endocannabinoid system, but if you take too much, you're actually potentially you could create more problems for yourself and still dysregulate yourself.

So what we're looking for, we call it the biphasic effect.

We want to find that right dose.

And how do you find the right dose?

And this is where it gets even more confusing because frankly, all of us metabolize certain things differently.

For example, I had my genetic testing done.

I metabolize CBD faster than anyone else, or then my husband, for example.

I can take a 25 milligram dose of CBD.

It reduces my anxiety, calm, you know, reduces and blocks cortisol production.

I get calmer.

My husband takes it.

He passes out and is asleep for eight hours because it's too much of a dose for him.

So the reason I say this is it's important to understand that dosing is really dependent on what your enzymes are and what your genetic makeup is.

So like everything else, unfortunately, we're moving towards more of a personalized medicine approach.

Cannabis should be looked at that as well.

We always want to start on the lowest dose possible to achieve the effect that you want.

We know that if you take too much of cannabis over a period of time, it's easier to become habituated to it.

We don't want that.

We all want to live our best lives with everything that we do.

So it's important to find that minimal dose that's going to be effective for you to treat your symptoms.

We also know that it's not just about flower.

So you can have inhaled dosing.

It can be from a flower, but it can also be from a pen.

There are incredible products out there that actually you can inhale these molecules without having to use a lighter, for example.

Also, another thing that's interesting are gynecological suppositories.

So if you have a pain condition, and there are states that they carry these products, and especially like for women who have endometriosis, or I don't wanna use endometriosis because of the issue around THC, but so for example, if they're having menstrual cramps.

Gynecological suppositories with THC are actually shown to be very effective in treating it.

And frankly, it's more localized.

So you get that effect in that specific area.

And so it does really create kind of an impact that's so much more impactful for consumers.

Additionally, there are creams that exist out there that you can use on your vulva.

So if you have something like vulvodynia where you have painful or pain in your vulva region that you can use these types of creams or personal lubricants that have cannabinoids in them as well.

I've heard of stories where people are using THC-infused personal lubrication and they report that their sex is so much more pleasurable than had they not used it.

And especially, when we get into, like, for example, menopause, women who are using it, they need lubrication if they have then vaginal tissue and have tearing and painful sex.

Well, if you can have that and use a cannabinoid that's actually gonna reduce any kind of pain you might have or increase pleasure and we absolutely know that sex is enhanced, a lot of women report enhanced sexuality when they use cannabinoids.

And so there are many different types.

There are capsules you can take.

In fact, there are powders you can put in drinks now.

There are beverages like in California and Colorado that are being sold with low-level cannabinoids in them, whether it's THC or CBD.

All of these things are really impactful.

And the reason I say this is that it's important again to find products that are actually going to speak with you.

If I inhale it, it's a totally different effect.

It's a fast effect, but it doesn't impact my body as much as if I ingest it.

If I ingest it through capsules, through tinctures, that way it absolutely will have a whole physiological reaction that will kind of reduce the pain and kind of help you relax.

The problem is, is that people often take too high of a dose.

So that's why I say, if you're inhaling, take a dose, wait 15 minutes, see how you feel, and if you're still in pain, inhale more.

And if you're in a state that has like a pharmacist, like New York does on staff, they're very helpful to give you the medical information that you need.

If you're using an ingestible, you absolutely want to try the lowest dose possible, wait about 45 minutes because it takes a long time for that to kick in.

But it also, when you have that kind of dosing, it also lasts a lot longer too.

So inhalation, fast-acting, shorter time span of effect.

Edibles or ingestion, it takes longer for it to effect, but it will last longer for it to take effect, but it will last longer in your system.

So method of consumption and dosing are two important things.

If you're older, we really wanna make sure that you don't take any too high of a dose because that can impact your ability, you know, your balance capabilities, et cetera.

And I work with the elderly population.

So I'm always trying to educate them around how they can use these products in the safest way possible.

- So Dr. Roberts, if somebody is, you know, something that they heard tonight was like, yes, I definitely am experiencing that.

I wanna try this.

What do you suggest?

Are there certain companies or I know we talked about some great products and then you did talk about starting with those doses and moving, start low and move forward.

How would I track that for example?

- Great.

So the first, the most important message I tell everyone is if you're in a state where you have legal access to cannabis, go through the legal system.

You will know exactly what you're getting and you will also know that it's been tested to make sure that it's safe for use.

If you buy illicit cannabis, you do not know if it has mold, if it's been grown with pesticides, you don't even know what the chemical compounds are in it.

And oftentimes, you might think you know, but you really don't know.

So for example, I know that there have been, we call it the illegal market or the illicit market where they will take products from other states that have been rejected and will sell them to consumers.

This is something.

Safety is at the heart of the work that I do.

So it's important for people to go through their legal avenues.

If you're in a state where there is a pharmacist on staff and in New York, we absolutely, they require pharmacists to be on staff, and thank heavens, they require that.

Most states do not, but if you have that access, utilize it.

They're there to help you for this reason.

They can recommend products.

They can tell you if there's a drug-drug interaction, because yes, like with everything, there are risks to this medication.

And we wanna make sure that you're using the right dosage, the right product, and you're getting the effect that you want.

And so it's about utilizing the resources out there.

Don't go on Google and try to be your own physician or cannabis educator, because there's a lot of misinformation out there as well.

But go to the experts because that's where the power comes from and you become empowered as well.

You know, I'm fortunate in that I love to read science.

I'm a little nerdy.

And so I have spent the last many years focusing on this, but it's important to be able to have trusted sources that you can go to for the information that you want.

- Absolutely.

Could you speak a little bit more to cannabis use for menstrual cramps?

Specifically, what extent would you recommend cannabis over a birth control pill to patients?

- Well, I don't recommend (laughs) I educate.

I have to be very careful with my language and my license.

And the reason I say that is it's so important for us to really to have that kind of conversation, 'cause it is really kind of silly that even physicians can't prescribe this.

I work in other countries where physicians do prescribe it and it's a very different environment there.

And that's a decision that a lot of people use birth control pills to kind of handle those cramps.

But not everyone wants to have that hormonal exposure and not everyone wants to be on birth control.

And so it really is a personal decision that has to be weighed against the risks and the benefits.

And so I know that when you're taking birth control, you have to take it throughout the entire monthly cycle, all days of the month, but with cannabis, you get to use it when you need it.

And if you're using a suppository, for example, or if you're using a topical, you can even use topicals on your stomach and the abdomen area to rub in to kind of help with that.

An edible or an adjustable kind of cannabinoid can be effective as well.

So I hope that answers the question.

- Thank you.

You touched on this a little bit, talking about dosing and if you inhale, you're gonna have a quick effect, but if you ingest, it's gonna take longer.

Do you suggest mixing those?

So if you do need quicker relief, you go for that, but if you're looking for something long term, go for an edible?

- Yeah, absolutely.

I think it's really important.

There are times when you need that immediate relief and there's nothing wrong with that.

So that's where an inhalation would be incredibly beneficial.

However, it doesn't mean you can't utilize an ingestible form of cannabis to kind of mitigate that as well, because we know that if you inhale, it lasts maybe two hours, two to four hours.

If you ingest, it can last up to eight hours and it gives you a totally different physiological response.

I've seen it where I've seen it myself, I've seen it in family members, friends, and clients or patients.

And so oftentimes what will happen depending on the severity of the pain, for example, they'll start with the inhalation just to take the edge off, but will take it over a period of time, maybe every four to six hours.

They'll take an ingestible.

And what they're doing is just trying to kind of keep them calm.

But if that pain is so acute, you need that immediate supplementation of THC or CBD or whatever cannabinoid you use, that's where the inhalation would come in.

And remember that each cannabinoid has a differing effect.

I didn't really go through that tonight because of the time, but we know that when we're talking about pain, THC is the most important piece.

But I will say this.

CBD, we don't talk enough about CBD.

A lot of pain goes along with inflammation, and CBD is incredible at reducing inflammation and kind of providing some immunity.

It's not a true medication that works on creating immunity, but it's been demonstrated to have some immune-like effects.

And so oftentimes when you have pain, there's inflammation involved.

So whether it's using THC and CBD together through like a one-to-one ratio or a one-to-two ratio, depending on what the issue is and your pharmacist can help you with that, it's important to be able to use those different cannabinoids together to get that entourage effect.

I know with my mother, when she had had her hip surgery, she used both CBD and THC.

THC was for the pain, CBD was for the inflammation and to help the immunity.

And so even her physical therapist, her doctors, they couldn't believe how well she had done using these products, whereas a year before, when she had had her other hip replaced and didn't really use the products, it was a totally different kind of experience.

- That's amazing.

Are you aware of a cannabinoid guy, both depository that might replace an estrogen, would be estrogen replacement?

- This is where again, and I hate to sound so nuanced here, but every state is different because of the laws.

So what might be available in one state may not even be available in another state.

And so unfortunately, that limits my ability to kind of talk about certain products and each state has different laws around ingestibles, flower, these different types of methods of consumption.

Again, depending on what the issue is, if it's not endometriosis, THC is very helpful and working with that and again, to make it even more complicated.

And I'm sorry, if I sound like I'm avoiding the question.

I'm not.

It also depends on which state you're in and the labs that do the safety testing.

So in New York, traditionally, we've only had one lab that actually did testing on products.

I know I had patients who were using this one product with incredible, wonderful effects, but they actually wound up not having the product for almost six months because the state was backed up in their testing labs.

So there are all these supply chain issues that exist out there, and it's so important for us to be really vocal and start to hold our legislators accountable and making sure that people can get the products that they need.

You can also learn.

There are videos online that you can learn how to create your own suppositories, for example.

Unfortunately, that's what's happening a lot or fortunately, depending on what your view is, is that sometimes people have to start making their own medications.

I know of states where they sell products so that you could actually create your own foods out of it, your own cannabutter.

They'll sell stuff that you can actually bake, you know, cook with it.

And the reason is, is that depending on the patient's needs, they might need edibles.

For example, I believe it's New Jersey that they don't allow edibles at all.

And many people prefer that because it actually mitigates some of the pain issues in a different way than an inhalation would.

And then there are states, for example, in Alabama, they don't have flower available, you know?

And so there are all these different states with these different patchwork of laws and none of them always make sense, but unfortunately, we have politicians making decisions based on propaganda from the past and not really what the science says.

There are some people who can't really inhale and so they might need an edible and there are some people who might need a suppository because they have extreme cancer or have some kind of issues but the state legislature or the laws won't allow some of these products to be developed.

- Yeah, absolutely.

Can you recommend any books or additional reading if we want to learn more about this topic?

- Well, I tell you what.

You can go to our YouTube channel.

The Cannabinoid Institute, absolutely, we have a lot of our clinical, well, we have all of our clinical information on our YouTube channel.

And so I encourage people go and learn.

Unfortunately, this has been kind of, this whole movement has been driven by patients and not clinicians, which I'm so grateful that the patients have been so vocal.

And that's probably why I'm so vocal 'cause I was once a patient.

But what that means then is that the clinicians really aren't up to speed.

And until we really demand that top-tier universities, colleges of medicine, colleges of nursing, pharmacy schools, social work schools, psychology schools, until we start demanding that these schools actually start to provide this kind of content for their students, we're gonna keep having this disparity of knowledge existing between the patients and the clinicians.

- Well, thank you very much.

Those links are available in the chat for you to dive into this a little deeper and find more information.

Thank you, Dr. Jan Roberts.

This was really fascinating.

I think we all learned quite a bit and I know that we probably could keep on talking.

(both laugh) - I know.

- It's really been fantastic.

Actually, if you are interested in finding out more information and you'd like a deeper dive into this topic, please let us know in the chat because you kind of drive what happens here on our Science Pub.

But thank you so much.

- Thank you, Nancy.

- For more information on Dr. Robert's work, follow those links in the chat for the Cannabinoid Institute and the Center for Empowering Women.

Our next Science Pub is on Tuesday, February 8th, with guest Charlene Sirianni on the science and secrets of keeping love alive.

New love is thrilling, but can we keep the magic alive?

What sort of secrets can ruin a good thing?

And how can we resolve resentments before they boil over?

We'll dive deep into the science of healthy relationships, revealing secrets that may surprise you.

For meeting your partner's needs to setting clear boundaries, we'll learn how to protect those precious bonds, steer clear of pitfalls, and keep things spicy.

So join us for the science and secrets of keeping love alive.

The link to the RSVP is in the chat.

You can watch this episode and past Science Pubs through the WSKG app on demand on your smart device and on WSKG's YouTube channel.

Be sure to like our Facebook page for future events and science updates.

I would like to thank our WSKG team tonight, our director, Andy Pioch, our chat moderators, Patrick Holmes and Kristine Kieswer.

I'm your host, Nancy Coddington.

Thank you, and good night.

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