From Sky news.

This is connections.

I'm Eric Logan filling in for Evan Dawson.

Our connection this hour was made in 2016 when New York State legalized medical marijuana or medical cannabis.

And then again when New York State legalize cannabis for recreational purchases purposes in March of 2021 or, to be more historically, price precise, according to an eye aided Google search I did.

Cannabis or weed first arrived in the Western Hemisphere with the Spanish, who cultivated industrial hemp, a type of cannabis, in Chile, starting at around 1545.

While Spanish explorers encountered native peoples using cannabis for intoxicating effects.

As early as the 1520s, final preparations of cannabis became available in American pharmacies in the 1850s, following its introduction into Western medicine by William O'Shaughnessy in 1839.

Today we will look at the current state of cannabis use for symptom management and the potential dangers of addiction, as well as other aspects of cannabis use.

As a side note, I am surprised at how many places I can smell the residuals of weed being smoked, including the lingering aroma I experienced in a rideshare or as I endanger.

I frankly don't know.

I think there's a lot of confusion regarding the use of cannabis.

Even the definitions of cabinets cannabis components are referenced as if everyone is an expert on the drug.

If you don't know the difference between THC and CBD, don't worry, we will answer those questions today.

Our goal is to clear the fog for all of us as much as possible in a 50 minute program.

And of course, we want to hear from you.

If you're using cannabis medically for mental health, pain management, or symptom management.

Our listeners would love to hear from you and learn from your experience.

If you're using cannabis recreational recreationally.

We'd like to hear from you.

Also, if you have questions for our guest.

You'll be able to ask them directly or via email.

I'll restate our goal is education so you can make informed decisions regarding cannabis use.

Also, our guest who are medical doctors cannot.

I want you to notice our guest who are medical doctors, cannot diagnosed or or recommend any treatment in this particular setting.

Joining me at the connections desks today are Doctor Paul Vermillion, assistant professor in the Department of Medicine, palliative care, neurology and child neurology and pediatrics and pediatric palliative care at the University of Rochester Medical Center.

And Doctor Aditya verbally.

Family medicine and addiction medicine specialist at Rochester Regional Health.

Evelyne Brandon Mental Health Center, a part of the Rochester Regional Health Network.

welcome.

Welcome.

Doctor Vermillion.

Hi.

Thanks for having me here.

It's a pleasure.

And welcome, doctor Varun Bolly.

Thank you for having me here.

Yes.

Thank you so much.

you know, I feel so fortunate to live in the Rochester area.

This is going to sound like a bit of a joke, but whenever, we fantasize about moving out of the area, one of my first questions is, what do they have for medical facilities?

I'm at that age where that is actually, becoming an actual deciding factor in whether or not it relocate.

Can they do what, Rochester regional Health or urgency can do?

If not, no, I don't want to live there.

so.

Thank you.

We are so glad that you're with us today, and I expect to learn as much regarding this topic as anyone else.

Like anyone who is not steeped or trained in the area of cannabis, I have preconceptions, many of which might be misconceptions or plain incorrect, so please call me on it if I make an incorrect statement.

I had a couple of beliefs that have already been changed as a result of preparing for this discussion.

So let's start, with Doctor Vermillion.

Tell me, tell us a little bit about who you are, your practice and your specialties.

Yeah, certainly.

So I am a doctor of palliative care.

My training is in caring for people who have some sort of serious illness, and trying to help them cope with that illness and the side effects of treatment.

and I came to marijuana through in my fellowship.

One of my mentors, doctor Rob Horowitz, was actively involved talking about marijuana with patients with support groups.

And he brought me to one of those support groups.

and I saw him give this talk, talk about the way that marijuana might help patients and the, excitement, enthusiasm in that room with more than I typically see in a doctor's office.

and he gave me the opportunity to take this on as something that I talk to, medical trainees to patient groups about.

And so I have become passionate about it through this work as well.

Wow.

We're going to have to talk a little bit more about that later in terms of, in terms of treatment and possibilities and, and research that, that supports that.

But we'll get to that.

Doctor from Bailey.

Tell us about yourself and your practice and your specialties.

Certainly, certainly.

I come from a background in family medicine, in which I was, training in Buffalo and then went on to addiction medicine fellowship, primarily to help those with addiction who are seeking out care and perhaps may not always have a voice for them.

I worked in in the hospital, in the clinics and saw many types of substances that people were struggling with and eventually ended up in Rochester.

And here I am kind of working primarily in as an addiction physician in both in the hospital where it's a 28 day type program out in Batavia, as well as covering in, our location in Greece.

In addition, I work in a clinic in our inner city in Evelyn Brandon, where, a lot of the patients are, coming in as a walk in basis sometimes simply because that's their best means of transportation.

And I work to help those with many types of substances, but also including cannabis use disorder.

Excellent.

We're going to have to get into that topic as well.

Actually, that's one of the preconceptions that I had or misconceptions that I had regarding, addiction possibilities.

And that as I was going through, quote unquote, my research, you know, just trying to figure out what should I be talking about, what questions, what our listeners have, what's the best thing for us to do?

there were a couple of misconceptions I had that, needed straightening out.

And so I'm, I'm planning, as I've said earlier, I plan to learn as much from you, as our listeners today.

Can can we define exactly what is cannabis or marijuana?

Doctor Van Bolly?

Certainly.

cannabis is a plant found naturally in the environment that is, often ruled as a bud or the flower that people will smoke or extract.

The some of the oils for the purposes, via other methods, whether it be through a gummy that can be sold or, simply just the oil.

the two major components of cannabis are THC, which is a psychoactive component, and CBD, which is far more used in the world of pain medicine that I think Doctor Vermillion can better answer.

THC.

That compound is, found as in varying potency of different strains as farmers will grow different types of crops and adjust to the environment.

many individuals have been doing similarly.

I think with cannabis, as I understand it, in cultivating different types of potency of THC or in combination with CBD.

so, Doctor Vermillion, that's one of the things that I was reading about that the potency of these things.

And actually, I will share some personal experience that is higher these days.

Yes, yes.

Sorry I didn't push the calf button.

Don't worry.

So I you know, one of the most true statements is that the marijuana of the 70s is not the marijuana we're seeing today.

And so when I'm seeing patients who last used marijuana when they were in college, and now they are 60 and 70, I need to make sure they know that we're dealing with different stuff.

because as my colleague said, you know, we have seen, you know, 50 years ago we had two cleared types of cannabis.

There was cannabis sativa, can cannabis indica, there were two strains of the same plant.

And over the years they have been crossbred re bred and they just don't really follow that same pattern anymore.

the potency of the plant itself is higher.

And then the way that we are preparing it, you know, you can buy, you can buy these really potent distilled edibles, tinctures that you have to be careful that you actually know the dose you're getting.

because it is quite possible that you inadvertently overdose yourself if you say, the last time I used this, I could handle, you know, I smoked a bowl and I didn't feel anything.

And right now, 20 years later, you're smoking a different plant.

So I'm one of those people, full disclosure.

For whom?

Smoking.

But as a kid, was a thing, right?

In my 20s, I stopped because I became an adult and had adult things to do, kind of things.

So it just wasn't that crucial for me.

and but then I'm one of those people also in their 60s and 70s who said, I'm hearing that if I get this chewable, it will help me with my leg pain, and maybe I should try a couple.

And so, right from a local dispensary, try tried a couple of what what what they described would be helpful.

And frankly, I didn't like the way it made me feel.

That was just it was sort of like, okay, okay, that's off the market.

it I have not talked to my doctor about it.

Right.

And, we'll get to that later as well.

about that.

But, we are indeed seeing that this is addictive.

Honorary doctor, doctor family.

Certainly.

We certainly are.

The way that cannabis can sometimes, present its cannabis use disorder can present itself.

May not be as typical as others.

and many may not recognize that this is the start of something worsening.

addiction has many components to it.

there I like to remember the forces control compulsion, cravings and consequences.

Maybe not necessarily in that order, but, cravings can develop at any point.

Tolerance can build from there.

But the consequences are often what individuals associate with addiction.

However, sometimes the compulsions or the the the typical pattern in which it becomes daily use and worsens from there, like those are the aspects of which of which we're not always able to identify, as in the doctor's office, but individuals may be able to recognize in themselves from a big picture perspective.

The CDC estimates something like 3 in 10 people are our lifetime risk of developing cannabis use disorder.

Three out of ten, three out of ten.

In those who use, that's a huge number.

So, that is one of the aspects of cannabis use that I was dissuaded from because if prior to last week, if you had said, cannabis is addictive, smoking pot's addictive, I would have said, no, it's not.

I mean, that's what I keep hearing.

People would say that.

And it wasn't addictive in my case.

but I'm reminded now of a situation and of a realization.

I had, when I went to quit smoking.

So, as I said, in high school and as a young adult, alcohol was a part of my existence.

marijuana was a part of my existence.

And smoking regular cigarets was a part of my existence.

And when it came time to quit smoking, now, my attitude about all of these things was, it's easy.

Just self control.

Just get it gets do do what you're supposed to do.

You know better.

when I went to quit smoking, I cannot tell you how difficult that was for me.

you know, I had to try a strategies and techniques, like, not back in the day when you could smoke in the office.

Not smoking in my cubicle, only smoking when I would go outside.

Only smoking at the beginning of the day.

Only at the beginning of before work.

Only smoking after work could I get down to about five, maybe five cigarets a day cutting back.

And that's back from a pack, right?

Coming down off of that.

and then, I keep calling it a God thing happened, with me.

And what it was, was I got this nasal and nasal infection that was so bad that even perfume was smelling like burning rubber.

And I could not touch a cigaret because of, because of how it was affecting me.

Right.

For a whole week.

And at the end of the week when I went, oh, I'm getting my smoke, I smell back, I think I'll, And I picked up the pack of cigarets and I said, oh, I haven't had one today.

Maybe I can not have one today.

And that, you know, went on for a week.

And then I said, maybe I don't need this pack of cigarets here and just kept pushing it.

Now I still always addicted to it.

So there were situations I couldn't put myself in.

I could not go to a bar after racquetball and, you know, have a couple of drinks with the guys because I'd be around people smoking cigarets all the time.

And I just knew that if I'm inhaling that stuff, I was.

So it was at that point, my realization was, wow, if people who are dealing with alcoholism have even a portion of the difficulty that I had with cigarets, and I know they have a larger difficulty than I can't imagine, I my hat is off for people who are actually able to fight and achieve victory over addiction.

What you're experiencing that I think, Eric, you really nailed it in saying that there are certain environments, there are certain people that you're around in certain places, and what we identify is are called triggers.

Triggers are something external that may cause you to have this automatic thought, this compulsion to want to, as you said, about cigaret smoke a cigaret.

And so it is very much the right thing to kind of remove yourself from those environments.

And that is entirely what we do in our clinic environment, where patients really develop both the coping strategies that they may need, the behavioral strategies they may need to start taking on.

And on top of that, I identifying their own triggers for you.

It may have simply been the bar environment.

For others, it can be boredom, it can be isolation, and it can be using a different substance that makes them use a second substance as well.

Doctor.

Yes.

Yeah, if I can.

At first, congratulations on quitting smoking.

I you know, one thing we know different substances are addictive at different levels.

And we tell people that quitting smoking cigarets is one of the hardest things I ever asked my patients to do.

Is it really?

It is incredibly difficult because nicotine is so incredibly addictive.

And other substances, you know, we know that pretty much anybody who is exposed to nicotine gets addicted to nicotine at some level, some portion of people who get exposed to alcohol get addicted to alcohol and not everybody.

And so this idea that there are substances where even a little bit is dangerous for addiction, opioids are incredibly addictive for many.

and cannabis, you know, dating back, it's hard to talk about cannabis and not sound overly biased because we were all trained and grew up in such a biased, environment.

We can talk about them more later.

but there's clearly people who misuse cannabis.

There are clearly people who are dependent on cannabis.

and so I don't want to diminish that.

But the majority of people who are using this, in a therapeutic manner have a very low, likelihood of going on to addiction in the classic sense.

I think, really going back to some of the seeds, if you will, you know, use disorders at the heart of them.

Get at is this impairing your ability to do work, to live life, or is this, enabling it?

And so I have an addiction to coffee, let's say.

And coffee helps me do my work.

And it is not preventing me from doing my tasks.

Whereas people with use disorders are typically, you know, not completing their tasks.

They are doing things in a dangerous, haphazard fashion because of their dependance on other substances.

And so for folks where coffee helps them get their work done and get through the day or start the day for people whose, you know, reasonable dose of pain medicine, although potentially addictive, is helping them live life, do their job.

be able to garden.

you know, those aren't use disorders, even though you may be dependent on them to get things done.

I have a relative who will go on named, who?

and this goes back a whole lot of years.

but, you know, she would when when I met over to meet with her, we happened to be in town, and, so we got together for lunch, and she pulled had I had a weed, and she said, oh, no, this is working weed.

This is just so I can, you know, do the things I need to do.

And, you know, I'm the kind of guy that doesn't even have a beer at the golf course because it's hard enough to hit that little white ball much less impairing my senses.

So I just couldn't imagine how that could how that could be the fact.

So according to Medscape, one of my research places.

Is that okay, Medscape?

They're good.

Good.

yeah.

Sure.

Good.

Okay, good.

According to Medscape, the US, DEA classifies marijuana as a schedule one substance under the Control Substances Act.

Marijuana is not approved by the Food and Drug Administration for medical use in the U.S, and remains classified as an illicit drug by the DEA.

However, 33 states in the District of Columbia have adopted individual state marijuana laws, and in October of 2009, the US Justice Department announced that it will no longer enforce federal drug laws on persons who use marijuana for medicinal purposes or their sanctioned suppliers, as long as state laws are followed.

that last statement there doesn't give me a lot of comfort for in terms of how things are going to be enforced, given how what we see going on now, right, just at the whim of, of the top leader could could change that tomorrow.

my, this may be a misconception.

One of my thought is that the challenge we have is that because it was deemed a controlled substance, it was not researched openly as well as it should have.

What are your thoughts on that?

Over the years, I it feels to me like CBD and, THC are, not as well officially researched as they could be.

Is that an appropriate kind of assumption?

Very much so.

without getting too political in the current realm, if you don't want to accept that something is potentially useful, you limit the ability to study it.

so if you don't want politically to accept marijuana or cannabis as a acceptable mainstream, intervention, then you prevent anyone from being able to study it, just like other things we might want to prevent.

And, for the longest time there was a single grow facility licensed by the federal government that had this stockpile of old, moldy weed.

that you anybody who wanted to study it had to go through this one thing, and it had mold in it.

That's why we have the ability to get fungal infections from smoking marijuana.

That's why we, consistently think of that as one of the risks of using marijuana for people who are immunosuppressed.

and so we have seen some movement in licensing more facilities for federal research.

it is really hard to get funding for this type of research for the same reason, because this is federally, still prohibited and, you know, the scheduling is its own nonsense, because without even going into some of the historical background of how it got scheduled, that way, to say that it's schedule one implies there are no accepted medical, uses for it, which is absurd.

We have FDA approved CBD, which is, Epidiolex used to treat certain types of seizures, and we have FDA approved THC in marinol drawn ethanol.

And so both of the main components of marijuana are FDA approved medications.

So to have our federal government claiming that there are no accepted medical uses for this is just nonsense, right?

Right, right.

So what are some of the indicated or some of the uses that you've seen for either THC or CBD?

yeah.

So when you looked at proposition 215 in California, you look at our Marijuana Regulation and Taxation Act.

which created, recreational, actually, sorry.

The signing I'm thinking of is for the medical, there were little girls with Dravet syndrome in both photo ops.

This is a rare epilepsy in California.

It was Charlotte Figgy in New York.

It was Amanda Hauser.

And, so the face of this push has really been rare.

Epilepsies that are helped by CBD.

The average person using, medical marijuana is probably more in.

You are my demographic with chronic back pain.

you know, something like 60% of the patients who were certified in New York when I last looked were adults with pain, with chronic pain, not not treating cancer.

the things that I am using it for and the reason why it is really appealing for people going through cancer treatment is that marijuana has the potential to help with pain, nausea, appetite, insomnia.

so many of the things that people with cancer and going through chemotherapy might experience marijuana might help.

And I'll say I emphasize might because it absolutely does not help everybody.

Interesting.

as a cancer survivor myself, two different bouts of different kinds of cancer, I think my, my recovery was mild enough that I probably wouldn't have tried marijuana if it was offered to me unless my doctor said, hey, try this.

but but that's just that's just sort of interesting.

Hey, I just want to remind our listeners that this is connections.

I'm Eric Logan, sitting in for Evan Dawson.

We're talking about marijuana and cannabis here today, with Doctor Paul Vermillion, assistant professor of the departments of medicine, palliative care, neurology and child neurology and pediatrics and pediatric palliative care at the University of Rochester Medical Center, and doctor Aditya Berman Brawley, family medicine and addiction medicine, medicine specialist at Rochester Regional Health's Evelyn Brandon Mental Health Center.

And so glad that to have both of these gentlemen here, and of course, it can be with you when you call four, five.

What number is this?

I'm going to say 4 or 5 for 60 trying to you know, I'm going to say that because I'm thinking pledge.

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But for this call for this, program, this conversation, you can call us at 844295 talk.

That's 844295825 5 or 5 852639994.

Or you can write us at connections.org.

Since it's 1230, I think what we'll do is take our only break of the hour.

And when we come back, we'll take your phone calls.

if you have used marijuana, if you've had an experience with it, if your doctor has described it, if your doctor said, hey, this might be helpful, or if you've been self-medicating, maybe even figuring out a way to do it yourself.

give us a call.

We'd like to hear that experience today, but we'll do that when we get back.

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This is connections.

I'm Eric Logan, sitting in for Evan Dawson.

We're talking about cannabis use in our community and the benefits and pitfalls, and we're talking about our guest, Doctor Paul Vermillion, assistant professor in the Department of Medicine, Palliative care, neurology and child neurology and pediatrics and pediatric palliative care at the University of Rochester Medical Center.

And doctor, did you have Averman Bailey apologize?

I will get that correct.

Family medicine, an addiction medicine specialist at, Evelyn Brandon Mental Center at Rochester Regional Health.

So.

And you, of course, when you call it 844295 talk or 844295825 5 or 5 852639994.

Or you can email us at connections.org.

Or you can use the chat feature in the YouTube stream.

If you happen to be watching on YouTube, you know you could have gone all day.

Julie, without telling me that, you know I was going to be on TV here trying to look for that.

So, but thank you.

But but please, we do.

We do very much, very much enjoy and would welcome your calls today and would like for you to do that.

So Medscape lists 23 serious drug interactions with marijuana and one drug.

premise.

I'd promote I'd, which is, contract country.

You know, I actually looked up how to pronounce that was contract contraindicated.

Contraindicated, exactly.

Gosh, you know, contraindicated such fancy words just says, no, don't do this.

contraindicated for simultaneous use.

So what are your recommendations?

for people thinking about or incorporating marijuana into their medicinal support or recreational habits?

So I can't speak so much to the, medical interactions.

primarily because I don't usually recommend cannabis in any way or form for my patient and especially those who have an active substance use disorder.

But with the conversations I do have are regarding those who might be self in a in a sense, self treating this psychological model that many patients will sometimes attach themselves to is very much, I try to, reduce my anxiety to, solve my insomnia.

And they may not always bring this up with their doctors.

They may start bringing it up with me instead, like, instead of their primary doctor.

But with me.

And so when I ask these conversation points about what may be the benefits that you're looking for, they say that they're finding it really helps their anxiety, but they're finding themselves having to use more and more to self-medicate for their anxiety.

and so the conversation then becomes talking about what happens in the withdrawal period from the cannabis that they're using, how often they're using, and kind of getting a more detailed history in this scenario that I'm kind of describing isn't all patients, but it's a number of patients.

And in those individuals we talk about how can we alternatively treat their anxiety, whether it be with coping strategies and having therapy therapist be involved in their care, along with any.

pharmacol.

Pharmacol farmaco interventions that we may consider so that we can kind of tackle it from a multidisciplinary perspective.

Patients are usually open to this, and they can recognize, the way that cannabis might be playing too much of a role.

And this, this paradoxical effect that I'm describing is basically the withdrawal state of cannabis.

Some individuals who have more severe mental illness or a history of severe mental illness.

I always tell them that it is not recommended for them.

That is simply because those with schizophrenia or family history of it, or even bipolar disorder, it has the potential to bring it out in them.

They may have a genetic underpinning that may get worsened by cannabis and lead to something called cannabis induced psychosis.

So with my internist, Doctor Julie, we, review all my meds and look for if there any things that are interactions.

Because I have a urologist, I have, you know, I have different doctors being a person of a certain age.

And so, it it's it's important.

And I've actually done a web search as well where you can go and look and see what some of the interactions are between drugs and maybe sometimes just taking them a different time of the day instead of together, those kinds of things and, and things like not eating grapefruit juice, you know, not consuming grapefruit juice, with some of the is that the statins that's corrected with the stent.

And so I haven't had a cut grapefruit in years.

you know, so, when I looked at that list, which I did not bring with me because I was not going to read that to all the folks here on on the air.

When I went through that list, there were a couple of drugs or versions of thereof that were listed as serious, potentially serious.

None of them were contraindicated, but they were listed as potentially serious.

And, I would I shouldn't be making recommendations, but I would recommend that if you're using cannabis in any form and going to continue to do that, you should check go on the web and look for those, and I think as, as you have said, talk to your doctor.

But Doctor Vermillion, what do you think about all of that?

Yeah.

Thank you.

I as someone who is in the, position to make that recommendation, it is really important to be open with your physicians about your use of cannabis.

For a long time, I would say that the medical community has preferred just not to think about it.

You know, I don't need to learn about cannabis because that's something my patients shouldn't be using, and I'm not going to bother.

but now that we're in a place where something about like 1 in 5 young adults is using cannabis, and I just don't know the numbers for other age groups, but they are using it at high numbers, too.

So if I am a physician prescribing a medicine that might be might interact with cannabis, I should probably be learning about that.

And so, you know, we are somewhat helped by the fact that we have FDA approved medications.

So it's easier to compare against THC because we have an FDA.

So all of our, you know, drug interaction, software includes the FDA approved medications.

but it is important for users of cannabis to be aware of some of those interactions.

It's really important to be open with the physicians, your doctors, your nurse practitioners, your physician assistants, because they are also in a position to be looking and making sure that those, interactions aren't significant.

It is hard to know exactly which medication interactions are the most important.

There are some really well documented things like warfarin, club exam, which is one of the benzodiazepines.

and then there's a bunch of theoretical ones based on the way that your liver enzymes work.

And so, talking with your doctor, if you're going to be using this particular, if you're using it to try and treat something.

Yeah, I saw as I was trying to read through those and what the interactions were.

And I'm not pretending to be insightful enough or knowledgeable about to turn to some of that.

But what I kept seeing was, either increases the action of this other drug or decreases the action of this other drug.

Either way, it's not giving you, the the results that your doctor wanted you to have when he or she prescribed that medication for you.

Now, you said that THC or CBD, there are formulations, excuse me, formulations of that that, can be prescribed.

And is that right?

Is that from a pharmacy.

Yeah.

So, Epidiolex is cannabidiol CBD that has been around.

I don't know.

But for some years now prescribed specifically for forms of epilepsy, seizures and then turn abnormal is a synthetic THC and that is only FDA approved for Coca-Cola weight loss associated with HIV or chemotherapy induced nausea and vomiting.

So that cannot be prescribed for pain.

Rather, it can be prescribed, but no insurance covers it in my experience, there have been some pilot studies looking at the use of this Agent International for pain.

and it.

Yeah, I want to make one thing clear.

I say synthetic THC for all, and that gets confused for K2 spice.

The, what get, you know, called synthetic THC on the streets.

It is very different than THC.

It has markedly different psychoactive, components.

And so although I will talk about the medical uses of THC for a long time, I will not endorse any use of K2 spice, that kind of thing.

yeah.

So you mentioned drugs on the street.

So, and this is a multi-part question that I'm kind of formulating in my head.

And you can help clear clear this up for me.

So we've heard a lot about fentanyl and other drugs that are being introduced into other drugs to deadly effect.

So that's one thing.

And the second thing is, the, the level of THC or CBD in a particular drug, in this chewables, for example, is there any central organization that is validating that what people are buying from the dispensaries are actually what they think they're getting?

Yeah.

So, you know, what I tell all of my patients is that my preference is that you obtain your marijuana from either a legal recreational dispensary or a medical dispensary, because those products are all tested.

There are laboratories certified by the state to do those testing, which cannot be said of the stuff on the street, cannot be said of the plants that people are growing themselves.

Right.

You don't know plant.

Can you tell the potency of it, even growing spinach in the backyard?

Certainly.

I think that there's also that consideration of I would agree with everything, Doctor Vermillion said.

I'm on the same page.

We always try to take a harm reduction perspective.

If someone is choosing to smoke or use cannabis of any in any way that they're getting it from a state regulated or any type of regulated manner, facility.

So to prevent any, cross-contamination or anything of that nature, but also to know if they're getting true cannabis versus K2, which is also called the the street where it is space.

And that has a lot of psychoactive active components that have put a number of individuals in the hospital just because of psychosis type symptoms that start developing, where you can't distinguish reality from, the hallucinations that 1 in 1 may experience.

Thank you.

We have, email here from Charlie.

it it says Eric, I graduated from college in 1980, so my roommates and I smoked weed for four years.

Absolutely no negative side effects.

In 1981, all that changed, and I got the classic paranoia from it, and I hadn't touched it until last Thanksgiving.

I had to spend, spend close quarters with the in-laws, and I thought it would.

I would need something to help take the edge off.

So I went to a dispensary and bought the lightest, smallest amount per dose that you could buy.

All it did was amplify my anxiety.

So that's my experience.

I wasted $32 on stuff.

It's expensive.

However, I do drink grapefruit juice every day and I wonder if that had something to do with it.

you're doing a fine job filling in, by the way.

you'll get the $5 in the mail for the compliment.

Thank you.

yeah, I like, you know, I'll say to that, you know, there are some people where, marijuana helps with anxiety, and there's some people who get really paranoid with it.

Even modest doses.

You know, this is the person that you, see, have one puff, two puffs off of a joint, and all of a sudden they're terrified.

The police are outside and they get really paranoid.

And those people, it is likely to happen the next time you expose them to, is probably driven by THC.

So if you wanted to try a higher CBD product, maybe, and all this stuff, looking at treating anxiety with, marijuana looks at CBD and not the THC.

again, I'm not recommending people treat their anxiety with marijuana, but, certainly thinking that the higher the THC, the more likely it is to cause that, paranoia.

So, at the risk of just continuing to reveal too much about myself, number one, understand I'm not recommending anything.

I'm not encouraging people to use, any form of marijuana.

I once again, the recommendations are talk to your doctor, get some, get some solid recommendations.

That makes sense.

And not just, what you're hearing, quote unquote, in the street.

But that was my experience.

As you know, my 20s was you never knew what potency it was going to be.

And the biggest surprise to me was marijuana brownies back then, because I hadn't had them before.

And they they ramp up more slowly in the bloodstream and, you know, you have one and you go, oh, I'm not feeling this.

And then you have another one and then a little bit later you're going, I can't drive, right.

Kind of kind of attitude.

And so that, that, that took me off of brownies for, for the rest of the time that I use marijuana only because, I don't like being out of control.

Right.

And, you know, particularly for people whose primary marijuana exposure was by smoking, it, you know, smoking hits your system.

16 90s you know, you feel it really quickly.

The sublingual tinctures, the drops under the tongue.

And, you know, five ish minutes and a gummy takes you, maybe an hour.

And so the people who are used to seeing this really quick impact.

Yeah.

You know, we saw, this, issue with tourism to Colorado when they first legalized it and people who had a fair amount of exposure went to Colorado, got the edibles, weren't used to having to wait and had some really bad experiences.

I want to make a plug for, cannabis Skinnygirl of the New York State Cannabis website.

And there's a lot of information on there, for people interested around, appropriate dosing, the time to effect for these different ways, you're going to take it.

So, you know, how long do I have to wait before I know what this does to me and try taking another part of that gummy that maybe I cut in quarters.

and they have resources for people who are feeling like they are struggling with their control over their use patterns.

So, according to Medscape, in a 2019 study, it said 7% of U.S. women reported using cannabis during pregnancy, which is double the rate of 3.4% in 2002.

So I read that report, and immediately the skeptic in me said in 2002 it wasn't legal.

So who's going to admit it?

And and, you know, 2019 people might be more willing to, to talk about it openly.

Have you heard, number one, first part of the question, would be, have you heard of that increase for pregnancy use?

And, is there a danger in that doctor family?

I would certainly say that.

I have heard it.

It is very much a situation in which people were prior using cannabis for their own nausea or their own appetite and or their own anxiety.

And as they became pregnant, whether they were aware, unaware at that time that they found themselves more nauseous, they may have leaned into it.

This is what I heard anecdotally from patients rather than from data.

I have actually read that study that you're describing, and it kind of highlights a really important point of the fact of harm reduction in our world of addiction medicine care.

While individuals may not always be ready to stop using, they may have situations in which they're kind of putting themselves when health consequences or risks legally from kind of being open about their use.

And so while we come from a very non-judgmental place, as we're talking to our patients, the system is a large does that with legalization or decriminalization?

I should say that aspect of decriminalization in in California happened during that period from I think it was 2002 onwards that the study looked at, to when they did the the second time they did that same type of survey that showed that increase in, pregnant women using cannabis.

and so it's hard to say if the data is very clear just the way you described.

I also have doubts myself.

However, it is more important to recognize that where that role of decriminalization may have had to help allow people to participate in the health care system, participate in, not being, in a very punitive sense, put into jail, but not having the opportunity to pursue things like drug court, where they can make amends for what may have had as a consequence of while using other substances.

And, just having that opportunity to participate in care, I think is super important for individuals.

And that's kind of the the perspective we take in both addiction medicine physicians and all those that I work with.

Doctor Vermillion, you indicated earlier about, about the fact that we don't study those things that societally we're trying to reduce.

And actually, that has always been a frustration of mine about marijuana, because we've studied alcohol, to the nth degree.

We we understand the actions.

I believe at least what I think I'm hearing is we understand how alcohol works in the system.

We understand the components, all of those kinds of things to the point that, you know, people do have alcohol issues and, and need to know alcoholism and things.

And there's support for that.

And, we want people to not have to go through that kind of stuff.

But in some medical, situations, alcohol is actually a part of the solution.

So where are we with research with, on cannabis in this nation?

So I, you know, I think that we are at a really important point.

We have seen very significant gains in the number of articles being published.

I did a quick PubMed search before I came on here.

And in 2004, there were something like 400 articles published.

In 2014, there was like 1200.

And in to 2024 there was almost 4000.

So we're seeing much more information out there.

unfortunately we what we really need now is good large studies and those studies need funding.

And so if you want the future of medical cannabis to be pharmaceutical agents that you need to get from the pharmacy, great.

Let pharma fund the next research.

But if what you want is more information about the plants that you can grow yourself, then what you need is public funding for this.

Because there is not large pharmaceutical funding for marijuana cannabis.

There is pharmaceutical funding for the pharmaceuticals.

could you comment a little bit about the difference between, sativa and indica?

That's a question we received off the air.

Yes.

So, sativa, historically, versus indica, one was much higher and thc one was much higher in CBD.

and so, you know, it used to be that you could order your sativa, online, it would get shipped to you because that was low THC, and indica was what had been the high THC products.

they still get talked about as if they are unique stran strains.

But at this point, things are so crossbred that it is hard to truly pick out which one is which.

but you'll see those words on marijuana products still.

I'm totally unaware.

It's all it needs to be.

so very, very innocent in that area.

So, Doctor Van Barley and what is when you look at what we have in terms of the addiction landscape, how serious is the marijuana piece?

It's somewhat difficult to answer that question.

I would say sometimes instead of it's hard to isolate those with only cannabis use disorder, many may be struggling with alcohol, with opioids, with, cocaine.

And in addition to that, cannabis.

we don't have any FDA approved medications to help with the withdrawal state or in the craving standpoint for those who struggle with cannabis.

And so, our options are somewhat limited, but there are things that we try to kind of incorporate in a very multidisciplinary approach to try to target that.

I think you mentioned earlier coping mechanisms and the fact that sometimes the addiction gets wrapped up in and you said it's multifaceted.

It, it so one of the facets may be, or I'm presenting and asking you to talk more about, you know, the coping mechanisms people get into routines even, even the, the who wrote us a little bit earlier, the the email from Charlie who said, you know, I'm going into a stressful situation and marijuana in the past has helped me relieve the stress.

And, How do we how do people, how should people deal with the issue of coping mechanisms around the use of marijuana?

I think that the, the crux of what, if I may understand, it's to clarify, it's to how can individuals work on their coping mechanisms instead of cannabis?

That would probably be a better question.

Yeah, yeah.

Thank you.

No no no that's okay.

That's okay.

I think that it's it's tricky.

It takes a lot of self-awareness.

It takes a conversation with yourself to recognize that perhaps if something might be happening, that, acute stress response in these certain situations, whether that look like a panic attack, whether that look like anger or whether that looks like uncontrolled emotions of any kind, having that conversation with yourself, maybe others may notice it in you.

And they bring it out, they bring it up with you, and kind of paying attention to that compulsive aspect to it where I'm so upset, I think I need to smoke.

Whether people may say that about a cigaret, they may say that about cannabis.

It's recognizing the, the that that the, the behavioral, response may be to use a substance to change our emotions rather than targeting the actual, emotion itself and finding ways to kind of address that.

So maybe you're not as quickly frustrated or as quickly angry, or recognizing that the gravity of the situation may not be as severe as maybe you may have initially thought.

It reminded me of a joke which is only somewhat related.

from Flip Wilson.

Those of you who actually old enough to remember him as a comedian, he would say, hey, have a drink for the road and you go, no, no thanks.

The road is already laid out.

Okay.

It's a bad joke, but, but but I always thought it was a good one.

All right.

so, Doctor Vermillion, when you are, helping people define what they might be able to use, to help them deal with it, what are some your perspectives on that?

So I think what you're asking, you know, how do I talk to patients about what might be helpful?

and first I want to say that this is something that many people who come to me don't feel like they can bring up.

I've had people referred to my office, and in the referral note it says, would like to talk about medical cannabis.

And in 40 minutes of our conversation, they never once bring it up until I ask them about it.

And so it has become my practice to when I meet with people, I'll ask, you know, is there anything else that people have been talking to you about that you might that you think might help you, that you might want to try?

You know, this might be a time they bring up acupuncture for their pain.

And if they don't specifically bring up marijuana, I bring it up anyway, because I've had people who say like, oh yeah, no, my cousin's been telling me about this.

I tried one of his gummies once.

and so it is a pretty standard thing for me to bring up.

and what I say is that this helps some people.

It does not help everyone.

And the biggest downside is cost, because if you're using it every day, people are spending a couple hundred dollars a month on this.

Wow.

And it is never covered by insurance.

And so if you care really strongly about avoiding pills, if this is like the only thing that helps make life worth living life livable, great.

Maybe it's worth it for you.

And so many of my patients.

Try it if they, you know, some people come to me knowing more about marijuana than I ever will.

Great.

They don't need my guidance.

Others have no idea.

and so I tell them, you know, there's a pharmacist at the medical dispensary.

They will talk with you about dosing any licensed dispensary.

and one last point I'd like to make.

I know our time is getting short.

what?

One of the titles you listed off there for me is pediatrics.

And so, running out of time?

No.

Keep it.

Okay.

you don't have much time, right?

So it is really important.

Safe storage, because we are seeing many kids come into the Ed having gotten into their parents edibles.

And so just like all your other medicines, we got to keep this out of the reach of children.

Thank you again, Doctor Paul Vermillion and Doctor DK, verbally, we really appreciate you being in here today.

Thank you to the connections team, Rob Braden, engineer, Mary Hassan, Kaitlyn Volunteer, and Julie Williams as our associate producer.

The music is by Aurora Riot and Basic Records.

I'm Eric Logan sitting in for Evan Dawson, and I am so glad that you are here on member supported radio.

And thank you so much for listening.

We'll be back in the next hour when we talk about horses, when I hope you will join me.

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