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Speaker 1: Pushkin. Hi everyone, Doctor Poyter here, I'm popping in to

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Speaker 1: let you know that we're working on a special episode

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Speaker 1: of Decoding Women's Health. We're i'll be answering your questions

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Speaker 1: about one of my favorite topics, hormone therapy. If you've

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Speaker 1: been wondering about the different types of therapy, when it

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Speaker 1: might make sense to start possible side effects? Are really

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Speaker 1: anything else? This is your chance to ask. You can

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Speaker 1: leave us a voicemail at four FI five two one

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Speaker 1: three three eight five, or send an email to Decodingwomen's

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Speaker 1: Health at Pushkin dot fm and let us know if

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Speaker 1: you'd like to stay anonymous, or if you're up for

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Speaker 1: having your voice featured on the show. I'm so excited

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Speaker 1: for this one. Hormone support is such a misunderstood area

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Speaker 1: of medicine, and there's a ton of new and fascinating

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Speaker 1: research to talk about together. I can't wait to hear

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Speaker 1: what you're curious about.

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Speaker 2: Our first paper. They said, aren't you worried that these

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Speaker 2: are people who are just looking to be high but

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Speaker 2: stay within the limits of the law. No, I'm not,

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Speaker 2: because most people that I deal with do not want

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Speaker 2: to be intoxicated. We have a clinical trial for endometriosis.

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Speaker 2: And the very first thing almost every one of them

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Speaker 2: has said to me is it's not going to get

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Speaker 2: me high, right, first thing, end of the box. Because

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Speaker 2: people have whole lives. They have work, they have children,

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Speaker 2: they have activities, they have partners, they have school lunches,

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Speaker 2: they have dinner dates, they have things. They don't want

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Speaker 2: to be high all day, every day.

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Speaker 1: Welcome to Decoding Women's Health. I'm doctor Elizabeth Poynter, and

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Speaker 1: today on the show, we're talking cannabis. You know, medical

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Speaker 1: marijuana first came on my radar about ten years ago

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Speaker 1: when it first became legal in the states where I practiced.

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Speaker 1: That meant as a doctor and as a surgeon, I

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Speaker 1: had another treatment option to explore for my patients who

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Speaker 1: were dealing with pelvic pain, endometriosis, and other chronic pain issues.

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Speaker 1: The patients that I referred to medical dispensaries generally had

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Speaker 1: positive experiences, and over time, more and more of the

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Speaker 1: women I treated began sharing that they were using cannabis

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Speaker 1: for other conditions, not just for their pain, but also

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Speaker 1: for psychological issues like anxiety and depression. This was many

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Speaker 1: years ago now, and so much has changed. Access to

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Speaker 1: these products has exploded in recent years as more states

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Speaker 1: legalized both recreational and medical marijuana. So before recording today's interview,

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Speaker 1: I did some homework. I reviewed the latest medical cannabis

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Speaker 1: research from top journals, and for the very first time,

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Speaker 1: I visited my own local dispensary. It was totally overwhelming.

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Speaker 1: There were so many options. The sales representative or bud

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Speaker 1: tender as I learned that she was called, was kind

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Speaker 1: and tried to be helpful, but she seemed to struggle

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Speaker 1: to answer some of the more specific questions that I

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Speaker 1: had about what products might be the best for certain

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Speaker 1: symptoms and conditions. For many women, and exploring this world

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Speaker 1: for the first time, I can totally see how it

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Speaker 1: might be very difficult to know what to ask for

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Speaker 1: or how to proceed safely in a way that addresses

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Speaker 1: your individual health needs. Fortunately, today we have an exceptional

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Speaker 1: guide to walk us through all of this. My guest

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Speaker 1: is doctor Stacey Gruber. She's a neuroscientist and an international

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Speaker 1: expert on the health effects of marijuana. This made me

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Speaker 1: do a deep dive into the science of the connabinoid pathway.

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Speaker 2: Super curious here and it's constantly changing what we know

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Speaker 2: today is different from what we'll know tomorrow. You know,

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Speaker 2: people used to think these things worked one way, and

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Speaker 2: they don't. So there's never a dumb moment.

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Speaker 1: That's the great thing about science. If you believe in science,

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Speaker 1: I agree with you. Yes, yeah, that's a whole another episode.

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Speaker 1: Doctor Gruber is the creator and the director of the

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Speaker 1: Marijuana Investigations for a Neuroscientific Discovery, or the MIND Program,

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Speaker 1: at McClain Hospital. She's also in a so Sociate Professor

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Speaker 1: of Psychiatry at Harvard Medical School. The overarching goal of

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Speaker 1: her research is to understand how medical cannabis affects individuals

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Speaker 1: over time. She and her team study how cannabis use

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Speaker 1: influences things like anxiety, depression, sleep, chronic pain, and reliance

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Speaker 1: on other medications. They began observing people before they start

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Speaker 1: using medical cannabis and then follow their progress for months

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Speaker 1: and sometimes years to see how things change.

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Speaker 2: In twenty fourteen, I launched the MIND Program because in

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Speaker 2: twenty twelve, Massachusetts was on the precipice of legalizing cannabis

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Speaker 2: for medical purposes, or I should say relegalizing cannabis was

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Speaker 2: legal in this country. Was part of our US pharmacopeia

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Speaker 2: it fell out of favor, became illegal, landed in the

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Speaker 2: most restrictive class of the Controlled Substance Act. But in

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Speaker 2: nineteen ninety six it was reintroduced in California for medical

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Speaker 2: purposes and reapproved. So in twenty twelve, Massachusetts was about

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Speaker 2: to approve cannabis for medical purposes, and I decided, let's

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Speaker 2: look at the literature and see what we know about

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Speaker 2: the long term effects of medical cannabis use. Scouring the literature,

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Speaker 2: I found almost nothing, and so that's why I launched

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Speaker 2: this program. There has never been a program dedicated to

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Speaker 2: looking at the long term impact of medical cannabis use,

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Speaker 2: despite the fact that it was relegalized in California in

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Speaker 2: nineteen ninety six. Almost everything we know about cannabis has

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Speaker 2: come from studies of recreational consumers, primarily young, healthy recreational consumers,

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Speaker 2: and that's a bit of a problem. In fact, it's

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Speaker 2: a huge problem. Individuals who are using for recreational purposes

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Speaker 2: by design, are looking for products with notable THHC or tetrahydrocannabinol,

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Speaker 2: the primary intoxicating constituent of the plant. In contrast, our

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Speaker 2: medical cannabis patients aren't necessarily looking for that same experience.

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Speaker 2: In fact, many will tell you I don't want to

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Speaker 2: be altered or high. As a result, it's very challenging

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Speaker 2: to really understand what the actual impact is on so

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Speaker 2: many of these indications and conditions that people will swear uptown,

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Speaker 2: left and right cannabis or cannabinoids are effect before. So

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Speaker 2: since twenty fourteen, we've spent a lot of time doing

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Speaker 2: longitudinal observational studies as well as some cross sectional studies

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Speaker 2: and some survey studies, but mostly focused on the what

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Speaker 2: is considered the holy grail getting to the clinical trial models,

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Speaker 2: which is where we are.

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Speaker 1: So it sounds like patients originally led you to look

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Speaker 1: at cannabis. What particular aspect of it drew you into

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Speaker 1: looking at cannabis other than the kind of lack of data.

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Speaker 1: Was it you saw efficacy? Did you see people getting

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Speaker 1: better using recreational cannabis? What did you observe that drew

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Speaker 1: you into this area of research.

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Speaker 2: So the first thing I would say is that going

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Speaker 2: back to the sort of recreational days when I was

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Speaker 2: still spending a lot of time in more general psychiatry,

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Speaker 2: I noticed a very interesting trend. We spent a lot

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Speaker 2: of time looking at patients with bipolar disorder, and I

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Speaker 2: would hear patients say, you know, when I feel like

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Speaker 2: I'm spiraling out of control, I take a few hits

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Speaker 2: and I feel better. On the other side, you'd hear

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Speaker 2: patients say, I feel so depressed and down. I take

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Speaker 2: a few hits. I feel better. I had never heard

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Speaker 2: of anything like this, and so this got me thinking,

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Speaker 2: so we did a study. I wrote a grant to

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Speaker 2: look at mood changes in individuals with bipolar disorder pre

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Speaker 2: and post cannabis use, and we gave people little devices

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Speaker 2: to chart their mood after every time they used cannabis

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Speaker 2: and three other times a day. And we found that

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Speaker 2: individuals with bipolar disorder who used cannabis actually had greater

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Speaker 2: mood relief, if you will, from their symptoms relative to

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Speaker 2: those patients with bipolar disorder who didn't use cannabis. What

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Speaker 2: I was hearing was really individuals saying that they felt

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Speaker 2: more stable.

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Speaker 1: So it was working on both the manic side of

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Speaker 1: the bipolar and the depressive side.

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Speaker 2: It seemed too for certain people. So that got me thinking,

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Speaker 2: how could something both provide relief from feeling hypomanic or

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Speaker 2: manic and give you more of a little bit of

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Speaker 2: a lift if you're feeling depressed. And I was desperate

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Speaker 2: to understand how both could be true, how can we

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Speaker 2: harness some of these things? And that's really how it began.

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Speaker 2: And the truth is, cannabis is a remarkable plant with

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Speaker 2: over five hundred compounds. You know, we have this tendency

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Speaker 2: to say cannabis and we refer to any and all

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Speaker 2: things the plant. But it's a missoe we shouldn't do that.

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Speaker 2: It's not one thing and it's not one size fits all. Yeah,

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Speaker 2: let's dig into that a little bit. Let's do cannabis

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Speaker 2: one oh one for our listeners. Okay, so, can you

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Speaker 2: just briefly explain the difference between cannabis and hemp, and

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Speaker 2: cannabis and cannabinoids and kind of the important components, and

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Speaker 2: just give us an overview of cannabis one oh one

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Speaker 2: what we need to know cannabis one on one. I

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Speaker 2: guess I would start by saying that Cannabis sativa l.

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Speaker 2: The plant is remarkably complex. It is comprised of over

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Speaker 2: five hundred compounds. Some of these are phytocannabinoids, things from

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Speaker 2: the plant that interact with our own system of chemicals.

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Speaker 2: Receptors throughout the brain and body the endocannabinoid system. These

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Speaker 2: are things like delta nying THHC or tetrahydric canabinol, the

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Speaker 2: primary intoxicating constituent of the plant that our recreational folks

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Speaker 2: are desperate to find. No judgment, We're fine with them.

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Speaker 1: That's what makes us high, right, The THHC.

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Speaker 2: That's what makes you high, exactly, So primary intoxicating constituents

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Speaker 2: of the plant. Cannabi diol or CBD is a primary,

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Speaker 2: but not the only, non intoxicating constituent of the plant.

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Speaker 2: Often touted for medical benefits.

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Speaker 1: CBD is an anti inflammatory, right.

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Speaker 2: CBD is touted for its anti inflammatory actions. It's also

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Speaker 2: got lots of other actions, but yes, it's one of them.

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Speaker 2: But there are literally dozens and dozens of other cannabinoids

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Speaker 2: that we spend time focusing on. There are also things

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Speaker 2: like terpenes, the essential oils that give cannabis its characteristic

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Speaker 2: scent and flavor profile. These essential oils, by the way,

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Speaker 2: present in every plant, have their own biobehavioral health effects.

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Speaker 2: As it turns out, flabinoids waxy penal. So the plant

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Speaker 2: is complex. It's not just THHC and CBD, as people

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Speaker 2: will often pretend a whole plant. Full spectrum product contains

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Speaker 2: everything from the native plant that made the product, so

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Speaker 2: that's THC, cbd, any and all cannabinoids, terpenes, flabinoids, everything.

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Speaker 2: A broad spectrum product is identical except that it has

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Speaker 2: no quantifiable amounts of THHC present, again the primary intoxicating

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Speaker 2: constituent of the plant. There are some people who, for

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Speaker 2: legal or health reasons, cannot have any exposure to delta

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Speaker 2: nine THHC, So broad spectrum products are like full spectrum products,

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Speaker 2: except they don't contain quantifiable amounts of THHC. Hemp is

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Speaker 2: a variety of cannabis with inherently low levels of delta

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Speaker 2: nine THHC. It's often referred to as industrial hemp because

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Speaker 2: it was used for industrial purposes. These are basically at

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Speaker 2: this point excluded from the Controlled Substance Act, which means

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Speaker 2: that products that are created from hemp are not under

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Speaker 2: the same federal jurisdiction. That is, they are not federally illegal.

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Speaker 2: If you will, as cannabis or quote marijuana is, can you.

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Speaker 1: Speak to us a little bit about delivery systems, I mean, smoking, vaping,

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Speaker 1: edible vaginal suppositories for pelvic pain s.

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Speaker 2: Yes, all the above. Root matters. Think of it as

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Speaker 2: a GPS like, it matters which way you go. So

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Speaker 2: the fastest way to get an effect from using cannabis

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Speaker 2: is or a cannabinoid based product is what I would

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Speaker 2: call a root of inhalation, right, so either smoking or vaping,

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Speaker 2: so we inhale, it goes into the lungs, into the bloodstream,

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Speaker 2: into the brain. That's what I would call moments to

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Speaker 2: minutes to get an effect. We use a sublingual delivery

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Speaker 2: system for all of our clinical trials because the area

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Speaker 2: just under the tongue, the salibary mucosa, is incredibly rich

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Speaker 2: and absorbent, and instead of waiting for you to swallow

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Speaker 2: something and digest it, which we're going to get to

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Speaker 2: in a second, with edibles, your body can actually use

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Speaker 2: it much more effectively, much more quickly. Edibles, whether that's

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Speaker 2: a brownie or a cookie, or a candy, or even

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Speaker 2: a beverage, although beverages are slightly faster anting than cookies

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Speaker 2: and brownies. So this is the type of product that

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Speaker 2: people are often very happy to explore. They think it's

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Speaker 2: going to be terrific and they eat it or they

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Speaker 2: drink it, and they wait what they feel is an

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Speaker 2: appropriate amount of time, they don't feel anything, and then

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Speaker 2: they have more. It takes a very long time, comparatively speaking,

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Speaker 2: for you to get an effect from an edible or

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Speaker 2: consumed product. That's because you have to digest it. Interestingly,

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Speaker 2: cannabinoids are processed then by the liver. Your liver process

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Speaker 2: is all compounds, all drugs, right, and things like delta

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Speaker 2: nine THHC. The primary intoxicating considering of the plant is

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Speaker 2: actually converted to something even more intoxicating, eleven hydroxy. I

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Speaker 2: always tell people hold on root of administration is important.

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Speaker 2: If you're eating it, you have to give yourself plenty

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Speaker 2: of time to feel the effect and to recover from

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Speaker 2: the effect. Isn't the same as smoking or vaping, where

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Speaker 2: it's almost immediate.

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Speaker 1: Any damage to the lungs with us smoking. So you know,

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Speaker 1: there's a lot of dispute about this, and the twenty

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Speaker 1: seventeen Nason Report, the National Academies of Science Engineering in

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Speaker 1: Medicine looked at what indications or conditions there might be real,

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Speaker 1: substantial or moderately significant evidence for it with regard to

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Speaker 1: cannabis being efficacious, and they did review things like head

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Speaker 1: and neck cancers, and the rates were not significantly higher necessarily.

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Speaker 1: I think it's early still to figure that out. And

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Speaker 1: really most people acknowledge that the amount of cannabis that

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Speaker 1: people are smoking or vaping and the ways in which

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Speaker 1: they're doing it may be very different from things like

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Speaker 1: cigarette smoking, So maybe that's one of the differences. But

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Speaker 1: there's lots of debate about the carcinogenic compounds and what's contained,

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Speaker 1: so I think we don't know the whole story yet

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Speaker 1: for sure. But there are people who would prefer to

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Speaker 1: use a root of inhalation, so smoking or vaping. Dabbing,

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Speaker 1: of course, is another where people take a very very

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Speaker 1: concentrated Bullus concentrates are exactly as their name suggests, designed

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Speaker 1: to give the consumer or patient a big bang for

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Speaker 1: the buck. These are primarily THHC focused and start at

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Speaker 1: about forty five or fifty percent PhD and go north

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Speaker 1: of ninety nine percent. How do you dab?

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Speaker 2: So, in the case of an actual quote dab this

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Speaker 2: little blob of very concentrated product, you actually need something

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Speaker 2: that you can get very very hot with a blowtorch.

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Speaker 2: It doesn't look anything like conventional cannabis.

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Speaker 1: Use.

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Speaker 2: Like when we think about people passing a blunt or

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Speaker 2: a spliff or a joint or something, or a bong.

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Speaker 2: You see people with a little blowtorch and a little

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Speaker 2: flat area. They get very very hot, and as soon

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Speaker 2: as they put this little tiny blob of very concentrated

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Speaker 2: product on it, they inhale. They get this giant bulus

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Speaker 2: all at once. Then we get to the you know

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Speaker 2: sort of we had the oromycoastal or transmucostal. So things

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Speaker 2: like suppositories vaginal or rectal people are using for more

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Speaker 2: localized relief, and they do seem to be efficacious for

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Speaker 2: some folks. For some things, we never see recreational folks

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Speaker 2: using suppositors. I will tell you if you had to

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Speaker 2: come across a recreational purssses, yeah, that's my favorite way.

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Speaker 2: Now nobody says that.

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Speaker 1: No, how about for enhancement of sexual pleasure? Do you

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Speaker 1: see that? Yes, vaginal suppositories.

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Speaker 2: I think vaginal suppositories began as a way of increasing

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Speaker 2: pleasure and increasing lubrication and decreasing discomfort from many many

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Speaker 2: individuals who are having any kind of discomfort around sex.

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Speaker 2: And it was also initially tattered as a way of

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Speaker 2: you know, sort of getting yourself in the mood. But

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Speaker 2: at this point we certainly see a number of products

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Speaker 2: in the marketplace designed to address or ameliorate symptoms relative

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Speaker 2: to meastural related discomfort or other types of discomfort, as

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Speaker 2: well as enhancing sexual pleasure. And then there's the daily

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Speaker 2: suppositories for women quote of a certain age. As time

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Speaker 2: marches on, right, lots of people experience the things like

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Speaker 2: vaginal dryness, so some of these oppositors are used on

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Speaker 2: a daily basis, or oils are used.

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Speaker 1: So what are you finding And let's just speak a

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Speaker 1: little bit about midlife women, right, do you see a

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Speaker 1: number of midlife women using cannabis for medical reasons and

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Speaker 1: not recreational reasons? And if they are, what are they

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Speaker 1: using it for? Hot flashes, mood disruptions, sleep anxiety.

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Speaker 2: So the answer to both those questions is yes, yes,

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Speaker 2: and yes. The top three indications for medical cannabis use

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Speaker 2: across the country are chronic pain, mood or anxiety, and

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Speaker 2: sleep disruption. Not surprisingly, these are the three top conditions

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Speaker 2: we hear about in individuals who are either perimenopausal or postmenoposal,

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Speaker 2: so that's not a surprise. Individuals are increasingly interested in

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Speaker 2: using cannabis or cannabinoid based therapies to help because they

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Speaker 2: have very limited treatment options currently and very limited clinical response.

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Speaker 2: As it turns out, those who get clinical response from

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Speaker 2: certain conventional medications often complain about side effects, and the

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Speaker 2: cannabis or cannabinoids they may be able to reduce or

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Speaker 2: completely eliminate that aspect from the equation, which is pretty amazing.

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Speaker 1: So you started the Mind program, you have the Women's

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Speaker 1: Health Initiative within the Mind program. Can you tell me

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Speaker 1: what kind of questions you're trying to answer with that?

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Speaker 1: What are your goals? Where are you moving with that?

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Speaker 2: I didn't realize what a vastly understudied population we are.

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Speaker 2: I didn't. I really didn't. I didn't think about it.

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Speaker 2: You know, in psychiatry we think about things that are

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Speaker 2: disproportionately higher in women than men, like anxiety disorders. Right,

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Speaker 2: things like dementia occur in women more often than in men.

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Speaker 2: We have all of these things that we need to

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Speaker 2: be mindful of. Guide Ecologic pain, by the way, affects

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Speaker 2: over one billion with a b B one billion, and

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Speaker 2: we do relatively little, or we've had relatively little in

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Speaker 2: terms of these giant discoveries in terms of allowing people

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Speaker 2: to be better and not just feel better, but actually

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Speaker 2: be better. Women or the Women's Health Initiative at MIND

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Speaker 2: was a program that was dedicated to looking at conditions

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Speaker 2: or disorders that either disproportionately or exclusively affect women or

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Speaker 2: some non binary folks. Because there's so little work.

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Speaker 1: In this area, Stay right there. We've got lots more

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Speaker 1: from my conversation with doctor Stacey Gruber. Coming right up,

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Speaker 1: Can you describe a little bit about the endocannabinoid pathway

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Speaker 1: in the human body and how cannabisc and CBD are

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Speaker 1: impacting these pathways?

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Speaker 2: Sure, I would say it very sort of. The overarching,

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Speaker 2: you know, ten thousand foot summary is that every mammal

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Speaker 2: has an endocannabinoid system, highly understudied, highly undervalued, and its

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Speaker 2: whole purpose really is what we call homeostasis. We're keeping

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Speaker 2: things in balance, in check, mood, appetite, pain, all of

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Speaker 2: these things are impacted by the end cannabinoid system, and

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Speaker 2: it's comprised of these chemicals and receptors. And for chemicals,

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Speaker 2: they're our own cannabinoids. En do cannabinoids, and we have

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Speaker 2: receptors including CB one and CB two receptors. CB one

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Speaker 2: receptors primarily throughout the central nervous systems, CB two receptors

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Speaker 2: throughout the periphery. And it appears that THHC is really

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Speaker 2: a very very strong agonist, that is, it binds very

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Speaker 2: effectively to CB receptors.

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Speaker 1: So the CB two receptors are all throughout our body, correct,

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Speaker 1: not just our central nervous system.

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Speaker 2: Throughout the periphery, right, So you know, you see CB

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Speaker 2: two receptors sort of everywhere else a few in the brain,

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Speaker 2: but not like CB one receptors, And that may be

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Speaker 2: one of the reasons that initially people were rather stunned

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Speaker 2: to see that things like Crohn's disease, INFLAMMATORID bowel disease

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Speaker 2: were responsive to different types of cannabinoid based therapies. Not all,

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Speaker 2: not all cannabinoids are created equally, and we have to

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Speaker 2: be mindful with some actions come reactions, and so it's

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Speaker 2: very important to know which cannabinoids for which types of indications,

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Speaker 2: in which patient populations. And until relatively recently, we were

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Speaker 2: under the impression that cannabidial or CBD also must exert

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Speaker 2: its effects through the CB one and CB two receptors.

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Speaker 2: As it turns out it's not true. It appears that

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Speaker 2: CBD modulates its effects through five ht one A or

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Speaker 2: serotonin receptors, other chemical and receptor systems. So it's really

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Speaker 2: very easy to understand then how you get a bigger

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Speaker 2: bang for the buck with more quote players on the field.

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Speaker 2: If you're involving more than one receptor subtype and chemical

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Speaker 2: messenger system, you're going to get more of a response.

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Speaker 2: Right and medical school, we don't spend a ton of

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Speaker 2: time thinking about the endocannabinoid system. Nobody hears about it,

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Speaker 2: but it turns out to be incredibly important. Again, when

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Speaker 2: I think of it, I think as keeping everything in balance,

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Speaker 2: your ability to keep things at status. Quote, that's its

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Speaker 2: entire goal. That's the endocannabinoid system.

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Speaker 1: Can you just give us a broad overview of how

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Speaker 1: cannabis is impacting the brain for an axiolytic effect or

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Speaker 1: a pain of fact and that type of thing, like

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Speaker 1: what is it actually doing in the central nervous system

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Speaker 1: to help our anxiety, to help our pain?

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Speaker 2: I think that the jury is absolutely still out with

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Speaker 2: regard to the specific absolute mechanisms, because so many different

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Speaker 2: types of products wind up being efficacious, and those different

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Speaker 2: types of products have different constituent profiles, and so you

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Speaker 2: can't necessarily know exactly. Okay, well, we know it's this

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Speaker 2: receptor system in this one of this one, and I

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Speaker 2: tend to think of us as being comprised of dials

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Speaker 2: and not switches, right, what we really want to do

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Speaker 2: in individuals who are anxious, and I will tell you

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Speaker 2: in general, when we can allow people to take an

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Speaker 2: emotional breath dial down that master gain. Everything begins to

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Speaker 2: fall into place. And so I think of all of

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Speaker 2: these things, whether it's anxiety or some of the other

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Speaker 2: mood related symptoms, but particularly for anxiety, it would appear

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Speaker 2: that higher levels of CBD being administered in our case

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Speaker 2: sublingually where people are holding for two full minutes, that's

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Speaker 2: the secret two full minutes multiple times a day, very

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Speaker 2: low to no levels of depending on what we're doing,

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Speaker 2: we do tend to see this down regulation right of

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Speaker 2: this hyper responsive activity. The real data will come when

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Speaker 2: we can actually look at the underlying change in what

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Speaker 2: we call endocannabinoid tone. So when you can take samples

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Speaker 2: of individuals before they use these products and then follow

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Speaker 2: them over time and look at how that changes, we'll

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Speaker 2: have a better sense of exactly what's happening, but I

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Speaker 2: like to think of it as again turning down this

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Speaker 2: unbelievable response system. And people with real anxiety will tell

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Speaker 2: you it is paralyzing. They can't get out of it,

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Speaker 2: they can't stop ruminating, and so this ability to sort

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Speaker 2: of allow them to shift cognitive set is hugely life changing.

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Speaker 1: I'm definitely going to steal that we're made of dials,

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Speaker 1: not switches, because I think in modern medicine and pharmacology,

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Speaker 1: we think we're going to turn this pathway off or on,

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Speaker 1: flip it off or on, and it's not. It's an

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Speaker 1: adjustment in multiple pathways and dials. I would like to

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Speaker 1: ask you about cognitive health because that is one of

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Speaker 1: the concerns obviously with younger individuals who are using cannabis.

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Speaker 2: Those are the kinds of questions we started off asking.

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Speaker 2: I was very interested in understanding the cognitive changes that

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Speaker 2: we might see in individuals who are using medical cannabis.

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Speaker 2: We spent decades documenting cognitive decrements associated with recreational cannabis use,

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Speaker 2: particularly in those who began using cannabis regularly or consistently

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Speaker 2: early prior to age sixteen. Not surprising because again, the

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Speaker 2: brain is nerd, developmentally vulnerable, or as I like to

415
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Speaker 2: say to my cannabis audiences, half baked. Right, the brain

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Speaker 2: is under construction, not vulnerable just to cannabis, but to

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Speaker 2: other substances alcohol, injury, illness, just vulnerable. And my question

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Speaker 2: was for those who are beginning medical cannabis use, who

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Speaker 2: are adults beyond this period of vulnerability, would we see

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Speaker 2: the same decrements? And I will cut to the chase

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Speaker 2: and give you a spoiler alert and tell you absolutely

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Speaker 2: we do not see that, which is amazing. It is

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Speaker 2: not what people think.

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Speaker 1: So the brain develops to what age like, where are

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Speaker 1: we most vulnerable to alcohol and cannabis?

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Speaker 2: Yes, Interestingly, we used to think that the brain was

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Speaker 2: quote done by the time we hit puberty. This is

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Speaker 2: long ago and far away, and we now know that

429
00:23:17,970 --> 00:23:20,369
Speaker 2: the brain continues to develop throughout the second and into

430
00:23:20,410 --> 00:23:23,890
Speaker 2: the third decade of life. And so when we see

431
00:23:23,930 --> 00:23:27,330
Speaker 2: individuals who are using cannabis regularly that are you know,

432
00:23:27,730 --> 00:23:32,050
Speaker 2: let's say, age fourteen or fifteen, that may wind up

433
00:23:32,090 --> 00:23:34,890
Speaker 2: looking very different in terms of a cognitive profile, maybe

434
00:23:34,930 --> 00:23:37,770
Speaker 2: a clinical profile for sure, in terms of brain structure

435
00:23:37,770 --> 00:23:40,730
Speaker 2: and function relative to someone who began using much later

436
00:23:40,770 --> 00:23:43,210
Speaker 2: in life. That's a really important finding.

437
00:23:43,730 --> 00:23:46,730
Speaker 1: What's the data on cognitive health and older individuals and

438
00:23:46,810 --> 00:23:49,610
Speaker 1: brain health in terms of cannabis use.

439
00:23:49,930 --> 00:23:52,889
Speaker 2: We're just starting to get some of that data on individuals,

440
00:23:52,970 --> 00:23:55,369
Speaker 2: let's just say from midlife on over the age of

441
00:23:55,410 --> 00:23:57,650
Speaker 2: forty forty five. And you know, I used to move

442
00:23:57,690 --> 00:23:59,490
Speaker 2: that line depending on where the number was and where

443
00:23:59,490 --> 00:24:02,010
Speaker 2: I was just kidding, But the truth is, it looks

444
00:24:02,129 --> 00:24:04,369
Speaker 2: very different if you begin to use cannabis later in

445
00:24:04,450 --> 00:24:07,609
Speaker 2: life as opposed to when you are again neurobiologically or

446
00:24:07,770 --> 00:24:12,409
Speaker 2: or neurodevelopmentally vulnerable. Our data suggests that in individuals that

447
00:24:12,450 --> 00:24:14,369
Speaker 2: we see over the course of one year, and we

448
00:24:14,410 --> 00:24:17,209
Speaker 2: take people again, we look at them at baseline and

449
00:24:17,250 --> 00:24:19,930
Speaker 2: we give them a whole neurocognitive battery, and we do

450
00:24:20,010 --> 00:24:22,330
Speaker 2: the same thing at three months, six months, twelve, fifteen, eighteen,

451
00:24:22,330 --> 00:24:24,369
Speaker 2: twenty four, and now we go out for years and

452
00:24:24,570 --> 00:24:27,490
Speaker 2: even just looking at baseline to one year. When we

453
00:24:27,530 --> 00:24:30,650
Speaker 2: think of recreational cannabis ues and what we know, especially

454
00:24:30,650 --> 00:24:34,369
Speaker 2: from young folks, we generally see these frontal executive decrements,

455
00:24:34,369 --> 00:24:38,570
Speaker 2: so the ability to inhibit an inappropriate response, for example,

456
00:24:39,010 --> 00:24:42,609
Speaker 2: the hallmark of somebody who is let's say mature versus

457
00:24:42,650 --> 00:24:45,490
Speaker 2: somebody who is not When we're coming along and we're

458
00:24:45,490 --> 00:24:48,889
Speaker 2: in our teens. Unfortunately, our frontal cortex isn't necessarily online

459
00:24:49,050 --> 00:24:51,650
Speaker 2: as we age. That's the first part to go. That's

460
00:24:51,690 --> 00:24:54,730
Speaker 2: why babies and old people have trouble with inhibiting, right,

461
00:24:54,930 --> 00:24:58,210
Speaker 2: So they just blurred things out. There was a pre

462
00:24:58,290 --> 00:25:01,609
Speaker 2: clinical study that was done years ago in free groups

463
00:25:01,609 --> 00:25:04,169
Speaker 2: of mice that was really quite stunning. A group of

464
00:25:04,250 --> 00:25:08,090
Speaker 2: juvenile mis let's think of them as adolescents, outperformed middle

465
00:25:08,090 --> 00:25:13,129
Speaker 2: aged and older mice investigators that inserted a tiny little

466
00:25:13,129 --> 00:25:17,010
Speaker 2: pump delivering only THHC. And now the adult let's just

467
00:25:17,050 --> 00:25:21,170
Speaker 2: say middle aged and older adult mice outperformed the young

468
00:25:21,210 --> 00:25:24,530
Speaker 2: mice and the young mice when exposed to THHG in

469
00:25:24,570 --> 00:25:29,409
Speaker 2: the tournament. So the brain is vulnerable to certain types

470
00:25:29,450 --> 00:25:32,010
Speaker 2: of cannabinoids. It doesn't appear that it's the same case

471
00:25:32,170 --> 00:25:35,570
Speaker 2: necessarily for things like CBD, which has been touted as

472
00:25:35,609 --> 00:25:40,810
Speaker 2: potentially neuroprotective. So it's important to understand that age matters.

473
00:25:41,330 --> 00:25:43,770
Speaker 2: What you do and when you do it makes a difference.

474
00:25:43,850 --> 00:25:48,250
Speaker 2: And our folks certainly are not demonstrating decrements across the

475
00:25:48,290 --> 00:25:51,770
Speaker 2: board in frontal executive tasks. And from a brain imaging perspective,

476
00:25:52,170 --> 00:25:54,210
Speaker 2: you know your brain is comprised of gray matter, white

477
00:25:54,250 --> 00:25:57,650
Speaker 2: matter and CSF and gray matters are hard working neurons.

478
00:25:57,650 --> 00:26:01,369
Speaker 2: White matter, you know, this is what connects brain region

479
00:26:01,410 --> 00:26:03,690
Speaker 2: to brain region for good communication. And you want white

480
00:26:03,730 --> 00:26:06,129
Speaker 2: matter to have what we call high integrity or coherence.

481
00:26:06,369 --> 00:26:09,409
Speaker 2: We did a study our medical cannabis pations and what

482
00:26:09,490 --> 00:26:12,330
Speaker 2: we found was that, and again we compare them to

483
00:26:12,369 --> 00:26:14,770
Speaker 2: treatment as usual, folks. What we found is relative to

484
00:26:14,810 --> 00:26:17,970
Speaker 2: baseline with no cannabis on board, we don't see changes

485
00:26:18,050 --> 00:26:21,330
Speaker 2: or decreases in white matter organization or coherence. Over time,

486
00:26:21,490 --> 00:26:27,170
Speaker 2: we see increases that stunned me. Our studies of recreational consumers,

487
00:26:27,410 --> 00:26:31,129
Speaker 2: younger cannabis consumers had lower levels of white matter integrity

488
00:26:31,210 --> 00:26:34,610
Speaker 2: or coherence. We do not see that in adults who

489
00:26:34,650 --> 00:26:37,930
Speaker 2: begin using in midlife. In fact, we see increased white

490
00:26:37,930 --> 00:26:42,649
Speaker 2: matter coherence. This is perhaps the most surprising thing for

491
00:26:42,770 --> 00:26:43,330
Speaker 2: most people.

492
00:26:43,650 --> 00:26:46,689
Speaker 1: So, if a woman wants to explore using cannabis to

493
00:26:46,970 --> 00:26:50,369
Speaker 1: help her health and well being, what are some guidelines

494
00:26:50,410 --> 00:26:52,690
Speaker 1: for her? What should she be aware of? What should

495
00:26:52,730 --> 00:26:56,010
Speaker 1: she ask if she goes into a dispensary, what kind

496
00:26:56,050 --> 00:26:58,010
Speaker 1: of questions? What should she look out for?

497
00:26:58,450 --> 00:27:01,290
Speaker 2: I would say the overarching things to be mindful of,

498
00:27:01,369 --> 00:27:02,970
Speaker 2: like what are the top things you say to people?

499
00:27:03,930 --> 00:27:06,330
Speaker 2: Start low and go slow. As an obvious one, here's

500
00:27:06,369 --> 00:27:09,250
Speaker 2: the thing that people don't know about cannabinoids. Necessarily, you

501
00:27:09,290 --> 00:27:13,169
Speaker 2: can always add, you can take away. Never Once it's in,

502
00:27:13,369 --> 00:27:15,650
Speaker 2: it's in. You can't really throw it up or poop

503
00:27:15,690 --> 00:27:18,050
Speaker 2: it out like it doesn't work that way. It's in, okay.

504
00:27:18,170 --> 00:27:20,369
Speaker 2: And so what we want to be mindful of is

505
00:27:20,690 --> 00:27:23,570
Speaker 2: the root of administration and knowing that you can always

506
00:27:23,609 --> 00:27:26,570
Speaker 2: add to what you've taken. So it's better to err

507
00:27:26,609 --> 00:27:29,409
Speaker 2: on the side of less rather than more until you

508
00:27:29,450 --> 00:27:32,050
Speaker 2: know how you're going to respond to different products, and

509
00:27:32,090 --> 00:27:36,409
Speaker 2: they are different. A gummy created for sleep versus pain

510
00:27:37,090 --> 00:27:40,050
Speaker 2: versus anything else, even by the same company, may very

511
00:27:40,090 --> 00:27:43,090
Speaker 2: well affect you very differently because the constituent profile is different.

512
00:27:43,450 --> 00:27:46,290
Speaker 2: What works for your best friend, your husband, your girlfriend

513
00:27:46,490 --> 00:27:48,850
Speaker 2: may not work for you. That's the other thing to

514
00:27:48,890 --> 00:27:51,290
Speaker 2: be mindful of. Be mindful of the here just try

515
00:27:51,330 --> 00:27:52,129
Speaker 2: this phenomenon.

516
00:27:52,609 --> 00:27:53,250
Speaker 1: Eh.

517
00:27:53,290 --> 00:27:55,650
Speaker 2: I had one patient who said her husband said, oh,

518
00:27:55,890 --> 00:27:57,730
Speaker 2: this is exactly what you need right now. And he

519
00:27:57,770 --> 00:27:59,810
Speaker 2: gave her something that was the equivalent of about fifty

520
00:28:00,090 --> 00:28:03,850
Speaker 2: milligrams of THHC. Look didn't dend well. Low doses of

521
00:28:03,890 --> 00:28:07,449
Speaker 2: THC are generally considered for many people angxiolytic. That is,

522
00:28:07,450 --> 00:28:10,490
Speaker 2: they can help reduce anxiety for the majority of individuals,

523
00:28:10,490 --> 00:28:13,650
Speaker 2: and in fact, at certain levels everyone, THHD can be exogenic.

524
00:28:13,730 --> 00:28:16,169
Speaker 2: That does, it can create or worsen anxiety. So you

525
00:28:16,210 --> 00:28:18,409
Speaker 2: have to be very very careful. And to me, a

526
00:28:18,490 --> 00:28:21,609
Speaker 2: quote small dose is not what other people's small dose is.

527
00:28:21,970 --> 00:28:24,850
Speaker 2: Five miligrams is not a small dose. That's a full dose.

528
00:28:25,090 --> 00:28:27,770
Speaker 2: Governor Hickenlooper and Colorado back in the day twenty twelve,

529
00:28:27,970 --> 00:28:31,970
Speaker 2: proposed ten milligrams of THC per serving. That was dropped

530
00:28:32,050 --> 00:28:34,810
Speaker 2: by Nora Walkoff, the director of NAIDA, the National Institutes

531
00:28:34,850 --> 00:28:38,170
Speaker 2: on Drug Abuse. So what's a small dose in my world?

532
00:28:38,290 --> 00:28:40,570
Speaker 2: Less than one milligram? And people laugh, they go, oh,

533
00:28:40,570 --> 00:28:42,930
Speaker 2: come on, you can't get anything. No, I can get

534
00:28:42,970 --> 00:28:45,490
Speaker 2: activity at a receptor, which is what I'm looking for.

535
00:28:45,890 --> 00:28:47,530
Speaker 1: And then you have to be careful, like if your

536
00:28:47,690 --> 00:28:49,730
Speaker 1: gummy is that ten milligrams are five milligrams and you

537
00:28:49,770 --> 00:28:51,090
Speaker 1: cut it up, you have to make sure it's a

538
00:28:51,130 --> 00:28:55,130
Speaker 1: homogeneous gummy, right, because some of them are not so homogeneous.

539
00:28:55,410 --> 00:29:00,450
Speaker 2: Edibles are the most challenging products in terms of dozing,

540
00:29:00,770 --> 00:29:03,050
Speaker 2: in terms of making sure that you know, if it's

541
00:29:03,090 --> 00:29:06,690
Speaker 2: a batch of brownies that a well intended manufacturer has created,

542
00:29:07,290 --> 00:29:09,530
Speaker 2: does the brownie on the bottom left have exactly the

543
00:29:09,570 --> 00:29:12,209
Speaker 2: same profiles a brownie in the bottom right, I don't know,

544
00:29:12,490 --> 00:29:14,250
Speaker 2: And it depends did you tip the pant? All these

545
00:29:14,250 --> 00:29:17,170
Speaker 2: things matter, and so not to scare anybody, but again,

546
00:29:17,290 --> 00:29:20,850
Speaker 2: start with something small, smaller than small. Start with a

547
00:29:20,930 --> 00:29:22,650
Speaker 2: quarter of what you think you should have, and then

548
00:29:22,810 --> 00:29:25,930
Speaker 2: add don't go the other way because unfortunately I get

549
00:29:25,930 --> 00:29:27,170
Speaker 2: the calls in the middle of the night where people

550
00:29:27,170 --> 00:29:30,250
Speaker 2: are in the emergency group, and that's decidedly unpleasant and

551
00:29:30,290 --> 00:29:31,090
Speaker 2: should be avoided.

552
00:29:31,330 --> 00:29:34,170
Speaker 1: So start low and go slow. And what's right for

553
00:29:34,290 --> 00:29:36,370
Speaker 1: your friend is not right for you, and you've got

554
00:29:36,370 --> 00:29:37,010
Speaker 1: to figure it.

555
00:29:36,930 --> 00:29:40,650
Speaker 2: Out your own. Metabolism affects things. What other products or

556
00:29:40,690 --> 00:29:44,370
Speaker 2: compounds are on board will affect things. Alcohol on board.

557
00:29:44,450 --> 00:29:47,770
Speaker 2: So here's another important fact. We know that in a

558
00:29:47,850 --> 00:29:50,450
Speaker 2: quote fed state, that is, with food in your system,

559
00:29:50,690 --> 00:29:54,690
Speaker 2: cannabinoids have much higher bioavailability. That is, the ability for

560
00:29:54,770 --> 00:29:58,610
Speaker 2: your brain and body to use these compounds. So somebody's

561
00:29:58,650 --> 00:30:00,730
Speaker 2: going out to a club with their friends and they pregame,

562
00:30:00,810 --> 00:30:02,250
Speaker 2: so they're going to drink at home. So what do

563
00:30:02,290 --> 00:30:04,370
Speaker 2: they do. They have like a half a cheese pizza, right,

564
00:30:04,490 --> 00:30:07,010
Speaker 2: something in the gut to help absorb, so they're not

565
00:30:07,370 --> 00:30:10,370
Speaker 2: out of their minds. When you do that with cannabinoids,

566
00:30:10,370 --> 00:30:12,290
Speaker 2: you actually make get I had a much bigger signal

567
00:30:12,290 --> 00:30:14,410
Speaker 2: from the connappenoids, so it's the opposite.

568
00:30:14,610 --> 00:30:15,530
Speaker 1: It's so interesting.

569
00:30:15,890 --> 00:30:18,610
Speaker 2: So when people said I had a full stomach, I'm like, oh, oh.

570
00:30:18,650 --> 00:30:21,810
Speaker 1: Yeah, So more food equals more effect.

571
00:30:22,010 --> 00:30:24,170
Speaker 2: You may get more effect. Yeah.

572
00:30:24,250 --> 00:30:26,370
Speaker 1: I want to pause for a moment here to talk

573
00:30:26,450 --> 00:30:29,610
Speaker 1: more about what we know about mixing cannabis and alcohol.

574
00:30:30,610 --> 00:30:33,290
Speaker 1: Researchers have found that using the two together can worsen

575
00:30:33,330 --> 00:30:37,690
Speaker 1: their effects on thinking and coordination, and alcohol can significantly

576
00:30:37,850 --> 00:30:43,130
Speaker 1: increase THHC absorption. This combination is also linked to more

577
00:30:43,210 --> 00:30:47,410
Speaker 1: risky behaviors. Overall, there hasn't been a lot of research

578
00:30:47,410 --> 00:30:49,890
Speaker 1: in this area yet, so we don't fully understand all

579
00:30:49,930 --> 00:30:53,170
Speaker 1: of the implications, and of course the effects can vary

580
00:30:53,210 --> 00:30:56,130
Speaker 1: a lot depending on how much alcohol you're drinking and

581
00:30:56,130 --> 00:30:59,530
Speaker 1: what kind of cannabis product you're using. So we've talked

582
00:30:59,570 --> 00:31:03,610
Speaker 1: about THC five milligrams being on the low end standard dose.

583
00:31:03,730 --> 00:31:07,050
Speaker 2: Yeah, what about CBD depends on what you're using it for.

584
00:31:07,170 --> 00:31:11,170
Speaker 2: So for some people, at our first clinical trial of anxiety,

585
00:31:11,730 --> 00:31:13,570
Speaker 2: we pitched very low. I based it on a product

586
00:31:13,610 --> 00:31:15,690
Speaker 2: that was being used in San Francisco in the Bay

587
00:31:15,730 --> 00:31:19,530
Speaker 2: Area that had great response, and it was somewhere between

588
00:31:19,570 --> 00:31:22,330
Speaker 2: ten and twelve milligrams per mil of CBD, but a

589
00:31:22,370 --> 00:31:25,050
Speaker 2: whole plant ful spatrum product and very low tcy like

590
00:31:25,370 --> 00:31:27,890
Speaker 2: less than point three milligrams, So it wasn't going to

591
00:31:27,930 --> 00:31:30,130
Speaker 2: get you high necessarily, and that was what I was

592
00:31:30,170 --> 00:31:34,290
Speaker 2: aiming for. But the amount of CBD that you might

593
00:31:34,770 --> 00:31:37,290
Speaker 2: think about using is really dictated by what ails you

594
00:31:37,890 --> 00:31:39,770
Speaker 2: for a mood. You might need less than you would

595
00:31:39,770 --> 00:31:45,050
Speaker 2: for chronic pain. Ourre chronic pain studies start significantly higher.

596
00:31:45,050 --> 00:31:48,050
Speaker 2: Most of my studies now use a whole lot more product,

597
00:31:48,290 --> 00:31:49,770
Speaker 2: a higher concentrated product.

598
00:31:49,850 --> 00:31:52,930
Speaker 1: So it depends back to some practical advice. For a

599
00:31:52,930 --> 00:31:57,330
Speaker 1: midlife woman who may be having perimenopausal symptoms issues or

600
00:31:57,410 --> 00:32:02,010
Speaker 1: menopausal issues worse than perimenopause, many times, start low, go slow.

601
00:32:02,090 --> 00:32:03,490
Speaker 1: What would you recommend to start with.

602
00:32:04,050 --> 00:32:07,650
Speaker 2: I would say systemic administration is generally better. A lot

603
00:32:07,690 --> 00:32:10,770
Speaker 2: of times people are caught up in the topical or

604
00:32:11,370 --> 00:32:13,970
Speaker 2: dermal realms. You know what, I have cramps. I'm just

605
00:32:13,970 --> 00:32:16,530
Speaker 2: going to put some of this salve or this lotion

606
00:32:17,210 --> 00:32:20,850
Speaker 2: of systemic application. Something that you take is likely to

607
00:32:20,850 --> 00:32:24,130
Speaker 2: give you the best response. A root of inhalation is

608
00:32:24,170 --> 00:32:26,450
Speaker 2: the fastest way of getting response, but it's not generally

609
00:32:26,530 --> 00:32:29,690
Speaker 2: the way that most patients want to take quote their medicine.

610
00:32:29,730 --> 00:32:34,090
Speaker 2: Not generally, so I would say again, if you're looking

611
00:32:34,130 --> 00:32:37,810
Speaker 2: to address things like chronic pain, I'm a fan of

612
00:32:37,850 --> 00:32:41,890
Speaker 2: sublingual solutions as opposed to other things, and you really

613
00:32:41,890 --> 00:32:44,650
Speaker 2: want to make sure that whatever you're using. In my

614
00:32:44,730 --> 00:32:47,610
Speaker 2: humble opinion, whole plant broad or whole plant full spectrum

615
00:32:47,610 --> 00:32:52,010
Speaker 2: products are highly efficacious For many things. The individual constituents

616
00:32:52,010 --> 00:32:55,890
Speaker 2: within the product dictate the outcome, So if you're having

617
00:32:55,890 --> 00:32:58,690
Speaker 2: trouble with sleep, might look for something with higher levels

618
00:32:58,690 --> 00:33:02,850
Speaker 2: of CBD and not a huge amount of teaching necessarily,

619
00:33:03,290 --> 00:33:04,450
Speaker 2: sometimes a little is fine.

620
00:33:08,050 --> 00:33:11,410
Speaker 1: After the break, we'll get into safety issues to tell

621
00:33:11,410 --> 00:33:14,770
Speaker 1: how much THHC is really in a product, regardless of

622
00:33:14,810 --> 00:33:27,330
Speaker 1: what the label says, We'll be right back looking for

623
00:33:27,370 --> 00:33:30,410
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624
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625
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627
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629
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631
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632
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633
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635
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636
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637
00:34:24,890 --> 00:34:27,930
Speaker 1: who wants to maybe you feel better, maybe better cognitive function,

638
00:34:28,370 --> 00:34:31,130
Speaker 1: get better sleep, is there an advantage of going to

639
00:34:31,170 --> 00:34:34,970
Speaker 1: a medical dispensary versus going to a recreational dispensary?

640
00:34:35,450 --> 00:34:39,530
Speaker 2: Very often medical products have a significantly lowered tax rate

641
00:34:39,570 --> 00:34:42,890
Speaker 2: associated Very often the same products the plant doesn't care

642
00:34:42,930 --> 00:34:44,489
Speaker 2: what you use it for. By the way, plant doesn't

643
00:34:44,530 --> 00:34:47,570
Speaker 2: care at all. Right, Cannabis is cannabis, But the products

644
00:34:47,570 --> 00:34:50,090
Speaker 2: themselves are tax very differently, and there may be a

645
00:34:50,130 --> 00:34:53,090
Speaker 2: different fund of information from the quote patient care advocates

646
00:34:53,130 --> 00:34:56,170
Speaker 2: or bud tenders that you're talking to. So there are

647
00:34:56,210 --> 00:34:59,250
Speaker 2: different types of products that people should probably be exploring

648
00:34:59,290 --> 00:35:03,330
Speaker 2: if they're interested in having let's say, better sleep versus

649
00:35:03,730 --> 00:35:07,170
Speaker 2: addressing things like chronic pain or motor anxiety. Sometimes it's

650
00:35:07,170 --> 00:35:09,330
Speaker 2: a question of dose with the same type of product,

651
00:35:09,570 --> 00:35:12,490
Speaker 2: and sometimes it's a whole different set of players we

652
00:35:12,530 --> 00:35:15,490
Speaker 2: want on the field. So there are some constituents that

653
00:35:15,530 --> 00:35:17,690
Speaker 2: people don't talk about too often, although now we're seeing

654
00:35:17,690 --> 00:35:22,530
Speaker 2: them more often, like CBN or cannabinol. Actually THHC degrades

655
00:35:22,610 --> 00:35:24,650
Speaker 2: over time and we get high levels of CBN and

656
00:35:24,730 --> 00:35:28,930
Speaker 2: old weed. But CBN has been remarkably effective for some

657
00:35:29,010 --> 00:35:31,690
Speaker 2: people with regard to decreasing sleep latency, so time to

658
00:35:31,730 --> 00:35:34,570
Speaker 2: fall asleep and the ability to have better sleep coherence

659
00:35:34,650 --> 00:35:37,290
Speaker 2: or staying sleep. I think of CBD is helpful for

660
00:35:37,330 --> 00:35:41,010
Speaker 2: coherence and CBN is great for latency, but high CBN

661
00:35:41,090 --> 00:35:44,090
Speaker 2: levels are often helpful for people with sleep disruption and

662
00:35:44,170 --> 00:35:48,530
Speaker 2: it's not really generally considered intoxicating. So different combinations of

663
00:35:48,530 --> 00:35:50,490
Speaker 2: these types of compounds are making their way into the

664
00:35:50,490 --> 00:35:53,650
Speaker 2: marketplace now, which makes me very happy. And it's what

665
00:35:53,690 --> 00:35:56,210
Speaker 2: we do in our clinical trials. We try to create

666
00:35:56,250 --> 00:35:59,330
Speaker 2: products and formulate them so that they're optimized to address

667
00:35:59,370 --> 00:36:01,090
Speaker 2: these different conditions and indications.

668
00:36:01,250 --> 00:36:03,850
Speaker 1: So it sounds like this where is like hypothesis generating

669
00:36:03,970 --> 00:36:06,890
Speaker 1: and then you move into making your own product. Do

670
00:36:06,890 --> 00:36:08,610
Speaker 1: you have your own tinc sure that you're making or

671
00:36:08,650 --> 00:36:09,890
Speaker 1: have made? Is that correct?

672
00:36:11,170 --> 00:36:13,890
Speaker 2: A number of different clinical trials, Each clinical trial generally

673
00:36:13,970 --> 00:36:16,490
Speaker 2: uses a different type of product. If you're looking for

674
00:36:16,570 --> 00:36:21,650
Speaker 2: something for sleep versus focus or concentration versus chronic pain,

675
00:36:21,650 --> 00:36:24,010
Speaker 2: they're going to look different. In our group, we spend

676
00:36:24,010 --> 00:36:25,930
Speaker 2: a lot of time I custom formulate all of our

677
00:36:25,970 --> 00:36:29,010
Speaker 2: products to capitalize on that idea.

678
00:36:29,210 --> 00:36:31,410
Speaker 1: How do women begin to what are safety concerns that

679
00:36:31,450 --> 00:36:33,810
Speaker 1: women should have? What do they need to ask, what

680
00:36:33,850 --> 00:36:35,890
Speaker 1: do they need to what do they need to look

681
00:36:35,970 --> 00:36:38,210
Speaker 1: for to be safe about this? If they want to

682
00:36:38,290 --> 00:36:41,490
Speaker 1: explore using cannabis to relieve some of their symptoms.

683
00:36:41,170 --> 00:36:43,690
Speaker 2: So yeah, for symptom relief, And if that's really clear

684
00:36:43,690 --> 00:36:46,250
Speaker 2: I always tell people no, before you go, be honest

685
00:36:46,290 --> 00:36:48,770
Speaker 2: with yourself and ultimately the people that you're talking with

686
00:36:48,930 --> 00:36:51,410
Speaker 2: or dealing with about what your real goal is. And again,

687
00:36:51,490 --> 00:36:53,690
Speaker 2: no shame in Ah. You know, I'd like to take

688
00:36:53,730 --> 00:36:56,370
Speaker 2: the endge off with my partner on Friday. Fine mazzle,

689
00:36:56,530 --> 00:37:00,010
Speaker 2: but very different from I have this intractable pain. I

690
00:37:00,010 --> 00:37:02,250
Speaker 2: can't move. I really I can't get off the couch.

691
00:37:02,290 --> 00:37:07,690
Speaker 2: I'm really uncomfortable. So label claims have been reported to

692
00:37:07,730 --> 00:37:11,530
Speaker 2: be both under and overstated. So sometimes product will say

693
00:37:11,530 --> 00:37:13,330
Speaker 2: that it has a whole lot more of let's say

694
00:37:13,330 --> 00:37:15,530
Speaker 2: CBD in it than it does, which, by the way,

695
00:37:15,610 --> 00:37:18,650
Speaker 2: is really heartbreaking when you're talking to somebody who's seventy

696
00:37:18,650 --> 00:37:21,210
Speaker 2: eight years old on a fixed income and has spent

697
00:37:21,570 --> 00:37:23,930
Speaker 2: ninety six dollars on a one ounce bottle of something

698
00:37:24,250 --> 00:37:27,010
Speaker 2: that's supposed to be fifty megs per mel and it's three.

699
00:37:27,250 --> 00:37:31,330
Speaker 2: That's a problem. Sometimes they're understated with regard to things

700
00:37:31,370 --> 00:37:34,330
Speaker 2: like THHC, where the individual is going to be exposed

701
00:37:34,370 --> 00:37:36,570
Speaker 2: to a whole lot more THC than they might have anticipated.

702
00:37:36,810 --> 00:37:38,930
Speaker 2: The only way to know really what's in your weed,

703
00:37:39,010 --> 00:37:41,610
Speaker 2: or what's in the product you're using is to ask

704
00:37:41,770 --> 00:37:44,210
Speaker 2: your dispensary or the point of sale if you're buying

705
00:37:44,210 --> 00:37:47,570
Speaker 2: it online, or a certificate of analysis to ensure that

706
00:37:48,210 --> 00:37:51,050
Speaker 2: the product is what they would like it to be.

707
00:37:51,530 --> 00:37:55,090
Speaker 2: Dispensaries have to have them by law, and most reputable

708
00:37:55,170 --> 00:37:59,650
Speaker 2: manufacturers and sellers online will also have coas for all

709
00:37:59,690 --> 00:38:02,730
Speaker 2: of their products by batch, not just the general one

710
00:38:02,730 --> 00:38:05,010
Speaker 2: that sort of represented what they made long ago and

711
00:38:05,050 --> 00:38:07,810
Speaker 2: far away, but the actual product that you're using. You

712
00:38:07,810 --> 00:38:10,290
Speaker 2: should be able to match the batch and look at

713
00:38:10,290 --> 00:38:13,130
Speaker 2: the CoA that will tell you exactly how much of

714
00:38:13,130 --> 00:38:15,290
Speaker 2: each of the compounds is in your product. I would

715
00:38:15,370 --> 00:38:19,490
Speaker 2: remind people that it is not necessarily without its own

716
00:38:19,650 --> 00:38:23,810
Speaker 2: associated concerns or risks. So we think about things like

717
00:38:23,890 --> 00:38:26,450
Speaker 2: drug drug interactions. This is what I call the least

718
00:38:26,450 --> 00:38:29,130
Speaker 2: popular girl at the dance phenomenon. When I bring this up,

719
00:38:29,170 --> 00:38:32,250
Speaker 2: people say, oh, with that already. So here's how it goes.

720
00:38:32,410 --> 00:38:35,890
Speaker 2: Your liver processes all drugs and so. As it turns out,

721
00:38:36,530 --> 00:38:40,010
Speaker 2: cannabinoids impact the liver's enzyme systems. The cytochrome P four

722
00:38:40,050 --> 00:38:43,450
Speaker 2: fifty enzyme system highly impacted by cannabinoids, and in fact,

723
00:38:43,850 --> 00:38:48,090
Speaker 2: CBD affects more of them than DHC so as a result,

724
00:38:48,290 --> 00:38:51,130
Speaker 2: we are very careful with individuals who are on certain

725
00:38:51,170 --> 00:38:55,050
Speaker 2: types of medications because you could wind up inadvertently increasing

726
00:38:55,410 --> 00:38:57,970
Speaker 2: or decreasing the serum level of certain drugs that you

727
00:38:58,010 --> 00:39:00,610
Speaker 2: would not want to do that with. For example, an

728
00:39:00,610 --> 00:39:03,490
Speaker 2: ANTIICOI got a blood fitter. It's not so great to

729
00:39:04,130 --> 00:39:06,930
Speaker 2: increase the amount of blood thatitter coursing through your body.

730
00:39:07,010 --> 00:39:07,530
Speaker 1: No, thank you.

731
00:39:07,970 --> 00:39:11,170
Speaker 2: Women should be mindful of that. It's not completely benign.

732
00:39:11,330 --> 00:39:12,250
Speaker 2: You have to be careful.

733
00:39:12,410 --> 00:39:15,610
Speaker 1: So a number of midlife women may be on SSRIs

734
00:39:15,810 --> 00:39:18,650
Speaker 1: or even hormone replacement therapy so or I call it

735
00:39:18,690 --> 00:39:22,290
Speaker 1: men a puzzle hormone support. Sorry, not HRT. That's old fashion, right,

736
00:39:22,330 --> 00:39:25,730
Speaker 1: we don't say that anymore, right, therapy support? Is there

737
00:39:25,770 --> 00:39:29,490
Speaker 1: any interaction with cannabis.

738
00:39:28,490 --> 00:39:30,850
Speaker 2: So there are some to be mindful of. The best

739
00:39:30,890 --> 00:39:33,090
Speaker 2: thing to do is to go online and actually look

740
00:39:33,170 --> 00:39:37,450
Speaker 2: for the drug drug interaction calculator, and you can put

741
00:39:37,490 --> 00:39:39,650
Speaker 2: in anything you're using. And the reason I wouldn't be

742
00:39:39,690 --> 00:39:42,850
Speaker 2: specific is because then you could misinterpret what I'm saying

743
00:39:42,850 --> 00:39:44,450
Speaker 2: and take it as postulate, and so we don't want

744
00:39:44,450 --> 00:39:48,410
Speaker 2: to do that. But to your point, generally, there are

745
00:39:49,170 --> 00:39:52,370
Speaker 2: a number of conventional medications that are not a concern,

746
00:39:52,490 --> 00:39:54,450
Speaker 2: and then there are a handful that are, and some

747
00:39:54,530 --> 00:39:57,650
Speaker 2: of them appear in certain classes like SSRIs for sure,

748
00:39:58,010 --> 00:40:02,690
Speaker 2: benzodiazepines for sure, anticoagulants or blood thinners, So we want

749
00:40:02,690 --> 00:40:06,290
Speaker 2: to be mindful of that. Hoomone replacement not generally an issue,

750
00:40:06,290 --> 00:40:09,370
Speaker 2: but always best to check with your PCP. But you

751
00:40:09,410 --> 00:40:12,770
Speaker 2: can look at a drug drug int Reaction tool online,

752
00:40:12,770 --> 00:40:17,650
Speaker 2: which is incredibly helpful because sometimes people aren't always forthcoming

753
00:40:17,650 --> 00:40:20,330
Speaker 2: about what they're using. That's the other thing. They don't

754
00:40:20,330 --> 00:40:22,770
Speaker 2: necessarily want to tell their treat that they're using cannabis

755
00:40:22,850 --> 00:40:24,690
Speaker 2: or cannabinoids. And I say this to you if you're

756
00:40:24,730 --> 00:40:27,650
Speaker 2: one of those folks, don't be afraid. If your doctor

757
00:40:27,810 --> 00:40:32,010
Speaker 2: isn't open minded and willing to listen to why you're using,

758
00:40:32,050 --> 00:40:34,530
Speaker 2: what you're getting from it, and your rationale, you may

759
00:40:34,570 --> 00:40:37,290
Speaker 2: want to consider talking to someone else. Let's talk about

760
00:40:37,290 --> 00:40:38,170
Speaker 2: physician education.

761
00:40:38,370 --> 00:40:42,490
Speaker 1: So I'm a pretty curious physician, early adopter of medical

762
00:40:42,530 --> 00:40:46,290
Speaker 1: marijuana twenty twelve, twenty fourteen in New Jersey, New York.

763
00:40:46,370 --> 00:40:49,850
Speaker 1: Good for you, And Demetriosi is pretty curious but know

764
00:40:50,090 --> 00:40:52,570
Speaker 1: very little about this. Know a lot more now, But

765
00:40:53,650 --> 00:40:57,930
Speaker 1: what is the average physician, what is their participation in

766
00:40:58,090 --> 00:41:01,410
Speaker 1: knowledge of these pathways and the impact that cannabis and

767
00:41:01,450 --> 00:41:03,970
Speaker 1: the utility and benefit that it can have for women

768
00:41:04,210 --> 00:41:05,410
Speaker 1: or just patients in general.

769
00:41:06,290 --> 00:41:09,810
Speaker 2: Generally, people are underinformed and they are overwhelmed by the

770
00:41:10,490 --> 00:41:13,130
Speaker 2: headline that will tell you cannabis is terrible for this

771
00:41:13,330 --> 00:41:15,930
Speaker 2: and awful for that, And it's so important to understand

772
00:41:16,010 --> 00:41:19,210
Speaker 2: once again, cannabis is not one thing. It is a

773
00:41:19,330 --> 00:41:22,530
Speaker 2: multi compound plant, so to refer to anything that comes

774
00:41:22,530 --> 00:41:26,330
Speaker 2: from it is foolish. It is also really unfortunately true

775
00:41:26,610 --> 00:41:29,610
Speaker 2: that most don't have the time to educate themselves about

776
00:41:29,610 --> 00:41:31,810
Speaker 2: where it may be most effications, where it may be

777
00:41:31,890 --> 00:41:35,330
Speaker 2: most concerning, or how it may differ from their firmly

778
00:41:35,370 --> 00:41:38,650
Speaker 2: held beliefs. Our patients require it, I mean, really, they

779
00:41:38,650 --> 00:41:41,490
Speaker 2: are looking to us to help make good, sound decisions.

780
00:41:42,130 --> 00:41:45,210
Speaker 2: Those decisions should be based on real data, real science,

781
00:41:45,250 --> 00:41:48,850
Speaker 2: and not rhetoric or your own personal beliefs. I think

782
00:41:48,890 --> 00:41:52,250
Speaker 2: that more and more physicians are interested in understanding it

783
00:41:52,290 --> 00:41:55,490
Speaker 2: because it's coming through the door every day now, and

784
00:41:55,570 --> 00:41:58,690
Speaker 2: it's usually because one of their quote more responsible patients

785
00:41:59,570 --> 00:42:01,690
Speaker 2: has raised the question, and so now they're going to

786
00:42:01,770 --> 00:42:03,850
Speaker 2: dig into it they had a handful before, But you know,

787
00:42:03,890 --> 00:42:06,410
Speaker 2: those people were probably just looking for a legal way

788
00:42:06,930 --> 00:42:09,130
Speaker 2: to be high. I was told the same thing when

789
00:42:09,170 --> 00:42:11,770
Speaker 2: we first started this program. We created a metric in

790
00:42:11,850 --> 00:42:14,770
Speaker 2: our lab called can account, and it allows us to

791
00:42:14,890 --> 00:42:17,850
Speaker 2: quantify the amount of individual cannabinoids that people are exposed

792
00:42:17,850 --> 00:42:20,530
Speaker 2: to on a weekly basis, whether you're using a tincture

793
00:42:20,650 --> 00:42:23,810
Speaker 2: or flower product, or an edible or beverage. There are

794
00:42:23,850 --> 00:42:26,050
Speaker 2: ways that you can calculate it based on both what's

795
00:42:26,050 --> 00:42:28,210
Speaker 2: on the label and a certificate of analysis, how long

796
00:42:28,250 --> 00:42:29,970
Speaker 2: it takes you to use it, how you're using all

797
00:42:30,010 --> 00:42:32,650
Speaker 2: these things. And the truth is when we look at

798
00:42:32,650 --> 00:42:36,290
Speaker 2: the data at three months, six months, and one year,

799
00:42:36,450 --> 00:42:41,170
Speaker 2: overwhelmingly just looking at CBD and THHC levels, CBD is

800
00:42:41,250 --> 00:42:44,970
Speaker 2: exponentially higher than THHC, underscoring the point that these people

801
00:42:44,970 --> 00:42:49,610
Speaker 2: aren't really chasing a high. So it's important for physicians, caregivers,

802
00:42:50,610 --> 00:42:54,130
Speaker 2: healthcare workers, legislators, everybody to sort of let go of

803
00:42:54,170 --> 00:42:56,610
Speaker 2: what we think we know and allow ourselves to be

804
00:42:56,650 --> 00:42:58,810
Speaker 2: open to what the science and the data tell us.

805
00:42:59,010 --> 00:43:01,690
Speaker 2: It's really important to remember and to remind people who

806
00:43:01,690 --> 00:43:04,330
Speaker 2: see patients every day all day to have dialogues and

807
00:43:04,330 --> 00:43:06,690
Speaker 2: not monologues with their patients. This is supposed to be

808
00:43:06,730 --> 00:43:10,250
Speaker 2: a conversation, not me telling you what to do. And

809
00:43:10,530 --> 00:43:13,250
Speaker 2: I think for a long time and still today, people

810
00:43:13,290 --> 00:43:17,170
Speaker 2: are very concerned about losing their license if they were

811
00:43:17,210 --> 00:43:21,570
Speaker 2: to perhaps consider writing a certification for medical cannabis use.

812
00:43:21,610 --> 00:43:23,330
Speaker 2: It's not by prescription. You can't get a prescription for

813
00:43:23,330 --> 00:43:27,690
Speaker 2: scheduled drug, right, So these things are recommendations or certifications.

814
00:43:27,730 --> 00:43:30,610
Speaker 2: And the number of folks that I see who say, yeah,

815
00:43:30,610 --> 00:43:32,170
Speaker 2: I'm not getting into that. I don't want to lose

816
00:43:32,170 --> 00:43:36,610
Speaker 2: my license because when things invariably come around, I don't

817
00:43:36,610 --> 00:43:38,330
Speaker 2: want to be in the crosshairs. So I think a

818
00:43:38,330 --> 00:43:40,010
Speaker 2: lot of it is fear, a lot of it is

819
00:43:40,370 --> 00:43:43,410
Speaker 2: misperception and a lot of misinformation. What do women need

820
00:43:43,450 --> 00:43:46,210
Speaker 2: to know about drug testing? There's definitely professions where there's

821
00:43:46,290 --> 00:43:49,090
Speaker 2: drug testing involved, and you may be using a high

822
00:43:49,130 --> 00:43:52,210
Speaker 2: CBD product that does have some THHC in it. What

823
00:43:52,290 --> 00:43:54,290
Speaker 2: do we need to know about that? We need to

824
00:43:54,330 --> 00:43:56,730
Speaker 2: know a bunch of things first and foremost. When people

825
00:43:56,890 --> 00:43:58,530
Speaker 2: hold up a bottle and they say to mean, look,

826
00:43:58,570 --> 00:44:01,210
Speaker 2: this is just CBD, it's almost never just CBD, and

827
00:44:01,210 --> 00:44:03,050
Speaker 2: that's Okay, from a clinical perspective, we don't want it

828
00:44:03,050 --> 00:44:05,850
Speaker 2: to be just CBD. Whole plant full or whole plant

829
00:44:05,850 --> 00:44:10,170
Speaker 2: broad spectrum. Botics are more efficacious. However, at our very

830
00:44:10,210 --> 00:44:13,050
Speaker 2: first clinical trial that I developed for folks with moderate

831
00:44:13,170 --> 00:44:17,130
Speaker 2: severe anxiety was basically a whole plant full spectrum product

832
00:44:17,170 --> 00:44:20,969
Speaker 2: and it was sourced from cannabis. However, that particular chemo

833
00:44:21,090 --> 00:44:23,250
Speaker 2: ar cultivar that made the base that I then created

834
00:44:23,250 --> 00:44:26,410
Speaker 2: the product from would be termed hemp today. I could

835
00:44:26,410 --> 00:44:28,890
Speaker 2: have used ten times the amount of THHC that I

836
00:44:28,930 --> 00:44:31,490
Speaker 2: had in that product and still been within the limits

837
00:44:31,530 --> 00:44:34,330
Speaker 2: of the law. It had point to two milligrams per

838
00:44:34,370 --> 00:44:38,450
Speaker 2: millileter very low. And what we found was after four

839
00:44:38,490 --> 00:44:42,690
Speaker 2: weeks of a relatively higher CBD containing compound and very

840
00:44:42,690 --> 00:44:46,330
Speaker 2: low THHC, half the sample was positive for THHC after

841
00:44:46,330 --> 00:44:47,930
Speaker 2: four weeks, so they would have filled a drunk test.

842
00:44:48,210 --> 00:44:50,730
Speaker 2: And so people say to me, but Doc, you know,

843
00:44:50,770 --> 00:44:54,570
Speaker 2: it's just this hold on broad spectrum. Products are designed

844
00:44:54,610 --> 00:44:57,650
Speaker 2: to eliminate that possibility from the equation. So civil servants,

845
00:44:57,650 --> 00:44:59,810
Speaker 2: people who are in jobs where they really can't take

846
00:44:59,850 --> 00:45:03,690
Speaker 2: the chance, or who are uber sensitive to THHC. And

847
00:45:03,810 --> 00:45:06,610
Speaker 2: there are many people who are hyper sensitive to THHC

848
00:45:06,970 --> 00:45:09,730
Speaker 2: and very very small amounts are still too much. So

849
00:45:09,850 --> 00:45:13,130
Speaker 2: that's something to be mindful of. Please be mindful of

850
00:45:13,170 --> 00:45:15,610
Speaker 2: what you're using in When it doesn't list how much

851
00:45:15,650 --> 00:45:18,770
Speaker 2: THHD is in the product, ask for a CoA. Any

852
00:45:18,810 --> 00:45:21,450
Speaker 2: and all amounts of THC can aggregate in the body,

853
00:45:21,490 --> 00:45:24,810
Speaker 2: and they do, and you will potentially have a positive

854
00:45:24,890 --> 00:45:25,450
Speaker 2: drug screen.

855
00:45:25,530 --> 00:45:27,570
Speaker 1: How long is the drug string positive for if you've

856
00:45:27,690 --> 00:45:29,170
Speaker 1: ingested some THC.

857
00:45:28,930 --> 00:45:31,410
Speaker 2: Depends on what you're using, how often, and how familiar

858
00:45:31,530 --> 00:45:34,090
Speaker 2: you are with cannabis. So some of our more routine

859
00:45:34,170 --> 00:45:36,970
Speaker 2: users in the old days, the recreational studies that we did,

860
00:45:37,450 --> 00:45:39,730
Speaker 2: these were what I would call heavy hitters. These are

861
00:45:39,730 --> 00:45:42,810
Speaker 2: people who are using multiple times a day. We had

862
00:45:42,850 --> 00:45:44,850
Speaker 2: some folks who are still positive at for forty some

863
00:45:44,890 --> 00:45:45,450
Speaker 2: odd days.

864
00:45:45,610 --> 00:45:48,010
Speaker 1: Do you have any personal experience in improving your own

865
00:45:48,050 --> 00:45:51,130
Speaker 1: health with cannabis? If you do use it, do you

866
00:45:51,250 --> 00:45:54,770
Speaker 1: have any any surprising effects or so?

867
00:45:54,890 --> 00:45:58,570
Speaker 2: I would tell you that not all people have a

868
00:45:58,650 --> 00:46:01,730
Speaker 2: positive relationship with THHC unfortunately, and I'm one of them.

869
00:46:01,810 --> 00:46:04,170
Speaker 2: Is like the plumber whose house has a leak in

870
00:46:04,210 --> 00:46:07,250
Speaker 2: the basement, Maybe THHC and I have a detuont other

871
00:46:07,290 --> 00:46:10,410
Speaker 2: cannabinoids that are non intoxicating. I'm fine with. Some people

872
00:46:10,450 --> 00:46:13,570
Speaker 2: are very very slow metabolizers of certain consiguents like THHC,

873
00:46:14,210 --> 00:46:17,370
Speaker 2: and a very little bit can go a very long way.

874
00:46:17,410 --> 00:46:19,730
Speaker 2: So you have to be very mindful. If I try

875
00:46:19,770 --> 00:46:22,290
Speaker 2: something and it's absolutely fine for me with like one

876
00:46:22,330 --> 00:46:24,810
Speaker 2: milligrammar or a milligram and a half of PC and

877
00:46:24,850 --> 00:46:27,370
Speaker 2: I don't feel altered, no one's going to feel altered

878
00:46:27,610 --> 00:46:29,690
Speaker 2: because it takes very very little. I'm a cheap data.

879
00:46:29,690 --> 00:46:31,330
Speaker 2: As it turns out, if.

880
00:46:31,130 --> 00:46:34,450
Speaker 1: You had to tell women or advise women, what would

881
00:46:34,490 --> 00:46:37,210
Speaker 1: be the one thing that you would say about cannabis

882
00:46:37,330 --> 00:46:39,610
Speaker 1: use and how cannabis can impact their health?

883
00:46:40,930 --> 00:46:44,770
Speaker 2: I think I would probably say that there is unprecedented

884
00:46:45,690 --> 00:46:49,610
Speaker 2: promise with regard to cannabis and cannabinoids for many many

885
00:46:49,690 --> 00:46:53,690
Speaker 2: indications and conditions that affect us. That said, you can't

886
00:46:53,730 --> 00:46:57,050
Speaker 2: believe all the hype, and you have to really educate

887
00:46:57,090 --> 00:47:01,970
Speaker 2: yourself and ask questions. In my very humble opinion, people

888
00:47:02,050 --> 00:47:05,330
Speaker 2: are exploring cannabis and cannabinoid based therapies to reduce their

889
00:47:05,410 --> 00:47:08,690
Speaker 2: use of conventional medications, to sleep better, to have less pain,

890
00:47:08,810 --> 00:47:11,250
Speaker 2: to have better mood and also to have better day

891
00:47:11,250 --> 00:47:13,490
Speaker 2: to day life. If we think of things as a

892
00:47:13,850 --> 00:47:18,810
Speaker 2: natural anti inflammatory or ways of improving your own immune system,

893
00:47:19,970 --> 00:47:22,490
Speaker 2: people are adding these products to their daily health and

894
00:47:22,490 --> 00:47:27,250
Speaker 2: wellness regimens. There are certain cannabinoids likes for sure, CBD,

895
00:47:27,330 --> 00:47:29,570
Speaker 2: but so many others that are the unsung heroes that

896
00:47:29,610 --> 00:47:33,770
Speaker 2: are actually more effective as anti inflammatory or neuroprotective agents

897
00:47:33,850 --> 00:47:35,170
Speaker 2: or all sorts of things we don't have time to

898
00:47:35,170 --> 00:47:38,290
Speaker 2: get into, and so you can create these compounds that

899
00:47:38,330 --> 00:47:40,250
Speaker 2: you might take on a regular basis or have other

900
00:47:40,290 --> 00:47:42,970
Speaker 2: people do it and feel a whole lot better than

901
00:47:43,010 --> 00:47:45,850
Speaker 2: you might otherwise. I've been in situations where I didn't

902
00:47:45,850 --> 00:47:47,810
Speaker 2: recognize the patient when I walked into the waiting room

903
00:47:48,050 --> 00:47:50,570
Speaker 2: because they looked so different from the way they looked

904
00:47:50,610 --> 00:47:53,610
Speaker 2: a month prior. I think we're at the very, very

905
00:47:53,610 --> 00:47:58,690
Speaker 2: beginning stages of what will ultimately be an absolutely unprecedented revolution.

906
00:47:58,930 --> 00:48:01,570
Speaker 2: I mean, we really can change some of the ways

907
00:48:01,570 --> 00:48:04,050
Speaker 2: that people are living. And I had this last week.

908
00:48:04,250 --> 00:48:05,650
Speaker 2: I had a woman say to me, I am for

909
00:48:05,730 --> 00:48:08,570
Speaker 2: the first time in nine years, I'm considering not having

910
00:48:08,570 --> 00:48:11,330
Speaker 2: a hesteractomy because I now know what it's like to

911
00:48:11,450 --> 00:48:14,850
Speaker 2: live without chronic debilitating. I'm at an eight or nine

912
00:48:14,930 --> 00:48:18,370
Speaker 2: out of ten pain all day, every day. What do

913
00:48:18,410 --> 00:48:22,210
Speaker 2: you do with That's that's amazing right.

914
00:48:24,530 --> 00:48:27,969
Speaker 1: Researchers like doctor Gruber are learning more every day about

915
00:48:27,970 --> 00:48:32,130
Speaker 1: how to use cannabinoid based therapy safely and effectively, but

916
00:48:32,210 --> 00:48:34,250
Speaker 1: for now, there are a few key things to keep

917
00:48:34,290 --> 00:48:38,130
Speaker 1: in mind. Start low and go slow. Begin with a

918
00:48:38,170 --> 00:48:40,650
Speaker 1: small dose, even just a quarter of what you think

919
00:48:40,690 --> 00:48:44,090
Speaker 1: you might need, and increase gradually. Be clear about what

920
00:48:44,130 --> 00:48:48,610
Speaker 1: your goal is. Low doses of THHC, the primary intoxicating

921
00:48:48,650 --> 00:48:52,250
Speaker 1: part of the plant, may help with anxiety, but be

922
00:48:52,330 --> 00:48:56,170
Speaker 1: careful because higher levels often trigger anxiety in many people.

923
00:48:57,050 --> 00:49:02,290
Speaker 1: Cannabinoids like CBN and CBD may be helpful for sleep.

924
00:49:03,210 --> 00:49:06,890
Speaker 1: CBD may also be helpful for things like anxiety and inflammation,

925
00:49:07,650 --> 00:49:12,450
Speaker 1: and also has potential neuroprotective qualities. Doctor Grueber has noted

926
00:49:12,570 --> 00:49:15,370
Speaker 1: that there are other cannabinoids that have shown promise with

927
00:49:15,410 --> 00:49:21,290
Speaker 1: regard to anti inflammatory and neuroprotective properties, including CBG, CBC,

928
00:49:22,130 --> 00:49:27,890
Speaker 1: and THCHCB. Look for full or broad spectrum products. These

929
00:49:27,930 --> 00:49:33,570
Speaker 1: formulations take advantage of multiple cannabinoids working together. Full spectrum

930
00:49:33,650 --> 00:49:39,210
Speaker 1: products contain the naturally occurring range of cannabinoids, including THHC, CBD,

931
00:49:39,890 --> 00:49:44,330
Speaker 1: and other minor cannabinoids. Broad spectrum products are similar to

932
00:49:44,370 --> 00:49:47,690
Speaker 1: full spectrum products, with the important distinction that they are

933
00:49:47,730 --> 00:49:52,370
Speaker 1: intended to have no quantifiable amount of THHC. So doctor

934
00:49:52,410 --> 00:49:55,530
Speaker 1: Gruber suggests looking into broad spectrum products if you want

935
00:49:55,570 --> 00:49:58,610
Speaker 1: to avoid feeling altered or high, or if you work

936
00:49:58,650 --> 00:50:02,450
Speaker 1: in a field that drug tests for THHC, and remember

937
00:50:02,690 --> 00:50:06,130
Speaker 1: always check the products certificate of analysis to get more

938
00:50:06,170 --> 00:50:09,410
Speaker 1: accurate information about the compounds that are included in it.

939
00:50:11,090 --> 00:50:15,050
Speaker 1: For interactions. If you're taking other medications, use a reliable

940
00:50:15,130 --> 00:50:18,450
Speaker 1: drug drug interaction tool online to see if cannabis might

941
00:50:18,490 --> 00:50:22,850
Speaker 1: interfere and be honest with your doctor. Let them know

942
00:50:22,890 --> 00:50:26,410
Speaker 1: what you're using or considering. If your provider isn't receptive

943
00:50:26,490 --> 00:50:30,250
Speaker 1: or informed, consider finding someone who is. There are plenty

944
00:50:30,290 --> 00:50:33,130
Speaker 1: of clinicians out there who are curious and excited about

945
00:50:33,170 --> 00:50:36,290
Speaker 1: the medicinal potential of cannabis and who can help you

946
00:50:36,370 --> 00:50:42,850
Speaker 1: figure out what's right for you. Coming up on the

947
00:50:42,890 --> 00:50:46,570
Speaker 1: next episode of Decoding Women's Health will be diving into

948
00:50:46,650 --> 00:50:49,570
Speaker 1: the world of glp ones, a class of drugs that

949
00:50:49,610 --> 00:50:53,850
Speaker 1: has completely changed the conversation around metabolic health and weight loss.

950
00:50:54,170 --> 00:50:56,970
Speaker 3: In the past few decades, we've only been pushing this

951
00:50:57,090 --> 00:51:02,730
Speaker 3: narrative of eating less and moving more, which is oversimplified

952
00:51:02,770 --> 00:51:05,610
Speaker 3: and not the right message. And I think what has

953
00:51:06,010 --> 00:51:10,290
Speaker 3: transformed the landscape of weight management is that now we

954
00:51:10,410 --> 00:51:12,530
Speaker 3: have tools to revillly dress the biology.

955
00:51:14,570 --> 00:51:17,450
Speaker 1: Decoding Women's Health is a production of Pushkin Industries and

956
00:51:17,490 --> 00:51:21,450
Speaker 1: the Atria Health and Research Institute. This episode was produced

957
00:51:21,450 --> 00:51:25,050
Speaker 1: by Rebecca Lee Douglas. It was edited by Amy Gaines McQuaid,

958
00:51:26,090 --> 00:51:30,090
Speaker 1: mastering by Sarah Buguer. Our associate producer is Sonia Gerwit.

959
00:51:30,810 --> 00:51:35,010
Speaker 1: Our executive producer is Alexandra Garreton. Our theme song was

960
00:51:35,050 --> 00:51:39,810
Speaker 1: composed by HANNS. Brown. Concept creative development and fact checking

961
00:51:39,890 --> 00:51:45,130
Speaker 1: by Shavon O'Connor. A special thanks to Alan Tish, David Saltzman,

962
00:51:45,770 --> 00:51:52,130
Speaker 1: Sarah Nix, Eric Sandler, Morgan Rattner, Amy Hagdorn, Owen Miller,

963
00:51:52,610 --> 00:51:56,450
Speaker 1: Jordan McMillan, and Greta Cohne. If you have a question

964
00:51:56,490 --> 00:51:59,610
Speaker 1: about women's health in midlife, leave us a voicemail at

965
00:51:59,650 --> 00:52:03,530
Speaker 1: four F five two O one three three eight five,

966
00:52:04,250 --> 00:52:07,010
Speaker 1: or send us a message at Decoding Women's Health at

967
00:52:07,010 --> 00:52:11,450
Speaker 1: Pushkin dot FM. I'm doctor Elizabeth pointer and thanks for listening.

968
00:52:11,690 --> 00:52:12,489
Speaker 1: Until next time.

969
00:52:23,970 --> 00:52:26,930
Speaker 4: Welcome to sex Ed with dB. I'm your host, dB.

970
00:52:27,570 --> 00:52:46,650
Speaker 4: Let's get into it. Hey everyone, welcome back dB here,

971
00:52:46,770 --> 00:52:49,930
Speaker 4: your favorite sex educator and pleasure expert, and today we're

972
00:52:49,970 --> 00:52:53,770
Speaker 4: talking about cannabis and sex. Now, maybe you've heard people

973
00:52:53,810 --> 00:52:56,930
Speaker 4: say that we'd make sex amazing, or maybe you've tried

974
00:52:56,930 --> 00:52:59,490
Speaker 4: it and thought was that hotter than usual? Or was

975
00:52:59,490 --> 00:53:01,970
Speaker 4: I just way too invested in the way my partner's

976
00:53:02,010 --> 00:53:04,850
Speaker 4: hair smelled because I was super high and it smelled

977
00:53:04,890 --> 00:53:07,170
Speaker 4: so good. Either way, there's a lot of hype and

978
00:53:07,210 --> 00:53:09,450
Speaker 4: a lot of myths around getting high and getting it on.

979
00:53:09,570 --> 00:53:11,970
Speaker 4: So today we are breaking down on what the science

980
00:53:12,010 --> 00:53:15,050
Speaker 4: actually says. As usual, we'll talk about how cannabis might

981
00:53:15,050 --> 00:53:19,050
Speaker 4: affect desire, arousal, and orgasm, why dose matters more than

982
00:53:19,090 --> 00:53:21,330
Speaker 4: you think, and then not so fun side effects that

983
00:53:21,330 --> 00:53:23,690
Speaker 4: you should know before you try it. We'll even dig

984
00:53:23,730 --> 00:53:26,330
Speaker 4: into what researchers have discovered about weed's role in pain

985
00:53:26,410 --> 00:53:30,210
Speaker 4: reduction and sexual satisfaction. And if you've ever wondered whether

986
00:53:30,250 --> 00:53:33,490
Speaker 4: cannabis could take your bedroom game higher or if it's

987
00:53:33,650 --> 00:53:37,570
Speaker 4: just smoke and mirrors. Oh sorry, it's such a bad pun,

988
00:53:37,610 --> 00:53:39,730
Speaker 4: but it's so good you are in the right place.

989
00:53:40,210 --> 00:53:43,410
Speaker 4: So first up, are people who use weed really having

990
00:53:43,450 --> 00:53:44,010
Speaker 4: more sex?

991
00:53:44,210 --> 00:53:46,490
Speaker 2: What do the data show?

992
00:53:46,610 --> 00:53:49,610
Speaker 4: Back in twenty seventeen, researchers at Stanford looked at over

993
00:53:49,690 --> 00:53:53,570
Speaker 4: fifty thousand Americans and found something kind of interesting. Daily

994
00:53:53,650 --> 00:53:57,970
Speaker 4: cannabis users reported having more sex than non users. Women

995
00:53:58,050 --> 00:54:01,530
Speaker 4: went from about six times a month to seven point one,

996
00:54:02,210 --> 00:54:05,930
Speaker 4: and men went from five point six to six point nine. Now,

997
00:54:06,010 --> 00:54:08,370
Speaker 4: before we start just kind of handing out blunts as

998
00:54:08,450 --> 00:54:11,970
Speaker 4: relationship therapy, here's the thing. This is self reported. It's

999
00:54:12,010 --> 00:54:14,250
Speaker 4: not proof that weed causes more sex. It's just that

1000
00:54:14,250 --> 00:54:15,890
Speaker 4: people who use it tend to say that they have

1001
00:54:15,970 --> 00:54:18,010
Speaker 4: more sex. Could be the weed, could be that people

1002
00:54:18,050 --> 00:54:20,450
Speaker 4: who are more open to cannabis are also open to

1003
00:54:20,730 --> 00:54:25,770
Speaker 4: other sexual activities. Hard to say, but interesting nonetheless, And

1004
00:54:25,810 --> 00:54:28,810
Speaker 4: that leads us nicely into this pleasure piece because even

1005
00:54:28,850 --> 00:54:32,610
Speaker 4: if frequency isn't directly caused by cannabis, plenty of people

1006
00:54:33,130 --> 00:54:37,130
Speaker 4: swear that it changes how sex feels. In a twenty

1007
00:54:37,130 --> 00:54:40,490
Speaker 4: twenty three study with around eight hundred people, over seventy

1008
00:54:40,530 --> 00:54:44,490
Speaker 4: percent said that weed made sex better, more desire, more

1009
00:54:44,490 --> 00:54:48,610
Speaker 4: intense orgasms, and touch that felt off the chart good.

1010
00:54:49,090 --> 00:54:52,730
Speaker 4: Let me repeat that eight hundred people were in this study.

1011
00:54:52,770 --> 00:54:56,810
Speaker 4: Over seventy percent said that weed made sex better. So fascinating.

1012
00:55:02,970 --> 00:55:06,290
Speaker 4: Hello dB here, thank you so much for listening. If

1013
00:55:06,290 --> 00:55:07,810
Speaker 4: you liked what you heard in this clip, you can

1014
00:55:07,810 --> 00:55:10,210
Speaker 4: find the rest of this episode and more by searching

1015
00:55:10,290 --> 00:55:13,970
Speaker 4: sex ed dB on your podcast app of choice, or

1016
00:55:14,010 --> 00:55:23,890
Speaker 4: by heading to sex edi dB dot com.