Transcript

Lee Tetreault:

Welcome to frequently asked questions from the session, Medical marijuana, weeding fiction from fact. We are joined by Dr. Caralis. Before we begin of these questions doctor, would you be able to reiterate a few quick pointers from today's session to our audience?

Dr. Caralis:

Yes, I think the most important thing that providers can do is realize that this whole field will change very quickly and there will be more research to provide answers to what is Marijuana good for, What are the side effects, what are the long-term concerns with it, as well as the ways by which we provide patients with the information, as well as the recommendations. Additionally, all states will be changing laws because this is a very fluid area in terms of whether it only be available as medicinal or it will be legalized for recreational and what will be the Federal responses to that.

Lee Tetreault:

Great. Let's start with some of these frequently asked questions. First, what are the three main classifications of cannabinoids?

Dr. Caralis:

The first one is the phytocannabinoids. They are what comes from the plant itself. They're grown naturally in the stems, the leaves, the seeds. And there are two main purified natural cannabinoids that are of medical interest, and they are cannabidiol or CBD and delta-9-tetrahydrocannabinol which is THC. CBD has no effect on the usual highs whereas THC is the predominant chemical which creates the highs that we all associate with marijuana.

The second is endocannabinoids, our own mammalian brain in the CNS, in glia, in peripheral nerves and in central nerves, contain receptors as well as naturally occurring cannabinoids. These regulate and have been shown by research in animals as well as humans to regulate pleasure, memory, thinking concentration, body movements, and sensations.

The final one is what we are producing now as synthetic molecules. They are almost entirely THC, the hallucinogenic chemical derivative. Things like nabilone and dronabinol, known on the streets as spice and K2.

Lee Tetreault:

What are the negative health effects of marijuana?

Dr. Caralis:

Well, research has shown different outcomes with that particular question, but the ones that are most important are really the effect on cognitive capacity and increased risk of psychotic episodes. And it has shown that adolescent brains in particular are most vulnerable to the effects on cognitive capacity. There's evidence that academic performance, job retention, even IQ is altered. The younger the age that you begin the marijuana and the longer the duration of use. There's also breathing problems, particularly Bronchorrhea, which looks like a bronchitis. But the studies have not shown any permanent lung damage or a higher incidence of lung cancer. There's a hyper-catecholamine state with increased heart rate, and blood pressure and finally there is a very unusual syndrome called hyperemesis with intractable nausea and vomiting.

Lee Tetreault:

Is marijuana addictive and can there be overdoses?

Dr. Caralis:

The prevalence of addiction is arranged everywhere from 6% up to 30%, but there is a withdrawal syndrome of agitation, irritability, increased heart rate that suggests that there probably is an addictive effect. And once again, the younger the age of starting the use, the more frequent the use and the longer duration of use, is usually associated with a higher rate of addiction. There's also reports of overdoses. And the interesting thing is that the overdose manifests primarily as an extreme psychotic reaction and it occurs more frequently again with younger people because... And with the edible forms of the cannabinoids, because they don't get the usual immediate high with the edible forms, and so they'll re-dose themselves and take more of the cannabinoid and so they end up really overdosing.

Lee Tetreault:

The National Academies of Science, Engineering, and Medicine in 2017, did a comprehensive view of literature on the subject. What is the evidence for effectiveness of marijuana on health?

Dr. Caralis:

Well, they did a comprehensive review of the literature, they looked at 24,000 abstracts and papers that utilized 10000 plus patients. And they rated the evidence as conclusive, most conclusive and moderate and no evidence. And what we know at this point is that most conclusive is the positive effect on managing chronic pain in adults. We also know the positive effect as an antiemetic for chemotherapy-induced nausea and vomiting. And finally the most conclusive evidence that on self-reported spasticity outcomes, there's a positive effect for MS patients.

The rest of the literature, there's always papers that are positive for a variety of things, ranging from chronic fatigue, sleep disorders, PTSD. But the problem is, it is not conclusive, and in some instances such as weight gain, anorexia, it actually doesn't exist. So at this point in time, we have to continue to do more research to show what the positive effects are, and whom we should actually be recommending the use of marijuana.

Lee Tetreault:

And lastly, what is the legality of cannabis in the US?

Dr. Caralis:

Well, this is an area that's extremely influx. The federal law still treats cannabis and cannabinoid products as Schedule One, meaning that they are not efficacious and they are essentially addictive. But there are 33 states where there have been referendums and it is current law that we can use a medicinal purposes marijuana. In 15 of those states, it limits the amount of the THC product, which essentially is the hallucinogenic product. But in nine states, we have laws that allow it, not only is medicinal but also as recreational.

In Florida, we have it only currently as medicinal. And we require in Florida only certified doctors or qualified doctors to be able to recommend it. It is not prescribed as such, but it is recommended. And we also have only certified licensed growers, licensed by the state, as well as certified treatment centers where patients have to register and with the physician's recommendation, go and get their medication from those treatment centers only. In Florida, we also have qualified conditions so that you could only recommend under those qualified conditions.

Lee Tetreault:

This is great information, Doctor, thank you so much for your time today.




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