Marijuana. Good? Bad?
Hello, friends and constituents! We’re trying something a bit differently this week. King David has his first guest contributor. Dr. Ghaznavi wants you to be knowledgeable about marijuana and to be able to make informed decisions. As the King David Blog focuses on consumer advocacy, this is right up our alley. We’re grateful to have Dr. Ghaznavi’s marijuana guide and hope you enjoy reading this article from a physician’s standpoint. If you’re already a fan of the ganja, use my Amazon affiliate link to support the blog and buy all of your CBD needs.
By Dr. Jim Ghaznavi
Addiction Physician
Disclaimer: This series is purely for educational and informational purposes. This is not intended to be used as a guide to treat or diagnose. Please consult your physician regarding your own personalized health needs, concerns and decisions.
Welcome to 2020: Marijuana is becoming legalized state after state. Right now, you can use marijuana recreationally in eleven states and with a doctor's recommendation in 33 states. Strangely enough, Marijuana is still technically illegal under federal law, but then, the FDA has approved cannabinoid derived medications, like Marinol, Cesamet and Epidiolex. As Weed becomes legal across the country, you are going to see and hear more about it. How do you filter the good, the bad, and the ugly about marijuana? Well, that’s where this series on recreational drugs comes in.
I’m going to talk about drugs - from a medical and social standpoint. The more you know about drugs, the better you’ll be informed when picking policies at the voter booth, and the better you’ll know when and where to get help if you or a loved one needs it. Also, there is power in truth: almost everything in life has good things about it and bad things about it - the key is the ratio. Without knowing the truth, you don’t know that ratio.
The D.A.R.E and the War on Drugs failed because panic won out over truth. The hyper-demonization of drugs and drug users wound up increasing drug use over the decades - not decreasing it. On the flip side, over-romanticizing drugs, like claims that “Marijuana can help cure cancer or alcohol is good for the heart” creates false expectations that can land people in some very dangerous situations. Hopefully, this will help demystify drugs, their social impact and how addiction works.
Now, onto the drugs!
9 FACTS ABOUT MARIJUANA
1) Marijuana is Complicated
When we talk about marijuana, it’s very different than talking about alcohol, cocaine, meth, caffeine, nicotine, or acid because unlike those substances, marijuana is not a single substance. It’s actually a lot of different ‘cannabinoids’ that each do very different things. Even more confusing is when you combine the different cannabinoids in different combinations and ratios, they can do really different things than either parts alone. So, with cannabinoids, 1+1 doesn’t always equal 2 - you might see effects greater or different than expected from the individual components alone. This “whole is greater than the sum of the parts” effect is called “synergy” or “the entourage effect”
2) The two Major Ingredients of Marijuana do very Different Things
When we think of weed, we think of THC (specifically Delta-9-THC). It gets you high and too much of it, especially more than you’re used to, can make you anxious or paranoid. On the flipside, it can help with pain and low appetite. Now, THC isn't the only cannabinoid that we know about.
The other major cannabinoid we know about is Cannabidiol (CBD). It has a totally different set of effects than THC. It seems to have a lot of possibly beneficial things about it. It can be helpful with anxiety, insomnia, weight loss, seizures, psychosis and there is even research into its ability to help with addictions (Ha, we go from fearing it because it could be a ‘gateway drug’ to thinking it can help with addictions. How crazy is that!)
When you go to a dispensary, you’ll hear “Indica” or “Sativa” tossed around. Basically “Indica” is a CBD-rich variety and “Sativa” is the THC-rich variety. Though there are some problems with the reliability of those labels as people are getting sloppier with them. CBD is more expensive than THC due to its beneficial properties and broader appeal. As a result, it’s becoming more common for some vendors to overstate the CBD content and understate the THC, so be careful.
3) Marijuana and Hemp are Basically the Same Plant…
...but are bred to have differences in THC content. The plant is known as Cannabis Sativa. Simply put, in the US, if the THC content is above 0.3%, it’s marijuana (and federally still illegal). If the THC content is below 0.3%, it’s hemp.
You probably have heard of hemp oil and wondered, what’s the difference between hemp oil and CBD oil and THC oils? Hemp oil is made from the seeds of Cannabis Sativa plant. The seeds basically have no THC or CBD and thus neither does hemp oil (there might be just enough traces of THC to cause a positive on a urine drug screen though, so keep that in mind if you’re in a position where you need to do drug screens for work or legal matters.). Hemp oil is pretty neat in and of itself: It’s rich in Omega-3 and Omega-6 fatty acids which are good for the heart health, generally anti-inflammatory and even can boost one’s mood. Now that said, some people are getting loose with their labeling of hemp oil, so be careful if you’re looking for hemp oil. Look at the bottle closely and stick to reliable vendors.
In contrast, CBD oil is made from the Cannabis plant, in particular, Hemp leaves and stalks which tend to be richer in CBD than THC. THC oils, well, those are a whole beast all together. They are super rich concentrates of THC (I’ve seen upwards of 80% straight-up THC in them). If you’re trying to cook dinner with hemp oil, but, for some reason, mistakenly use THC oil, you’re going to be in for one helluva night.
4) Marijuana is both Federally Illegal BUT also Found to be Beneficial by the Food and Drug Administration
So, this is a tricky topic and I’m not a lawyer, but basically marijuana (THC specifically) is still a Schedule I Drug, which essentially means it’s illegal at a federal level despite having some legal status in most US states. CBD, on the other hand, is legal federally as long as the THC content remains below 0.3%.
The FDA has formally recognized 3 cannabis-based drugs for treatment: Epidiolex which uses actual purified CBD for the treatment of two particular seizure disorders. The other two are Marinol (Dronabinol) and Cesamet (Nabilone) which are synthetic cannabinoids for the treatment of nausea and vomiting related to chemo. Dronabinol also is used for boosting appetite in patients with AIDS or cancer who are struggling to maintain their weight.
Canada and the UK have also legalized Sativex (Nabiximols) which a 50/50 mix of THC and CBD used for nerve pain, muscle tension and bladder issues related to Multiple Sclerosis (MS).
5) Reefer Madness is a Thing
People can indeed become psychotic on marijuana especially considering marijuana is far stronger today than it was in the 70s and 60s. To be clear, when I say ‘psychotic’, I mean in the medical sense. In other words, they start to hear voices and have paranoid delusions. You’ll see it happen most frequently in a couple groups: people with a strong family history of Schizophrenia, people who generally don’t use marijuana frequently and people who use high doses of THC strong marijuana (think dabs). It often times goes like this: you start feeling high, then anxious, then paranoid, and if it continues on or you use more THC, you start hearing voices and/or become delusional.
When the psychosis hits, it can stay for several days to weeks. There even is some concern that especially in teens, it can actually ‘unlock’ Schizophrenia and people will remain psychotic long after they stopped using weed.
Funny enough, Reefer Madness, being an old term, is actually a new relatively new phenomenon as marijuana has been bred for stronger and stronger THC content. For example, in 1994 your average weed was about 4% THC. By 2014, your average weed was about 12% THC. Conversely, CBD strength went down by half in that same period of time. This has resulted in a ratio of THC:CBD from 14 to a ratio of 80 in just 20 years! And this leads me to the next weed fact...
6) Weed Ratios are a Big Deal
Remember what we mentioned above, THC in high doses can cause psychosis. But what’s really interesting is that CBD can actually IMPROVE psychosis. So, what this means is theoretically if you increase the THC while lowering the CBD content, you actually increase the risk of getting psychotic. Reversing it, if you lower the THC content while increasing the CBD, you reduce the likelihood you’ll become psychotic. So, one of the theories of why people are getting psychotic on weed, but didn’t used to in the past, is the ratio of THC:CBD. Back in the day, low ratio weed allowed people to get high without risking psychosis but nowadays with high ratios, becoming psychotic is much easier.
Adding to all of this is high THC concentrates. There are waxes and hash oils with THC levels over 80%. Using this much THC at once translates to smoking 20 joints of 4% weed all at once. Using a more relatable example, let’s imagine drinking one can of soda, then drinking 20 cans of soda over the exact same period of time. It would cause problems. You can imagine using that much THC can start to cause all sorts of trouble.
In short, the CBD in weed may be protective when using THC and using really high-strength THC with very low doses of CBD can produce some scary effects. Again, ratios are important.
7) Edibles can do Different Things than Smoking Weed
I think most of us have that buddy who could smoke weed with no problems, but who, one day, ate too many pot brownies and started wigging out. For the vast majority of drugs, smoking a drug produces much more intense effects than eating, but why does marijuana seem to do the opposite for most people? The answer is uncertain but it probably has to do with two things: the delayed effect of eating weed and the difference between how your body processes marijuana when you eat it.
The delayed effect of getting high when eating lulls people into a false sense of security. Fifteen minutes after munching on a brownie, they still haven’t noticed a high, so they start eating more...and then it hits them. There also is an issue of potency and portions. Many edibles are meant to be eaten in small pieces compared to their non-cannabis counterparts. For example, instructions for weed brownies might often say eat a piece of a single brownie; whereas, we are all accustomed to eating whole normal brownies. This confusion can cause folks to eat much more weed that they’d have been exposed to by smoking.
Finally, your body does kinda different things when eating weed versus smoking weed. When you smoke something, it goes to your lungs then into the rest of your body. When you eat something, it has to go to your stomach, then gets absorbed through your intestines, then goes through your liver and then it goes to the rest of your body. At some point in this path, marijuana (Delta-9-THC) turns into 11-OH-THC. There is still some uncertainty about this but it seems that 11-OH-THC is quite a bit more potent than just THC, which also might explain the intensity people experience when eating weed compared to smoking it
8) Criminalization of Marijuana Paralyzed Good Research on it
As a doctor myself, I can tell you most patients - hands down - know more about weed than the doctors. One big thing I noticed when I finished med school was how crappy old research studies on marijuana were. The studies would describe marijuana effects vastly differently than what my patients were telling me their experiences were. I always wondered why. Why would the medical community have such a huge lapse of knowledge in something that was pretty commonly used for hundreds of years?
Well, the answer is simply because marijuana was illegal. Every legitimate medical study had to go through the DEA to get samples of marijuana. Getting the DEA approval could take years which doesn't make studying an illegal drug very appealing. Plus, you had to use what the DEA gave you - and if their samples sucked, well, tough luck. As a matter of fact, the only federal "legal" grower since 1968 was the University of Mississippi. The samples were often times not anything like what people were using out in community. So in short, it would take forever to get a study approved by the DEA, then get their samples, which also took forever and which basically was 52 year old garbage weed whose composition didn't reflect what people were actually using in the community.
9) Is Marijuana Addictive?
I think most people can agree that marijuana does not cause the kind of harm that meth, heroin, or alcohol does. But, it’s also not completely a benign substance either. Sure, it’s not nearly as addictive as other substances like tobacco, crack, or heroin, and the addiction generally is nowhere near as destructive as harder drugs - like, people don't start stealing stuff or killing each other to support a marijuana habit typically. But, that said, I have definitely had plenty of patients who have dropped out school because they would be too high most days to go to classes or would forgo paying their rent in order to buy marijuana - and then get evicted unsurprisingly, or would keep on using it despite it making their anxiety or depression worse (and knowing that it does but feeling powerless to stop it). The chances of you becoming addicted to marijuana is about 9%. It's easier to get addicted if you start in your teens or use daily.
By the way, as far as we know the only addictive part of weed is THC. CBD fortunately doesn't seem addictive or cause withdrawal symptoms. CBD was tested at up to a whooping 4500mg a day and people didn’t get hooked on it. Furthermore, people taking 1500mg of CBD for 28 days didn’t seem to have any issues stopping the medication. Not only does CBD not seem addictive, it actually may be helpful in treating addictions too and it’s been a hot area of research recently. Let’s hope it pans out!
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References:
https://khn.org/news/medical-marijuanas-catch-22-fed-limits-on-research-hinder-patients-relief/amp/
Chye Y, Christensen E, Solowij N, Yücel M. The Endocannabinoid System and Cannabidiol's Promise for the Treatment of Substance Use Disorder. Front Psychiatry. 2019;10:63. Published 2019 Feb 19. doi:10.3389/fpsyt.2019.00063
Davies C, Bhattacharyya S. Cannabidiol as a potential treatment for psychosis. Ther Adv Psychopharmacol. 2019;9:2045125319881916. Published 2019 Nov 8. doi:10.1177/2045125319881916
ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States. Biol Psychiatry. 2016;79(7):613–619. doi:10.1016/j.biopsych.2016.01.004
VanDolah HJ, Bauer BA, Mauck KF. Clinicians' Guide to Cannabidiol and Hemp Oils. Mayo Clin Proc. 2019;94(9):1840–1851. doi:10.1016/j.mayocp.2019.01.003
