#03 Is Cannabis Safe? Part Three: Adolescent Use and Harm Reduction



Episode Description: In this episode of the Curious About Cannabis Podcast we wrap up our three-part series on Cannabis safety and harm reduction by exploring the question, “Is Cannabis Safe?”. First we talk about adolescent Cannabis use before discussing ways in which Cannabis users can minimize or eliminate many of the risks associated with Cannabis. Make sure you listen to episodes 1 and 2 prior to listening to this episode!

 

Episode Transcript:

#03 Is Cannabis Safe? Part Three: Adolescent Cannabis Use and Harm Reduction

You’re listening to the Curious About Cannabis Podcast.

[Reefer Madness Clip]

[Shutter]

Hey everybody, this is Jason Wilson with the Curious About Cannabis podcast, thanks so much for tuning in once again. Over the last two episodes we have been exploring the topic of Cannabis safety and harm reduction. We explored the toxicity of some of the major chemical constituents of Cannabis resins, how Cannabis can interact with medications, and contaminants that could be found in Cannabis products. Now, for this third and final part of this series, we are focusing on the topics of teen Cannabis use before diving into some of the ways that Cannabis users can minimize the potential risks associated with Cannabis use.

So here we go, the third and final part of our series where we explore the question: “Is Cannabis Safe?”

[INTRO MUSIC]

What about adolescent Cannabis use?

What are the risks of exposing children to Cannabis at an early age? As you might imagine, this is a very complicated question. For this episode we are going to ignore the topics of Cannabis use during pregnancy, while breastfeeding, or medical Cannabis use in children. We’ll explore those topics in other episodes. For this episode, we are going to focus on looking at the health risks of adolescent Cannabis use during the teenage years.

The topic of adolescent Cannabis use is a complicated and sensitive topic. Kids today have become very wary of drug education of any kind, primarily because kids have been exposed to tales of exaggerated harms or outright lies about drug use for decades as part of prohibition and abstinence-based drug education programs.[1] [2]

[MATT VOGEL SEGMENT]

This is Matt Vogel. Matt is a health and wellness educator that works with high school and college students to teach about health, substance use, and harm reduction strategies.

[MATT VOGEL SEGMENT]

Regarding Cannabis, kids have been told that it will kill brain cells, lead to schizophrenia or other mental health issues, make them lazy or stupid, or cause them to move on to other drugs like cocaine or heroin.

It should first be pointed out that there are big differences between acute or occasional Cannabis use and chronic Cannabis use. In general, acute Cannabis use is pretty safe, physiologically, with the biggest risks being risks of motor discoordination, which is why it is not a good idea to drive after using THC-rich Cannabis, memory disruption, and psychological distress.[3] However, most of the major risks that adolescents learn about Cannabis are associated with chronic, or repeated, Cannabis use.

While chronic Cannabis use can alter the way the brain functions[4] [5] [6], and we need to understand the consequences of that more, to say that it kills brain cells is dishonest. Cannabis can make some parts of the brain less active while making other parts of the brain more active.[7] In fact, in some cases Cannabis can actually encourage new brain cells to grow in a process called neurogenesis[8] [9].

While Cannabis can exacerbate or reveal underlying mental health problems in adolescents, there is not strong evidence that it actually causes these problems.[10] [11] And the only time that Cannabis seems to act as a gateway to other drugs seems to be when users are exposed to those other drugs on the black market.[12]

The issue of adolescent Cannabis use and IQ is a more complicated problem. Research has confirmed that there does not seem to be a link between Cannabis use and low IQ, but there does seem to be a link between early onset Cannabis use and poor cognitive performance.[13] [14] If you dig through the research, a common theme emerges. The issue is that THC in Cannabis can, in some people, interfere with the learning process, by disrupting attention and memory. Ultimately users that are affected in this way have to work harder to perform as well as they typically would without Cannabis.

Depending on the situation, Cannabis use can also cause kids to avoid social interactions, which can cause problems with the development of emotional intelligence and social skills.[15] [16] [17] Chronic THC-rich Cannabis use can interfere with learning processes at a time when a person is going through critical developmental stages, resulting in poor development into adulthood. Although the brain is not actually a muscle, it acts like one in the sense that if you don’t exercise it, it won’t perform well.

But a lot of these possible outcomes are difficult to assess[18] because there are a lot of variables that affect a person’s cognitive development including social factors, concurrent drug use, such as alcohol use, and underlying mental health disorders to name a few. In addition, everyone responds to Cannabis differently. There are also a wide variety of Cannabis products, with different risks associated with them.

It has to be noted here, that the context of Cannabis use has a lot to do with outcomes. There are children, teens, and adults throughout the world with qualifying medical conditions that are using Cannabis medically and exhibiting very few adverse events.[19] [20] In addition, CBD rich Cannabis or Cannabis products that don’t have intoxicating effects do not present the same psychological health risks as THC rich Cannabis products. Dose is also an important factor to consider. Lower dosages of either THC or CBD present fewer risks than higher doses.

So if Cannabis can be used responsibly, while minimizing adverse events, then what does that look like?[21] When does Cannabis use become Cannabis abuse?

[MATT VOGEL SEGMENT]

One thing I really appreciated about my conversation with Matt was his attention to how complicated this topic is, and that there is no one size fits all answer regarding teen Cannabis use and the potential risks involved. Even just finding reputable information about Cannabis can be challenging in the age of internet headlines and memes

[MATT VOGEL SEGMENT]

So, let’s assume an adolescent has decided that they want to experiment with Cannabis. How long should they wait in order to stay safe?

[MATT VOGEL SEGMENT]

How can people minimize the risks of using Cannabis?

This all begs the next question, what can people do to reduce the risks associated with Cannabis use? From Matt’s perspective, that begins with cultivating a healthy amount of self-awareness regarding not only substance use, but health and wellness in general.

[MATT VOGEL SEGMENT]

And beyond all of that, Matt had a simple recommendation to reduce risk that was echoed by many of my other guests.

[MATT VOGEL SEGMENT]

I asked veteran Cannabis and cannabinoid researcher, Dr. Ethan Russo, about his thoughts on minimizing risks associated with Cannabis use. Right away he wanted to bring attention to the diverse and sometimes uncertain quality of Cannabis products on the market.

[ETHAN RUSSO SEGMENT]

So it’s clear that the first step of minimizing risk is to ensure you find clean, high quality products. But what comes next? Many people understand that it can be a very uncomfortable and unpleasant experience to take too much Cannabis, so what can people do to avoid this?

I spoke with Dr. Jason Miller about this issue. Jason is a doctor of acupuncture and Chinese medicine that is an expert regarding the clinical use of medicinal plants. Recently he started having a lot of patients coming to him to ask about Cannabis, so he began taking note of what their experiences and outcomes were like in order to be prepared to counsel others on the potential pitfalls and promises of Cannabis use.

The first goal, he noted, was to develop strategies to avoid taking too much in the first place…

[JASON MILLER SEGMENT]

Okay, so let’s say you’ve done your best to find your minimum effective dose, and you still went too far and are in the midst of an uncomfortable Cannabis experience. What can be done?

[JASON MILLER SEGMENT]

In case you don’t know, Acetylcholine is a neurotransmitter in our brains that among many things is responsible for influencing things like sleep, arousal, memory, and attention.[22] [23] [24] [25] [26]

[JASON MILLER SEGMENT]

And if you forget all of these suggestions, there are some products on the market now that claim to combat Cannabis intoxication.

[PEGGY ANDERSON SEGMENT]

That’s Peggy Anderson, the founder of a company called Canna Help You? Which is dedicated to providing seniors with education about Cannabis. In one recent study, it was found that the demographic of Cannabis users over the age of 65 is growing faster than any other demographic of older adults. Many of these users don’t want to be intoxicated and are particularly concerned about taking too much THC. Peggy shared some of her experience with this issue.

[PEGGY ANDERSON SEGMENT]

The feedback I got from some of my guests mirrors some of the suggestions found in literature dating back all the way to the 10th century.  See Taming THC by Ethan Russo.[27]

I asked some of my guests whether they thought that Cannabis products, overall were safe or not. The response was consistent. In places where Cannabis is legal and the quality of Cannabis products are regulated, Cannabis seems to be safer than it has ever been.

[ANTHONY SMITH SEGMENT]

[PEGGY ANDERSON SEGMENT]

Alright, Let’s review what we’ve learned, across these past three episodes:

  • While the exact level of toxicity of cannabinoids is unclear, we know that cannabinoids are orders of magnitude less toxic than caffeine or nicotine. It is physically impossible to lethally overdose on herbal As far as extracts and concentrates are concerned – there are a lot of unknowns. There is no long-term safety data available yet to understand how chronic consumption of Cannabis concentrates might affect health, however we do know that a variety of contaminants in Cannabis can become concentrated in Cannabis extracts, presenting greater risk to consumers – particularly those that have pre-existing health problems.
  • Although Cannabis is unlikely to present the risk of a lethal overdose, there are still health risks to users, including risks to lung health, heart health, mouth health, immune system health and mental health.
    • Many of these health risks stem from smoking and can be minimized or eliminated by using other consumption methods like vaporizing[28] or using edibles, tinctures or sublingual products.
    • Naïve users are at greater risk for experiencing psychological adverse effects than experienced users.[29] Start low, go slow.
  • Cannabis can potentially interact with other medications.[30] Usually this leads to sedation, but in some cases, particularly with CBD, Cannabis could slow down the body’s ability to metabolize drugs, resulting in elevated concentrations of those drugs in the blood. For anyone taking medications with narrow safety windows, this could be dangerous.
  • Some people with pre-existing health conditions could be at greater risk to suffer adverse events from Cannabis use. If you are using Cannabis and have a heart condition, compromised immune system, diabetes, or mental health condition – it’s best to work with a health care professional to make sure you stay safe.
  • Cannabis use in adolescents can exacerbate underlying mental health issues. In general it is best for young people to wait as long as possible before trying Cannabis, ideally until the age of 25, as this is the age when the brain is thought to have reached maturity.
  • If you decide to use Cannabis, start with a low dose and slowly work your way up. If you end up getting too high, there are a number of home remedies to counteract the effects of THC, including drinking water or warm milk, eating peppercorns or black pepper, taking tinctures of passionflower or calamus root, chewing on pine nuts, or drinking lemonade. There are even some targeted Cannabis antidotes now on the market. In addition, CBD may help curb the effects of THC to some extent.
  • Finally, if you consume Cannabis regularly, it’s important to perform regular abstinence breaks and wellness audits to evaluate your relationship with Cannabis to ensure that your Cannabis use is not negatively impacting your health.

So, is Cannabis safe? In toxicology it is well known that nearly anything can be toxic when consumed in a particular way or in a particular dose. In the early 1500s, the swiss physician, alchemist, and astrologer Paracelsus said, “All things are poison, and nothing is without poison. It is the dose alone that makes a thinit so a thing is not a poison.”[31] Today this is often simplified to the saying, “The dose makes the poison.” This applies to everything, including the water we drink and the air we breathe. Nothing in life is without risk, but in general Cannabis is safer, physiologically, than many substances we engage everyday, like coffee.

While there are some rare exceptions and contraindications to be aware of, Cannabis, as long as it is clean, seems to be pretty safe and well tolerated by most people, especially at low doses. Deaths attributed to Cannabis are extremely rare[32] [33], and most adverse events that could arise from Cannabis use, like hyperemesis syndrome[34], are usually reversible. To minimize risk, wait as long as you can to try Cannabis for the first time, avoid smoking, only use Cannabis of a known quality, start with low dosages, and slowly increase dosage to find a minimum effective dose. And remember, if you do take too much THC and are having an uncomfortable experience, there are a variety of things you can do to help ease that uncomfortable feeling, and, most importantly, the feeling will eventually pass and you will be fine.

I know that some of you listening might be wondering about the issue of substance abuse and addiction as a risk, which I did not cover in these episodes. Don’t worry, there will be an episode dedicated to that issue, as well as issues like pediatric Cannabis use and Cannabis use while pregnant or breastfeeding. So stay tuned as we revisit the issue of Cannabis safety in other episodes.

And with that, I’m your host, Jason Wilson. Until next time, stay curious.

[OUTRO Music]

Special thanks to our guests that were so gracious in spending time with me for interviews. To check out the citations for this episode, and there are plenty, you can check out the show notes by visiting CACPodcast.com. If you want to learn more about Cannabis, you can check out the Curious About Cannabis book, available on Amazon.com and other online book retailers. If you like what we are doing and want to support the show please consider supporting the podcast by liking and sharing this episode. You can also support us on Patreon at patreon.com/naturallearningenterprises where you can get access to the full-length guest interviews, behind-the-scenes content, and more! You can also connect with Curious About Cannabis on social media on Instagram, Facebook, Twitter, and YouTube.

[OUTRO Music continues]

 

Citations:

[1] Rosenbaum DP, et al. Cops in the Classroom: A Longitudinal Evaluation of Drug Abuse Resistance Education (DARE). Journal of Research in Crime and Delinquency. 1994. 31(1): 3-31.

[2] Birkeland S et al. Good reasons for ignoring good evaluation: the case of the drug abuse resistance education (D.A.R.E.) program. Evaluation and Program Planning. 28(3): 247-256.

[3] Karilla L et al. Acute and long-term effects of cannabis use: a review. Curr Pharm Des. 2014. 20(25): 4112-4118

[4] Ashtari M et al. Medial temporal structures and memory functions in adolescents with heavy cannabis use. Journal of Psychiatric Research. 2011. 45(8): 1055-1066.

[5] Demirakca T et al. Diminished gray matter in the hippocampus of cannabis users: possible protective effects of cannabidiol. Drug and Alcohol Dependence. 114(2-3): 242-245.

[6] Steel R et al. Delta-9-tetrahydrocannabinol disrupts hippocampal neuroplasticity and neurogenesis in trained, but not untrained adolescent Sprague-Dawley rats. Brain Research. 2014. 1548: 12-19.

[7] Jager G et al. Cannabis use and memory brain function in adolescent boys: a cross-sectional multicenter functional magnetic resonance imaging study. J Am Acad Child Adolesc Psychiatry. 2010. 49(6): 561-572.

[8] Wolf SA et al. Cannabinoid receptor CB1 mediates baseline and activity-induced survival of new neurons in adult hippocampal neurogenesis. Cell Communication and Signaling. 2010. 8:12.

[9] Jiang W et al. Cannabinoids promote embryonic and adult hippocampus neurogenesis and produce anxiolytic and antidepressant like effects. Neuroscience. 2005. 115(11): 3104-3116.

[10] Rubino T et al. Adolescent exposure to cannabis as a risk factor for psychiatric disorders. J Psychopharmacol. 2012. 26(1): 177-188.

[11] Johns A. Psychiatric effects of cannabis. Br J Psychiatry. 2001. 178: 116-122.

[12] Hall W and Lynskey M. Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. Drug and Alcohol Review. 24(1): 39-48

[13] Jackson N et al. Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies. PNAS. 113(5):E500-E508.

[14] Harvey M et al. The relationship between non-acute adolescent cannabis use and cognition. Drug and Alcohol Review. 26(3): 309-319.

[15] Nehra DK et al. Emotional intelligence and self esteem in cannabis abusers. Journal of the Indian Academy of Applied Psychology. 38(2): 385-393.

[16] Nehra DK et al. Alexithymia and emotional intelligence among people with cannabis dependence and health control: a comparative study. Dysphrenia. 2013. 5(1): 49-55.

[17] Limonero JT et al. Perceived emotional intelligence and its relation to tobacco and cannabis use among university students. Psicothema. 2006. 18: 95-100.

[18] Pope HG et al. Early-onset cannabis use and cognitive deficits: what is the nature of the association? Drug and Alcohol Dependence. 2003. 69(3):303-310.

[19] Sznitman SR and Zolotov Y. Cannabis for therapeutic purposes and public health and safety: a systematic and critical review. International Journal of Drug Policy. 2015. 26(1): 20-29

[20] Blake DR et al. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology. 2005. 45(1): 50-52.

[21] Lau N et al. Responsible and controlled use: older cannabis users and harm reduction. International Journal of Drug Policy. 2015. 26(8): 709-718.

[22] Acetylcholine. Neuroscience. 2nd Edition. https://www.ncbi.nlm.nih.gov/books/NBK11143/

[23] Miyazawa M and Yamafuji C. Inhibition of Acetylcholinesterase Activity by Bicyclic Monoterpenoids. J Agric Food Chem. 2005. 53(5): 1765-1768.

[24] Ryan MF and Byrne O. Plant-insect coevolution and inhibition of acetylcholinesterase. Journal of Chemical Ecology. 1988. 14(10): 1965-1975.

[25] Pattanaik J et al. Acorus calamus Linn.: A herbal tonic for central nervous system. Journal of Scientific and Innovative Research. 2013. 2(5): 950-954.

[26] Mukherjee PK et al. In vitro Acetylcholinesterase inhibitory activity of the essential oil from Acorus calamus and its main constituents. Planta Med. 2007. 73(3): 283-285.

[27] Russo EB. Taming THC: potential cannabis synergy and phytocannabinoids-terpenoid entourage effects. Br J Pharmacol. 2011. 163(7): 1344-1364.

[28] Abrams D et al. Vaporization as a Smokeless Cannabis Delivery System: A Pilot Study. Clinical Pharmacology and Therapeutics. 82(5): 572-578.

[29] Volkow ND et al. Adverse Health Effects of Marijuana Use. N Engl J Med. 2014. 370: 2219-2227.

[30] Bornheim LM et al. Characterization of cannabidiol-mediated cytochrome P450 inactivation. Biochemical Pharmacology. 1993. 45(6): 1323-1331.

[31] Paracelsus, dritte defensio, 1538.

[32] Gargani Y et al. Too Many Mouldy Joints – Marijuana and Chronic Pulmonary Aspergillosis. Mediterr J Hematol Infect Dis. 2011. 3(1): e2011005.

[33] Bachs L and Morland H. Acute cardiovascular fatalities following cannabis use. Forensic Science International. 2001. 124(2-3): 200-203.

[34] Simonetto DA et al. Cannabinoid Hyperemesis: A Case Series of 98 Patients. Mayo Clinic Proceedings. 87(2): 114-119.


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