Summary

In this conversation, Dr. Igor Grant and Dr. Eric Leas delve into the complexities surrounding Delta-8-THC, exploring its differences from Delta-9-THC, consumer demand, regulatory challenges, and safety concerns. They discuss the implications of state regulations on the market, the need for compliance in cannabis research, and the future of Delta-8-THC regulation. The conversation also touches on the broader landscape of cannabinoids and psychoactive substances, highlighting the ongoing evolution of cannabis regulation and public health considerations.

Takeaways

• Delta-8-THC is structurally similar to Delta-9-THC but less psychotropic effect.
• Consumer demand for Delta-8 is driven by its legal status as a hemp product in states without medical or recreational cannabis use regulations.
• Regulatory challenges exist due to the lack of standardized safety measures.
• States with legal cannabis markets are concerned about competition from Delta-8 products.
• Research on Delta-8 is limited, necessitating further studies on its effects.
• The market for Delta-8 is largely unregulated, raising safety concerns.
• There is a growing interest in other cannabinoids and psychoactive substances.

• Compliance checks in cannabis retail are complicated by federal laws.
• The patchwork of state regulations creates confusion for consumers and manufacturers.

Chapters:

00:00 Introduction to Delta-8 THC

02:51 Understanding Delta-8 THC: Differences and Similarities

05:15 Consumer Demand: Supply and Demand Dynamics

09:48 Regulatory Challenges and Safety Concerns

17:01 Research Background and Interest in Delta-8 THC

19:33 Compliance and Regulation in Cannabis Sales

21:50 Redesigning State and Federal Cannabis Policy

24:24 The Future of Delta-8 THC Regulation

27:39 Exploring Other Cannabinoids and Their Implications

32:25 The Broader Landscape of Psychoactive Substances

In this conversation, Dr. Igor Grant and Dr. Alison Moore discuss the increasing prevalence of cannabis use among older adults, the reasons behind this trend, and the medical applications of cannabis. She highlights the complexities of cannabis use, including its association with comorbid conditions and the challenges in educating both healthcare providers and patients about its safe use. The conversation emphasizes the need for more research and better education in the field of geriatric care regarding cannabis.

Takeaways

• Alison Moore is the Chief of Geriatrics at UC San Diego.

• Cannabis use among older adults is increasing.

• Reasons for cannabis use include pain, sleep issues, and anxiety.

• Older adults often use cannabis for medical purposes.

• The prevalence of cannabis use in older adults varies by survey.

• Long-term users tend to prefer smoking, while newer users prefer edibles.

• Cannabis use is linked to comorbid conditions like diabetes and heart disease.

• Education on cannabis use is lacking among healthcare providers.

• Patients often receive cannabis information from non-medical sources.

• There is a need for more research on cannabis effects in older adults.

Chapters

00:00 Intro

02:00 Prevalence and Reasons for Cannabis Use

03:56 Medical Applications and User Experiences

06:41 What Types of Products Are Older Adults Using?

08:32 Cannabinoids and Behaviors in Older Adults

11:40 Cannabis as a Treatment for Dementia Symptoms

13:54 Risk/Benefit for Clinicians Recommending Cannabis

14:38 Different Risks for Different Methods of Use

16:14 Pharmacokinetics of Different Methods of Use

16:45 Sources of Products for Older Adults

19:37 The Stigma of Cannabis Disclosure

20:48 Complexities of Cannabis and Alcohol Use

25:08 Educating Physicians on Cannabis

26:57 Advice for Patients Considering Cannabis

29:58 Understanding Cannabis Use Disorder

32:07 Inhalation vs. Oral Cannabis Use

33:31 Final Thoughts on Cannabis Education

36:16 Outro

Bio

Alison A. Moore, MD, MPH, FACP, AGSF, is a Professor and Chief of the Division of Geriatrics, Gerontology and Palliative Care, and Director of the Sam and Rose Stein Institute for Research on Aging and the Center for Healthy Aging. She holds the Larry L. Hillblom Chair in Geriatric Medicine. She is a geriatrician who provides primary and consultative care to older adults and a public health researcher whose work focuses principally on older adults with unhealthy substance use. She also has interests in healthy aging, gerontechnology, health equity, and aging and HIV. Dr. Moore has a passion for health equity; she was the inaugural Vice Chair for Justice, Equity, Diversity and Inclusion in the Department of Medicine. She is equally passionate about mentorship; in 2019, she was awarded the UC San Diego Health Sciences Faculty Excellence in Mentoring Award. She is MPI of an NIA-funded Alzheimer’s Disease Resource Center for Minority Aging Research (P30AG059299) and has been the recipient of a K24 Midcareer Award in Patient-Oriented Research from NIAAA (K24AA15957). She is an elected member of the Board of Directors of the American Geriatrics Society and is currently its President-elect.

Summary

In episode 10, Drs. Grant and Alan Budney, PhD of Dartmouth explore the intersection of cannabis use and behavioral health, focusing on contingency management as a method for addressing problematic cannabis use. The discussion highlights the integration of digital technologies in interventions, the role of craving in cannabis use, and the challenges healthcare providers face in communicating about cannabis. Additionally, the conversation addresses the co-occurrence of mood disorders with cannabis use and the potential of social media to influence public perception and behavior regarding cannabis.

Takeaways

• Contingency management applies principles of reinforcement to change behavior.
• Monitoring systems are essential for effective interventions.
• Incentives are crucial for encouraging positive behavior change.
• Setting achievable targets increases the likelihood of success.
• Digital technologies can enhance the accessibility of interventions.
• Craving is a significant factor in substance use behavior.
• Real-time assessments can help manage cravings effectively.
• Healthcare providers need better education on cannabis use.
• Mood disorders often co-occur with problematic cannabis use.
• Social media can be leveraged for positive cannabis messaging.

Chapters

00:00 Intro - Ecological Momentary Assessment

00:46 Intro

02:06 The Role of Reinforcement Schedules (ContingencyManagement)

10:17 Digital Innovations in Cannabis Treatment

16:19 Privacy Concerns in Digital Interventions

18:57 Exploring the Phenomenon of Craving

20:51 Ecological Momentary Assessment in Action

24:50 Healthcare Providers and Cannabis Communication

32:55 Mood Disorders and Cannabis Use

39:54 The Role of Social Media in Cannabis Education

43:17 Outro Animation.mp4

43:57 Changes in Use Patterns Amid Legalization 

Summary

In episode 9, Drs. Grant and Ziva Cooper discuss her research on medicinal cannabis, focusing on gender differences in cannabis response, the therapeutic potential of minor cannabinoids and terpenes, and the opioid-sparing effects of cannabinoids. The conversation highlights the complexities of cannabis research, including regulatory challenges and the need for further studies to clarify the role of cannabinoids in medicine.

Takeaways

• Dr. Ziva Cooper is a leading researcher in medicinal cannabis.

• Gender differences in cannabis response are significant.

• Women may be more sensitive to the pain-relieving effects of cannabis.

• Minor cannabinoids like CBG show promise for therapeutic use.

• Terpenes may enhance the effects of THC without psychoactivity.

• Cannabinoids could potentially reduce opioid use in chronic pain patients.

• Research on cannabinoids faces significant regulatory hurdles.

• Understanding the psychological aspects of pain is crucial.

• The therapeutic potential of cannabinoids is still being explored.

• Future research is needed to clarify the role of cannabinoids in medicine.

Chapters

00:00 CBG for Pain and Appetite Stimulation

00:51 Exploring Sex Differences in Cannabis Response

00:52 Intro

01:24 Understanding Cannabinoids: THC, CBD, and Beyond

01:24 Introduction to Ziva Cooper, PhD

02:17 THC and Sex and Gender Differences

11:09 Minor Cannabinoids, Terpenes and Terpenoids

13:46 Cannabigerol (CBG) for Pain and Appetite Stimulation

20:21 Cannabichromine for Pain

21:48 Exploring Cannabichromine (CBC) and Its Potential

22:21 Understanding Terpenes and Terpendoids (Myrcene and Beta-Caryophyllene)

24:46 The Different Regulatory Status of Terpenes and Terpenoids

26:04 Cannabinoids as Opioid-Sparing Agents

30:22 Cannabinoids and Substance Use Disorders

32:04 The Psychological Experience of Pain

35:14 Advancing Cannabinoid Research in Medicine

38:10 Regulatory Hurdles to Researching Cannabis and Cannabinoids

40:16 Outro

Summary

In episode 8, Drs. Igor Grant and Dale Gieringer discuss Dr. Gieringer’s extensive involvement in cannabis legalization efforts in California, particularly through his work with California NORML. He reflects on the historical context surrounding cannabis laws, the significance of Proposition 215, the first medical marijuana initiative, and the subsequent passage of Proposition 64, which legalized recreational use. Dr. Gieringer emphasizes the need for continued advocacy and research in the field of cannabis, highlighting the challenges and opportunities that lie ahead in harmonizing state and federal regulations.

Takeaways

• Dale Gieringer has been involved in cannabis reform since 1987.

• NORML was founded to advocate for consumer rights regarding marijuana.

• Proposition 215 was the first medical marijuana law in the U.S.

• The medical marijuana movement gained momentum in the 1990s in San Francisco, CA.

• Public support for cannabis legalization has grown significantly over the years.

• Proposition 64 decriminalized marijuana and reduced felony arrests.

• Research on cannabis remains limited due to federal restrictions.

• The medical ID card program in California is underutilized.

• There is a need for better education among cannabis dispensary staff.

• Future cannabis policy should focus on harmonizing state and federal laws.

Chapters

00:00 – Intro

01:02 – Dr. Geringer's Background

05:54 – What is NORML and CalNORML?

07:05 – The Role of NORML in Cannabis Legalization

10:14 – The Journey of Proposition 215

13:29 – Dr. Tod Mikuriya's Role

16:35 – Dennis Peron and San Francisco's Medical Marijuana Initiative in 1991

18:27 – San Francisco's Patient's Buyers Club & Prop 215

21:04 – Ballot Measures in California & Prop 215

23:20 – Rescheduling Cannabis

24:24 – Prop 19, Prop 64, & Adult Use Legalization

35:35 – Future Directions for Cannabis Legislation

37:10 – The State of Medical Cannabis in California

42:50 – Outro

In episode 7, Dr. Igor Grant and Dr. Daniele Piomelli examine intricacies of the endocannabinoid system (ECS), exploring its mechanisms, functions, and implications in health and medicine. They discuss the role of cannabinoids in signaling, the distribution of cannabinoid receptors, and the ECS’s influence on feeding behavior, pain management, and social interactions. The conversation highlights potential therapeutic approaches targeting the ECS, highlighting differences between central and peripheral Fatty Acid Amide Hydrolase (FAAH) inhibitors, while also addressing the challenges faced in drug development and the need for further research.

Takeaways

• The endocannabinoid system (ECS) is crucial for cellular communication.
• The ECS operates on-demand, producing endocannabinoids when needed.
• Cannabinoid receptors are widely distributed throughout the body.
• 2-AG acts as a circuit breaker in the brain's signaling.
• Anandamide plays a role in stress coping and social bonding.
• The ECS influences feeding behavior and hunger regulation.
• New drug classes targeting the ECS show promise for obesity management.
• Pain management through ECS modulation is complex and requires careful study.
• Research into para-cannabinoids (e.g., Palmitoylethanolamide (PEA)) may reveal new therapeutic avenues.
• The ECS's role in social interactions is an emerging area of interest.

Chapters

00:00 - Introduction to the Endocannabinoid System

08:16 - Understanding the Endocannabinoid System

18:02 - Functions and Distribution of Cannabinoid Receptors

20:00 - Endocannabinoids and Feeding Behavior

28:26 - Endocannabinoids in Pain Management

37:22 - Endocannabinoids and Social Interactions

44:53 - Surprises and Future Directions in Research

In episode 6, Dr. Grant and Dr. Meg Haney delve into thecomplexities of Cannabis Use Disorder, exploring its definition, withdrawal symptoms, and the psychological dependency associated with cannabis use. They discuss the impact of cannabis on sleep and mood, the prevalence of CannabisUse Disorder among those with psychiatric conditions, and the challenges in treating cannabis dependency. The conversation also highlights the intersection of cannabis use with other substances, particularly tobacco, and emphasizes theneed for further research to understand the therapeutic benefits and risks of cannabis use.

Takeaways

• Cannabis Use Disorder is characterized by preoccupation and disruption in life.
• Withdrawal symptoms include irritability, anxiety, and disrupted sleep.
• Cannabis can lead to psychological dependency, similar to other substances.
• The severity of withdrawal symptoms can vary among individuals.
• Cannabis withdrawal can disrupt sleep patterns and lead to nightmares.
• Cannabis is often used for sleep, but it may not be effective long-term.
• The prevalence of Cannabis Use Disorder can be higher among those with psychiatric conditions.
• Treatment approaches for Cannabis Use Disorder include medications like Nabilone.
• Tobacco use can predict worse outcomes in treatment of Cannabis Use Disorder.
• Future research is needed to understand the effects of cannabis on pain and tolerance.

Chapters

00:00 - Intro

01:06 - Introduction of Meg Haney, PhD

01:45 - Cannabis Use Disorder Defined

03:22 - Cannabis Dependence & Withdrawal Symptoms

07:49 - Cannabis & Sleep

09:46 - Withdrawal & Anxiety

10:47 - Cannabis Withdrawal Compared to Alcohol, Tobacco& Other Substances

13:45 - The Complexity of Cannabis Use and Dependency

19:33 - Treatment Approaches for Cannabis Use Disorder

25:41 - The Intersection of Cannabis and Other Substances

32:22 - Future Research Directions in Cannabis Studies

34:25 - Closing Thoughts

36:24 - Outro

In episode 5, Dr. Grant speaks with Dr. Mark Ware as he discusses the evolution of cannabis use in pain management, the implications of the Cannabis Act in Canada, and the differences in cannabis policies between Canada and the U.S. Dr. Ware highlights the importance of understanding the psychoactive effects of cannabis, the challenges in medical research, and the need for a cohesive regulatory framework to ensure safety and efficacy in cannabis products.

Bio

Mark A. Ware, MD, MBBS, MSc, MRCP

Dr. Ware is an Associate Professor of Family Medicine and holds the Alan Edwards Chair in Clinical Pain at McGill University. He is also the Director of the interdisciplinary Alan Edwards Pain Management Unit at Montreal General Hospital.

He was a co-founder of the non-profit Canadian Consortium for the Investigation of Cannabinoids and served as Executive Director from2007 to 2018. Dr. Ware has advised the Canadian federal government on cannabis policy since 2001, and in 2016, he served as the vice-chair of the Federal Task Force on the Legalization and Regulation of Cannabis in Canada. The task force’s report became Canadian law as the Cannabis Act in October 2018. 

Takeaways

• Patients reported that cannabis helped their pain.

• The Cannabis Act was developed to allow for legalization and regulation.

• Cannabis is not covered under most provincial drug frameworks.

• The sky didn't fall after legalization; no major public health issues arose.

• The consumer has become a lot more educated about cannabis products.

• There is a patchwork of cannabis regulations in the U.S.

• The industry didn't pick up on medical research as hoped after legalization.

• A federal strong policy would be a game changer for cannabis regulation.

• The psychoactive effects of cannabis can play a role in pain management.

• The narrative around cannabis is slowly changing from prohibition to acceptance.

Chapters

00:00 High5 Introduction

01:09 Intro & background of Dr. Mark Ware

02:08 Early Research and Patient Experiences

05:38 Cannabis as an Analgesic

07:53 The Cannabis Act: Overview and Features

09:43 The Evolution of the Cannabis Act

10:34 Medical Use and Prescription Challenges

12:06 Insurance and Coverage for Cannabis

12:58 Patient Conversations and Treatment Frameworks

15:40 Post-Legalization Insights and Observations

19:21 Provincial Variations in Cannabis Regulation

21:16 Impact on Medical Research

24:25 GPP v. GMP

27:27 Lessons for the U.S. from Canada’s Experience

33:20 Outro

Dr. Grant speaks with Alex P. Miller, Ph.D., an Assistant Professor of Psychiatry at Indiana University School of Medicine. This conversation explores the intricate relationship between substance use, genetics, and brain structure, focusing on the ABCD study, which follows children over a decade to understand the onset of substance use and its effects on mental health. Dr. Alex Miller discusses the role of neuroimaging in identifying brain differences that may predispose individuals to substance use, the influence of genetics and environment, and the implications of these findings for understanding addiction and recovery.

Takeaways

• The ABCD study involves nearly 12,000 children and tracks their development over time.
• Neuroimaging can reveal brain differences that may predispose individuals to substance use.
• Genetics and environment interact to influence the risk of substance use disorders.
• Impulsivity is linked to both personality traits and substance use initiation.
• The caudate plays a role in reward processing and may influence cannabis use.
• Brain structure can change over time, indicating resilience in recovery from substance use.
• Findings suggest that larger brain volumes may not correlate with better outcomes.
• The study highlights the importance of early environmental influences on brain development.
• Understanding the relationship between brain structure and substance use is complex and multifaceted.
• Future research will continue to explore the dynamic interplay between genetics, environment, and substance use.

Chapters

00:00 -Preview

00:12 - Dr. Miller's background

01:39 - The chicken and egg problem

02:08 - Dr. Miller's research & the ABCD Study

05:18 - Genetics & epigenetics, Nature v. Nurture

07:33 - Impulsivity and Substance Use

09:19 - Neuroimaging techniques used to evaluate brain size

13:16 - Findings on brain structure and size

16:02 - Cannabis use and brain structure

21:29 - The Dynamic Relationship Between Brain and Behavior

22:11 - Implications of the research findings

25:27 - Where do brain differences come from?

27:18 - Outro

Studies

Neuroanatomical Variability and Substance Use Initiation in Late Childhood and Early Adolescence

In this episode, Dr. Igor Grant speaks with Dr. Jamie Corroon about the impact of cannabis use on cardiovascular health. They explore various studies focusing on heart disease, hypertension, and atherosclerosis, discussing both acute and long-term effects of cannabis. Dr. Corroon shares insights from his research, highlighting the importance of understanding the relationship between cannabis and cardiovascular outcomes, while also addressing the need for more rigorous studies to clarify potential risks.

Chapters

00:00 - Research Methodology and Data Collection

00:31 - Podcast overview

01:06 - Dr. Corroon's background

03:26 - Acute effects of cannabis use on the heart

04:13 - Chronic effects

05:39 - Research methods used to study chronic effects

07:05 - Datasets used to study cardiovascular disease

07:48 - Findings for heart attack

10:14 - Cannabis use and heart attack

12:30 - Heavy use and heart attack

13:36 Atherosclerosis & carotid artery calcification

18:22 - Findings related to carotid artery calcification

20:37 - Hypertension and Long-term Cannabis Use

21:52 - Conclusions and Future Research Directions

24:08 - Final thoughts

24:51 - Outro

Additional resources:

1. Trends in Cannabis Use, Blood Pressure, and Hypertension in Middle-Aged Adults: Findings From NHANES, 2009-2018
2. Associations Between Monthly Cannabis Use and Myocardial Infarction in Middle-Aged Adults: NHANES 2009 to 2018
3. Regular cannabis smoking and carotid artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA)