What Do I Need to Know about Marijuana?

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points Israel has had marijuana for medical use for a long time. Mechoulam first discovered THC in 1964. Not until 1988 did we discover the cannabinoid receptor. First International Medical Cannabis meeting Doctors expected patients to return to them but found patients got their advice from untrained dispensary workers. This meeting changed that. Israel has no recreational use at all. Advice for US researchers

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio. Key Points ABCD Study=children ages 9 & 10 Healthy BCD Study=infants, toddlers What can we learn from alcohol, tobacco marketing to kids? Can we learn anything from Canada? What about edibles? Next Up? Dr. Huestes on Israel’s Experience & Advice for Researchers

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points 1999 Institute of Medicine stated no medicine should be smoked and there was a critical need for research National Academies of Medicine looked at this again in 2017 Unbiased look at where we are now Lessons learned from Colorado about marijuana-infused edibles Next Up? Dr. Compton on More on Executive Function: What is the ABCD Study?

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes.   Key Points Lay term for marijuana infused into a food stuff Risk that people may eat something but not know it contains marijuana, especially children Route of administration impacts drug effect CBD (Epidiolex) has been shown to be safe for use by children. FDA has issued warning letters against false medical claims for unapproved CBD products. Describes synthesis Pet peeves Next Up? Dr. Huestis on Marijuana Edibles

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points In utero drug exposure—growth, behavior, IQ, learning, memory Some obstetricians in Colorado are recommending marijuana to pregnant women Infants and toddlers are exposed if parents smoke Exposed via breast feeding Adolescents Whole spectrum of ways children can be exposed Next Up? Dr. Vandrey on Marijuana Edibles, CBD & What is Synthesis?

Mahmoud A. Elsohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse. Key Points Epidiolex is a very well-defined pharmaceutical preparation of CBD Difference between it and other CBD is like night and day. Difference between Epidiolex and CBD on the Internet and in stores What is the OTC process? What is biphasic activity? What is low bioavailability? Is there an entourage effect? Next Up? Dr. Huestis on How Marijuana Affects Kids

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of National Families in Action and Smart Approaches to Marijuana. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points Occasional user needs lower amount of THC to get high  Chronic frequent user needs quite a bit more to get the same high Some evidence showing cannabis can change the proteins that surround your DNA and determine what genes are going to reproduce. Next Up? Dr. ElSohly on Is Marijuana the Same as Epidiolex?

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio. Key Points What we don’t know Our two legal drugs, nicotine and alcohol, are responsible for devastating morbidity and mortality. What might the unintended consequences be of legalizing a third addictive drug? Exposure to adolescents and prenatally Teen vaping Next Up? Dr. Huestis on Marijuana Tolerance

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes. Key Points Impact of marijuana industry deciding how to regulate itself Lack of industry standards based on science States don’t have capability, infrastructure, or financing to deliver regulation Testing-lab shopping to find best “safety” results Hemp legalization potentially a game-changer because it opens pathway for regulation by federal agencies with knowledge of regulatory science Next Up? Dr. Compton on Predicting Future Marijuana Problems

Michael Kuhar, PhD, chairs National Families in Action’s Science Advisory Board and recruited the scientists who serve on it. He is Candler Professor of Neuropharmacology at Emory University. Among many things, Dr. Kuhar discovered the mechanism by which cocaine causes addiction. He wrote The Addicted Brain and teaches an online Coursera course of the same name, which at any given time is visited by some 300,000 people. Key Points Different kinds of studies Open studies Important to have control group Double blind studies Difference between correlation and causation What about two studies that contradict each other? Importance of replication Next Up? Dr. Vandrey on Can States Regulate Medical Marijuana Like FDA Can?

Mahmoud Elsohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse. Key Points Again, this is not something that has been shown. Science has been preempted by anecdotal evidence Education is key. First time in history that a drug has been approved by popular vote Marinol and Syndros are dronabinol (THC) approved by FDA. Clinical trials have shown what dose is needed. Epidiolex (CBD) is latest drug to be approved by FDA to treat rare forms of epilepsy. Next Up? Dr. Kuhar on Understanding Marijuana Studies

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes. Key Points Correlation but not causality States with lower death rates may have implemented other programs Population studies don’t apply to individuals; need to look at individual patients Need to compare marijuana pain relief with standard pain relievers  Next Up? Dr. ElSohly on Can Marijuana Cure Brain Cancer?

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio. Key Points What’s the difference between nabilone and dronabinol? Is marijuana safer than alcohol? Is Epidiolex the same as CBD sold almost everywhere? Where on the Internet can I find scientifically accurate information? Next Up? Dr. Vandrey on Marijuana and Opioids

Dr. Mahmoud Elsohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse. Key Points No evidence to support this thus far Georgia allows CBD oil with 5% THC 5% THC is 50 mg per gram or per milliliter, which is one 30th of an ounce That’s like 20 2½ mg Marinol capsules A super dose that needs to be fixed Developing an eye drop from THC that does not get into the blood to treat glaucoma. Next Up? Dr. Compton on What are Epidiolex, Marinol, Cesamet, and Syndros?

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points THC is fat soluble – brain is one of the fattiest tissues in the body. In chronic, frequent users, THC comes out of the blood rapidly, but active THC that is stored in the body’s fatty tissues, including the brain, leaches out slowly and can be detected for as long as 30 days. What is body burden? Cannabinoid system can turn off both excitatory and inhibitory neurons. Next Up? Dr. ElSohly on Does Marijuana Reduce Opioid Use, Deaths?

Michael Kuhar, PhD, chairs National Families in Action’s Science Advisory Board and recruited the scientists who serve on it. He is Candler Professor of Neuropharmacology at Emory University. Among many things, Dr. Kuhar discovered the mechanism by which cocaine causes addiction. He wrote The Addicted Brain and teaches an online Coursera course of the same name, which at any given time is visited by some 300,000 people. Key Points More about neurotransmitters How marijuana fits into this picture Impaired judgment and motor coordination Long-term effects Do we know much about the other chemicals in marijuana? Next Up? Dr. Huestis on Chronic, Frequent Marijuana Use

Ryan G. Vandrey, PhD, is associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. His research focuses on the behavioral pharmacology of marijuana in adult research volunteers, clinical trials, web-based survey research, and patients using marijuana or cannabinoids for therapeutic purposes. Key Points Endocannabinoid system in our brain Acute effects, chronic effects Tolerance, withdrawal Treatment of mj use disorders Marijuana may change adolescent brain structure Researchers CAN obtain mj people are using today Difference between potency and dose Cannot trust labels Next Up? Dr. Kuhar on How Marijuana Works in the Brain

Wilson Compton, MD, is deputy director of the National Institute on Drug Abuse, an agency of the National Institutes of Health. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. Dr. Compton works with the director to provide scientific leadership of NIDA’s research portfolio. Key Points Difference between whole marijuana plant and chemicals in the plant “Legal” is not the same as “safe” Marijuana toxicities Do states that legalize marijuana protect consumers from unsafe, ineffective drugs? CBD is a mostly unregulated industry Next Up: Dr. Vandrey on What Does Marijuana Do to My Brain

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points Consequences of impact on executive function Divided attention Effects on respiratory and cardiovascular systems Chronic use changes brain structure Why worry about heavy metals found in some marijuana? Next Up: Dr. Compton on If Marijuana is Medicine, How Can It Hurt Me?

Mahmoud A. ElSohly, PhD, is a pharmacologist known for his work on marijuana. He is professor of pharmaceutics in the school of pharmacy at the University of Mississippi where he directs the Marijuana Project, which grows pharmaceutical-grade marijuana for research. He is an expert in the processing, testing, and detection of drugs of abuse. Key Points Standard manufacturing conditions Sinsemilla and potency Rigorous scientific data missing Side-effects of marijuana Increase in potency parallels increase in ER admissions over time Next Up: Dr. Huestis on More on Executive Function

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Boards of Smart Approaches to Marijuana and National Families in Action. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points Marijuana toxicities Two major studies of use during pregnancy and breastfeeding show cognitive deficits in children by age 6 New Zealand study shows regular use lowers IQ What is executive function Next Up: Dr. ElSohly on What's Involved in Growing Research-Grade Marijuana

Michael Kuhar, PhD, chairs National Families in Action’s Science Advisory Board and recruited the scientists who serve on it. He is Candler Professor of Neuropharmacology at Emory University. Among many things, Dr. Kuhar discovered the mechanism by which cocaine causes addiction. He wrote The Addicted Brain and teaches an online Coursera course of the same name, which has been visited by some 300,000 people. Key Points Medical marijuana comes from the same plant recreational marijuana comes from FDA-approved drugs vs state-approved drugs Do medical societies endorse marijuana as medicine? Treatment for marijuana addiction Next Up: Dr. Huestis on Safe and Effective Medicines

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse but remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa. Here she explains how other nations do a better job of ensuring road safety than the US. Key Points Australia since 2004 has conducted random stops. Screen with oral fluid, confirm with oral fluid. You are not allowed to have these drugs in your body when you drive. Series of penalties. Don’t base it on impairment. Europe way ahead of the US in oral fluid screening. Germany - Doctor observes impairment, draws blood on site. Police officers can take the sample. Point of Contact Testing (POCT) (taken right where you are) Roadside tests. Probable cause. Canada Drug Recognition Experts (DREs) Next Up: Dr. Kuhar on Medical Marijuana

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse, but remains highly active in the field. She is known for her research on how marijuana use affects driving and how exposure to parents’ marijuana use affects the developing fetus, breast-feeding newborns, and young children, as well as the new psychoactive substances. Key Points US is not prepared for driving with marijuana on board. Huge issue and huge problem. In occasional users, 74% of THC comes out of the body in 30 minutes, 90% in 1.4 hours. Average time to get drivers’ blood drawn is 1.4 to 4 hours. Many states have zero tolerance levels such as 1 or 2 nanograms per milliliter. Establish impairment first, then take the biological sample. A-Ride Program (NHTSA) trains every police officer to do the field sobriety test. Also can establish impairment via witnesses. Next Up: Dr. Huestis on How Other Nations Ensure Road Safety

Marilyn A. Huestis, PhD, recently retired as chief of chemistry and drug metabolism at the Intramural Research Program of the National Institute on Drug Abuse, but she remains highly active in the field. She is a senior fellow at the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University in Philadelphia, Pa.; consultant to the US Department of Transportation; and serves on the Science Advisory Board of National Families in Action. Here she relates what she and her team learned from studying how marijuana affects driving. Key Points National Advanced Driving Simulator Cannabis affects critical tracking Speeding is number-1 reason marijuana-impaired drivers are stopped Drug Recognition Experts (DREs) Next Up: Dr. Huestis on State Regulations to Ensure Road Safety