WEBVTT 00:00:00.000 --> 00:00:03.620 Welcome to today's deep dive. We are genuinely 00:00:03.620 --> 00:00:05.620 thrilled you could take some time to join us 00:00:05.620 --> 00:00:08.199 for this conversation. Today, we're tackling 00:00:08.199 --> 00:00:10.960 a subject that you simply cannot escape right 00:00:10.960 --> 00:00:13.619 now. No, you really can't. It's debated in politics. 00:00:13.720 --> 00:00:16.100 It casually pops up in movies and television. 00:00:16.239 --> 00:00:20.379 It's all over social media. And it's highly likely 00:00:20.379 --> 00:00:22.899 that you or someone in your immediate circle 00:00:22.899 --> 00:00:25.980 has a very strong opinion about it. Oh, absolutely. 00:00:26.539 --> 00:00:28.480 We're talking about medical cannabis. It's a 00:00:28.480 --> 00:00:31.260 topic that carries a tremendous amount of cultural 00:00:31.260 --> 00:00:34.320 baggage. When you look at the landscape of information 00:00:34.320 --> 00:00:37.420 out there, you are met with a wall of noise. 00:00:37.619 --> 00:00:39.719 Just a total wall. Yeah. You have one headline 00:00:39.719 --> 00:00:41.859 claiming it's a miracle cure for just about everything. 00:00:42.060 --> 00:00:44.579 And then the very next headline is warning of 00:00:44.579 --> 00:00:47.359 dire consequences. It becomes a real challenge 00:00:47.359 --> 00:00:49.859 to parse out what is actually grounded in reality. 00:00:50.100 --> 00:00:51.719 Which is exactly why we're sitting down to do 00:00:51.719 --> 00:00:54.789 this today. Core mission for this deep dive is 00:00:54.789 --> 00:00:57.329 to cut right through that static. We want to 00:00:57.329 --> 00:01:00.689 bypass the hearsay, the pop culture myths and 00:01:00.689 --> 00:01:03.490 the loud political opinions. To do that, we are 00:01:03.490 --> 00:01:05.650 going straight to the source material. We're 00:01:05.650 --> 00:01:08.049 pulling our insights today from a highly comprehensive, 00:01:08.510 --> 00:01:11.489 thoroughly cited Wikipedia article dedicated 00:01:11.489 --> 00:01:14.489 specifically to the topic of medical cannabis. 00:01:14.769 --> 00:01:17.530 And our goal here is to extract what the rigorous 00:01:17.530 --> 00:01:20.310 science. the pharmacology, and the historical 00:01:20.310 --> 00:01:23.420 records actually tell us about this plant. We 00:01:23.420 --> 00:01:25.379 want to serve this up to you in a way that is 00:01:25.379 --> 00:01:27.780 easy to digest and hopefully give you a solid 00:01:27.780 --> 00:01:30.780 foundation of facts. So as you are listening 00:01:30.780 --> 00:01:32.980 today, I want you to ask yourself how much of 00:01:32.980 --> 00:01:34.840 what you currently believe about medical cannabis 00:01:34.840 --> 00:01:37.439 comes from a laboratory and how much is just 00:01:37.439 --> 00:01:39.959 cultural osmosis. That is the perfect mindset 00:01:39.959 --> 00:01:42.319 to carry into this discussion. My goal today 00:01:42.319 --> 00:01:44.739 is to look at the evidence with strict impartiality. 00:01:45.120 --> 00:01:47.540 We're going to examine the modest potential benefits 00:01:47.540 --> 00:01:49.700 and we are going to weigh them directly against 00:01:49.700 --> 00:01:52.480 the established documented risks. the actual 00:01:52.480 --> 00:01:55.200 science. Exactly. The science we're going to 00:01:55.200 --> 00:01:57.840 look at is compelling, but it also serves as 00:01:57.840 --> 00:02:01.500 a fantastic exercise in thinking critically about 00:02:01.500 --> 00:02:05.500 how modern medicine is evaluated categorized 00:02:05.500 --> 00:02:08.300 and ultimately approved. OK, let's unpack this, 00:02:08.439 --> 00:02:10.280 because the very first thing that jumps out from 00:02:10.280 --> 00:02:12.479 the research is the sheer botanical challenge 00:02:12.479 --> 00:02:15.879 of dealing with this plant. It's a huge hurdle. 00:02:16.020 --> 00:02:17.460 I mean, think about what happens when you go 00:02:17.460 --> 00:02:19.919 to the pharmacy to pick up a typical government 00:02:19.919 --> 00:02:22.439 approved medication. You're usually getting something 00:02:22.439 --> 00:02:25.479 incredibly precise. Right. You get a pill that 00:02:25.479 --> 00:02:28.319 contains one, maybe two active chemicals and 00:02:28.319 --> 00:02:32.629 some binding agents, but a cannabis plant. You 00:02:32.629 --> 00:02:35.349 are dealing with over 400 different chemicals. 00:02:35.590 --> 00:02:39.110 Over 400. Wow. And out of those, about 70 are 00:02:39.110 --> 00:02:41.330 classified specifically as cannabinoids. Just 00:02:41.330 --> 00:02:44.310 a massive cocktail. Yes. And this chemical density 00:02:44.310 --> 00:02:46.930 is the fundamental reason why medical cannabis 00:02:46.930 --> 00:02:49.849 is so notoriously difficult for the medical community 00:02:49.849 --> 00:02:52.990 to study. Because there's so much going on. Precisely. 00:02:53.349 --> 00:02:55.990 Researchers prefer to isolate a single variable 00:02:55.990 --> 00:02:59.349 to see exactly what it does. But here, you aren't 00:02:59.349 --> 00:03:01.830 dealing with a single isolated variable. You're 00:03:01.830 --> 00:03:05.009 dealing with a complex botanical cocktail. I 00:03:05.009 --> 00:03:07.169 can imagine that makes running a controlled trial 00:03:07.169 --> 00:03:09.550 a bit of a nightmare. How does the human body 00:03:09.550 --> 00:03:12.509 even process a cocktail like that? That is where 00:03:12.509 --> 00:03:15.449 the endocannabinoid system comes into play. Humans 00:03:15.449 --> 00:03:18.330 actually have specific receptors built into our 00:03:18.330 --> 00:03:21.569 biology that interact directly with these chemicals. 00:03:21.849 --> 00:03:24.430 Okay. The two primary ones that researchers focus 00:03:24.430 --> 00:03:28.129 on are known as CB1 and CB2. So we have a built 00:03:28.129 --> 00:03:30.889 -in lock. And the plant provides the keys. That's 00:03:30.889 --> 00:03:32.909 a great way to put it. But do those two receptors 00:03:32.909 --> 00:03:35.050 do the same thing? Not at all. They have very 00:03:35.050 --> 00:03:37.650 distinct functions. Okay. CB1 receptors are found 00:03:37.650 --> 00:03:40.110 in high concentrations of the brain. When those 00:03:40.110 --> 00:03:42.409 receptors are activated, they produce the psychoactive 00:03:42.409 --> 00:03:44.629 effects that's the high typically associated 00:03:44.629 --> 00:03:47.270 with cannabis. And the other one. CB2 receptors, 00:03:47.389 --> 00:03:49.830 on the other hand, are located peripherally throughout 00:03:49.830 --> 00:03:52.550 the body's immune system and tissues. Activating 00:03:52.550 --> 00:03:55.150 a CV2 receptor doesn't produce a psychoactive 00:03:55.150 --> 00:03:57.990 effect. Instead, it's thought to modulate things 00:03:57.990 --> 00:04:00.909 like pain and inflammation. So the effect a patient 00:04:00.909 --> 00:04:03.009 feels isn't just about the fact that they consumed 00:04:03.009 --> 00:04:05.629 cannabis. It depends entirely on which of those 00:04:05.629 --> 00:04:07.969 70 cannabinoids are hitting which receptors. 00:04:08.210 --> 00:04:11.129 The source material puts a huge emphasis on the 00:04:11.129 --> 00:04:14.110 ratio between two specific chemicals, CCD and 00:04:14.110 --> 00:04:17.610 THC. Yes, the ratio between those two dictates 00:04:17.610 --> 00:04:20.790 the entire therapeutic outcome. Tetrahydrocannabinol, 00:04:20.850 --> 00:04:24.009 or THC, is the primary psychoactive cannabinoid. 00:04:24.029 --> 00:04:26.610 It hits those CB1 receptors in the brain hard. 00:04:26.829 --> 00:04:28.910 Right. That's the one that causes the high. Yes. 00:04:29.529 --> 00:04:33.329 Cannabidol, or CBD, is non -psychoactive. What 00:04:33.329 --> 00:04:36.329 a major 2014 review pointed out is that CBD actually 00:04:36.329 --> 00:04:39.250 attenuates, meaning it reduces or blunts the 00:04:39.250 --> 00:04:41.970 psychoactive impact of THC. Wait, so the CBD 00:04:41.970 --> 00:04:45.029 actively fights the high of the THC? In a sense, 00:04:45.069 --> 00:04:48.449 yes. It changes how the THC binds. So if a patient 00:04:48.449 --> 00:04:51.149 uses a product with high THC and low CBD, they 00:04:51.149 --> 00:04:53.069 will experience a strong psychoactive effect. 00:04:53.310 --> 00:04:55.709 Got it. If the product has high CBD and low THC, 00:04:55.730 --> 00:04:57.550 they might get the anti -inflammatory benefits 00:04:57.550 --> 00:04:59.829 without the cognitive impairment. The balance 00:04:59.829 --> 00:05:02.129 of those two molecules changes the medicine entirely. 00:05:02.470 --> 00:05:05.290 That alone makes standardizing a dose complicated. 00:05:05.610 --> 00:05:07.930 Highly complicated. But then the source dives 00:05:07.930 --> 00:05:10.089 into how the method of consumption completely 00:05:10.089 --> 00:05:13.129 changes the equation. The medical field uses 00:05:13.129 --> 00:05:16.910 a term called bioavailability. Which is basically 00:05:16.910 --> 00:05:19.250 how much of the substance actually makes it into 00:05:19.250 --> 00:05:22.069 your system to have an effect. Exactly. If someone 00:05:22.069 --> 00:05:25.370 smokes or vapes cannabis, the bioavailability 00:05:25.370 --> 00:05:28.930 ranges anywhere from 10 to 35 percent. But if 00:05:28.930 --> 00:05:31.129 they consume it orally, like in a brownie or 00:05:31.129 --> 00:05:34.089 a gummy, that number drops to about 6 percent. 00:05:34.269 --> 00:05:36.829 A substantial drop. Yeah. Here's where it gets 00:05:36.829 --> 00:05:39.029 really interesting, though. It isn't just the 00:05:39.029 --> 00:05:41.889 amount that gets absorbed. the entire timeline 00:05:41.889 --> 00:05:44.810 of the effect shifts. Right. I think a lot of 00:05:44.810 --> 00:05:46.810 people assume that eating it and inhaling it 00:05:46.810 --> 00:05:48.430 are basically the same thing, just a different 00:05:48.430 --> 00:05:51.410 delivery method. But the journey of an edible 00:05:51.410 --> 00:05:54.290 cannabis product through the human body is completely 00:05:54.290 --> 00:05:56.449 different. It follows a totally different metabolic 00:05:56.449 --> 00:05:59.829 pathway. When cannabis is inhaled, the compounds 00:05:59.829 --> 00:06:02.269 pass through the lungs directly into the bloodstream 00:06:02.269 --> 00:06:05.209 and straight to the brain. Very fast. The onset 00:06:05.209 --> 00:06:07.870 of the effect is almost immediate. But when you 00:06:07.870 --> 00:06:09.930 eat an edible, it has to travel through your 00:06:09.930 --> 00:06:12.290 gastrointestinal tract, and then it goes to the 00:06:12.290 --> 00:06:14.750 liver first. And this process is called first 00:06:14.750 --> 00:06:17.050 -pass metabolism. Correct. And the liver doesn't 00:06:17.050 --> 00:06:19.949 just pass it along, does it? It actually alters 00:06:19.949 --> 00:06:22.310 the chemistry. Your liver acts like a chemical 00:06:22.310 --> 00:06:25.089 laboratory. It takes the primary psychoactive 00:06:25.089 --> 00:06:28.949 molecule, standard delta -9 -THC, and converts 00:06:28.949 --> 00:06:31.610 it into a completely new metabolic product called 00:06:31.610 --> 00:06:35.009 11 -hydroxy -THC. which according to the text 00:06:35.009 --> 00:06:37.509 is far more potent. Think of it as a supercharged 00:06:37.509 --> 00:06:41.069 variant. It is highly psychoactive. And this 00:06:41.069 --> 00:06:44.050 specific liver metabolism explains a lot of the 00:06:44.050 --> 00:06:46.009 confusion surrounding edibles. That makes so 00:06:46.009 --> 00:06:48.069 much sense. It explains why they have such uniquely 00:06:48.069 --> 00:06:51.290 potent effects compared to inhalation, and crucially, 00:06:51.290 --> 00:06:54.220 why they take so long to kick in. a patient might 00:06:54.220 --> 00:06:56.199 not feel the peak effects for two to six hours 00:06:56.199 --> 00:06:58.800 after ingestion. That delayed onset must cause 00:06:58.800 --> 00:07:01.480 so many dosage errors. Someone takes a dose, 00:07:01.680 --> 00:07:04.220 feels nothing an hour later, takes more, and 00:07:04.220 --> 00:07:06.000 then the liver finally finishes processing that 00:07:06.000 --> 00:07:07.980 supercharged variant. It happens frequently. 00:07:08.300 --> 00:07:11.019 Eventually, the liver processes it a second time, 00:07:11.120 --> 00:07:13.420 breaking it down into an inactive byproduct, 00:07:13.620 --> 00:07:16.980 11 -COHTHC, that your body just flushes out. 00:07:17.740 --> 00:07:21.000 But that metabolic detour through the liver creates 00:07:21.000 --> 00:07:23.620 a pharmacological response. that is distinct 00:07:23.620 --> 00:07:25.759 from smoking. So you have this unpredictable 00:07:25.759 --> 00:07:28.720 delayed effect with edibles. When you pair that 00:07:28.720 --> 00:07:30.800 with the sheer chemical complexity of the plant 00:07:30.800 --> 00:07:34.160 itself, it completely reframes why doctors have 00:07:34.160 --> 00:07:36.139 such a hard time writing a standard prescription 00:07:36.139 --> 00:07:38.800 for it. It's a logistical nightmare for a prescriber. 00:07:38.959 --> 00:07:41.600 But left to the million dollar question, what 00:07:41.600 --> 00:07:43.519 does the research actually say about whether 00:07:43.519 --> 00:07:46.379 or not it works as a medicine? To evaluate that 00:07:46.379 --> 00:07:48.699 fairly, we need to look at the highest level 00:07:48.699 --> 00:07:50.699 of clinical evidence available in the source. 00:07:51.360 --> 00:07:54.120 The text references a scoping review that analyzed 00:07:54.120 --> 00:07:57.139 72 different systematic reviews. Just to clarify 00:07:57.139 --> 00:07:59.399 for you listening, a systematic review is already 00:07:59.399 --> 00:08:02.019 a summary of many individual trials. So a scoping 00:08:02.019 --> 00:08:04.939 review of 72 systematic reviews is a bird's eye 00:08:04.939 --> 00:08:07.740 view of a mountain of data. A very large mountain. 00:08:07.860 --> 00:08:09.579 And the overall conclusion from all that data. 00:08:09.740 --> 00:08:12.399 The evidence for cannabis -based medicines is 00:08:12.399 --> 00:08:15.680 decidedly mixed. Broadly speaking, it is inconclusive, 00:08:15.839 --> 00:08:17.680 and the researchers noted that the underlying 00:08:17.680 --> 00:08:20.120 studies are generally of low to moderate quality. 00:08:20.730 --> 00:08:24.089 So definitely not a magical cure -all. No, not 00:08:24.089 --> 00:08:26.750 at all. But the text does highlight specific 00:08:26.750 --> 00:08:29.949 areas where it shows genuine documented promise. 00:08:30.389 --> 00:08:33.429 It provides modest relief for chronic pain, specifically 00:08:33.429 --> 00:08:36.009 neuropathic pain, where the nerves themselves 00:08:36.009 --> 00:08:38.950 are misfiring. Yes. It also showed slight improvements 00:08:38.950 --> 00:08:41.610 in sleep and physical function for patients dealing 00:08:41.610 --> 00:08:44.309 with those chronic pain conditions. It also has 00:08:44.309 --> 00:08:46.669 proven somewhat effective in managing chemotherapy 00:08:46.669 --> 00:08:50.799 -induced nausea and vomiting, or CINV. Though 00:08:50.799 --> 00:08:52.759 the medical guidelines usually suggest using 00:08:52.759 --> 00:08:55.100 it only after conventional anti -nausea treatments 00:08:55.100 --> 00:08:57.419 have failed, right? Correct. Primarily because 00:08:57.419 --> 00:08:59.500 of the side effects we'll discuss shortly. There 00:08:59.500 --> 00:09:01.639 is also a major milestone mentioned regarding 00:09:01.639 --> 00:09:04.320 the FDA. Now, the FDA has not approved whole 00:09:04.320 --> 00:09:07.080 plant cannabis, but they have approved a specific 00:09:07.080 --> 00:09:10.460 purified CBD medication for treating two very 00:09:10.460 --> 00:09:13.700 severe rare forms of childhood epilepsy. Lennox 00:09:13.700 --> 00:09:16.909 -Gastaut syndrome and Dravet syndrome. Yes. That 00:09:16.909 --> 00:09:20.909 represents a tangible, recognized medical breakthrough. 00:09:21.250 --> 00:09:23.509 Absolutely. Those are debilitating conditions 00:09:23.509 --> 00:09:26.870 and the CBD treatment offers real relief. Yeah. 00:09:26.990 --> 00:09:29.169 However, we also need to address the areas where 00:09:29.169 --> 00:09:31.710 public perception has heavily outpaced the scientific 00:09:31.710 --> 00:09:34.470 reality. The gaps between what people think and 00:09:34.470 --> 00:09:37.549 what science proves. Yes. And the most glaring 00:09:37.549 --> 00:09:39.690 gap there is in mental health. The mental health 00:09:39.690 --> 00:09:42.370 gap. You hear people say casually all the time 00:09:42.370 --> 00:09:44.389 that they use cannabis to treat their anxiety 00:09:44.389 --> 00:09:46.690 or their depression. It's practically a given 00:09:46.690 --> 00:09:49.009 in certain circles. But what does the actual 00:09:49.009 --> 00:09:52.029 clinical data say? According to a major 2019 00:09:52.029 --> 00:09:55.210 systematic review, there is a distinct lack of 00:09:55.210 --> 00:09:57.490 evidence that cannabinoids are effective in treating 00:09:57.490 --> 00:10:00.450 depressive disorders, anxiety disorders, ADHD, 00:10:01.070 --> 00:10:04.350 Tourette's syndrome, or PTSD. Wait, really? None 00:10:04.350 --> 00:10:06.429 of them. The clinical evidence just isn't there. 00:10:06.529 --> 00:10:08.850 Now, the relationship is nuanced. Some individual 00:10:08.850 --> 00:10:11.570 users will absolutely self -report relief. Sure. 00:10:11.710 --> 00:10:13.889 But when researchers look at observational studies 00:10:13.889 --> 00:10:16.730 and conduct rigorous clinical trials, the overall 00:10:16.730 --> 00:10:19.289 evidence remains inconclusive at best. That is 00:10:19.289 --> 00:10:21.710 a stark contrast to the narratives you see on 00:10:21.710 --> 00:10:23.730 social media, where it is often presented as 00:10:23.730 --> 00:10:26.389 a perfect natural remedy for anxiety. And that 00:10:26.389 --> 00:10:28.830 contrast brings up a critical factor in clinical 00:10:28.830 --> 00:10:32.200 trials, the placebo effect. Ah. the media attention 00:10:32.200 --> 00:10:34.500 and cultural hype surrounding cannabis therapies 00:10:34.500 --> 00:10:38.539 are enormous. And while media hype does not correlate 00:10:38.539 --> 00:10:42.379 with actual clinical outcomes, researchers have 00:10:42.379 --> 00:10:44.559 found that it significantly boosts the placebo 00:10:44.559 --> 00:10:46.860 effect in these trials. Because patients expect 00:10:46.860 --> 00:10:49.019 it to work. Exactly. They've been told by the 00:10:49.019 --> 00:10:51.080 culture that it works, so their brain creates 00:10:51.080 --> 00:10:53.740 that relief during the trial. What stands out 00:10:53.740 --> 00:10:55.980 to you as a listener when you consider how much 00:10:55.980 --> 00:10:58.460 cultural hype might actually be altering medical 00:10:58.460 --> 00:11:01.460 results? It really highlights the power of expectation. 00:11:01.919 --> 00:11:04.399 It serves as a powerful reminder to question 00:11:04.399 --> 00:11:08.019 our expectations versus the cold clinical realities. 00:11:08.379 --> 00:11:10.000 Speaking of realities, we need to talk about 00:11:10.000 --> 00:11:12.919 the risks. The idea that cannabis is a completely 00:11:12.919 --> 00:11:16.480 harmless natural herb is a myth the source material 00:11:16.480 --> 00:11:19.139 actively dismantles. It does. Short -term use 00:11:19.139 --> 00:11:21.899 comes with common, usually mild adverse effects. 00:11:22.440 --> 00:11:25.440 Dizziness, feeling tired, vomiting. At higher 00:11:25.440 --> 00:11:28.039 doses, it can impair motor coordination, alter 00:11:28.039 --> 00:11:31.139 your judgment, and even induce paranoia or hallucinations. 00:11:31.379 --> 00:11:33.919 Those are the acute effects. But we must also 00:11:33.919 --> 00:11:36.820 look at the serious psychiatric risks, specifically 00:11:36.820 --> 00:11:40.039 regarding psychosis. Right. Exposure to THC can 00:11:40.039 --> 00:11:43.279 cause acute, transient psychotic symptoms, even 00:11:43.279 --> 00:11:46.120 in completely healthy individuals. But the long 00:11:46.120 --> 00:11:49.080 -term data requires careful attention. A 2007 00:11:49.080 --> 00:11:51.899 meta -analysis concluded that cannabis use reduced 00:11:51.899 --> 00:11:55.220 the average age of onset of psychosis by 2 .7 00:11:55.220 --> 00:11:57.580 years compared to non -users. Almost three years 00:11:57.580 --> 00:11:59.639 earlier. That is a significant acceleration. 00:12:00.179 --> 00:12:02.320 It is. Furthermore, another literature review 00:12:02.320 --> 00:12:04.879 from 2004 found that cannabis use is associated 00:12:04.879 --> 00:12:07.220 with a twofold increase in the risk of developing 00:12:07.220 --> 00:12:10.330 psychosis. Twofold. Yes. Now, the text uses a 00:12:10.330 --> 00:12:12.190 very specific phrase here that we should clarify. 00:12:12.490 --> 00:12:14.870 It states that cannabis is neither necessary 00:12:14.870 --> 00:12:17.830 nor sufficient to cause psychosis on its own. 00:12:17.929 --> 00:12:20.090 Let me make sure I have that right. Neither necessary 00:12:20.090 --> 00:12:22.549 nor sufficient means that someone doesn't need 00:12:22.549 --> 00:12:25.360 to use cannabis to develop psychosis. And just 00:12:25.360 --> 00:12:27.600 using cannabis isn't enough to guarantee they 00:12:27.600 --> 00:12:30.179 will get it. It isn't the sole cause. Precisely. 00:12:30.179 --> 00:12:33.120 It acts as a major catalyst, especially for vulnerable 00:12:33.120 --> 00:12:36.019 populations. If someone has an underlying genetic 00:12:36.019 --> 00:12:38.779 predisposition to psychotic disorders like schizophrenia, 00:12:39.139 --> 00:12:42.840 introducing cannabis, especially high THC doses, 00:12:43.159 --> 00:12:45.620 acts as a significant trigger. That's a major 00:12:45.620 --> 00:12:48.440 risk factor. It is. This is why the medical community 00:12:48.440 --> 00:12:51.340 emphasizes that long -term treatment, particularly 00:12:51.340 --> 00:12:54.720 in adolescents, must be weighed carefully. The 00:12:54.720 --> 00:12:56.879 developing adolescent brain is much more susceptible 00:12:56.879 --> 00:13:00.240 to lasting cognitive deficits. The text also 00:13:00.240 --> 00:13:02.539 firmly notes it should not be used during pregnancy. 00:13:02.899 --> 00:13:05.580 And while we are on the topic of unexpected medical 00:13:05.580 --> 00:13:08.019 outcomes, there is a detail in the text that 00:13:08.019 --> 00:13:10.220 blew my mind. We just talked about how cannabis 00:13:10.220 --> 00:13:12.500 is used to treat nausea in chemotherapy patients. 00:13:12.700 --> 00:13:15.039 Yes. But there is a paradoxical condition called 00:13:15.039 --> 00:13:18.340 cannabinoid hyperemesis syndrome, or CHS. The 00:13:18.340 --> 00:13:21.100 irony of CHS is striking. Oh, really? While cannabis 00:13:21.100 --> 00:13:23.820 can suppress nausea in the short term, Chronic, 00:13:23.820 --> 00:13:26.440 heavy, long -term use of cannabis can actually 00:13:26.440 --> 00:13:29.100 trigger severe intractable nausea and vomiting. 00:13:29.299 --> 00:13:31.919 The very symptom it's famous for treating becomes 00:13:31.919 --> 00:13:34.899 the symptom it continuously causes. It just goes 00:13:34.899 --> 00:13:36.759 to show how much we still have to learn about 00:13:36.759 --> 00:13:38.980 the long -term pharmacology of this plant. We 00:13:38.980 --> 00:13:41.600 really do. But ironically, while modern science 00:13:41.600 --> 00:13:43.759 is still trying to figure it out, the history 00:13:43.759 --> 00:13:46.120 of humans using this plant goes back further 00:13:46.120 --> 00:13:49.019 than almost anyone realizes. The historical timeline 00:13:49.019 --> 00:13:52.500 is remarkable. It truly is a global story that 00:13:52.500 --> 00:13:55.120 stretches back thousands of years. We're talking 00:13:55.120 --> 00:13:58.860 ancient, ancient roots. The text traces the use 00:13:58.860 --> 00:14:03.120 of cannabis back 10 ,000 years to Taiwan. 10 00:14:03.120 --> 00:14:05.519 ,000 years. Back then, it was primarily used 00:14:05.519 --> 00:14:08.480 for its tough fiber. In Chinese, it's known as 00:14:08.480 --> 00:14:10.759 Dama, with the characters roughly translating 00:14:10.759 --> 00:14:13.039 to big hemp. And its transition from industrial 00:14:13.039 --> 00:14:15.730 fiber into medicine happened quite early. By 00:14:15.730 --> 00:14:20.370 2737 BCE, Emperor Shen Nung in China, who acted 00:14:20.370 --> 00:14:23.029 as an early pharmacologist, was documenting its 00:14:23.029 --> 00:14:25.149 medical benefits. He recommended it for a wide 00:14:25.149 --> 00:14:27.649 variety of ailments, including gout, rheumatism, 00:14:27.710 --> 00:14:30.029 and my personal favorite, absent -mindedness. 00:14:30.190 --> 00:14:32.870 Which is pretty funny. Right. Given the modern 00:14:32.870 --> 00:14:35.289 stereotype of the forgetful stoner, it feels 00:14:35.289 --> 00:14:38.070 a little counterintuitive today. But it shows 00:14:38.070 --> 00:14:40.230 just how differently the plant was viewed and 00:14:40.230 --> 00:14:42.690 utilized. It became one of the 50 fundamental 00:14:42.690 --> 00:14:45.309 herbs in traditional Chinese medicine. Its use 00:14:45.309 --> 00:14:48.059 wasn't confined to Asia either. As civilizations 00:14:48.059 --> 00:14:51.100 traded and expanded, so did the medical applications 00:14:51.100 --> 00:14:53.559 of the plant. Yes. If we move over to ancient 00:14:53.559 --> 00:14:56.580 Egypt around 1550 BCE, there's a medical text 00:14:56.580 --> 00:14:59.399 called the Ebers Papyrus. A very famous text. 00:14:59.639 --> 00:15:02.100 It reveals they were using cannabis and suppositories 00:15:02.100 --> 00:15:05.090 to relieve the pain of hemorrhoids. a very practical, 00:15:05.190 --> 00:15:08.490 if unpleasant, application. Then you have the 00:15:08.490 --> 00:15:11.049 ancient Greeks, who were using it to dress sores 00:15:11.049 --> 00:15:13.309 on their horses. Oh, dang. They would also use 00:15:13.309 --> 00:15:15.690 the dried leaves for human nosebleeds, and they'd 00:15:15.690 --> 00:15:18.769 steep the seeds to expel tapeworms. It was a 00:15:18.769 --> 00:15:21.889 versatile staple of ancient pharmacopoeias. In 00:15:21.889 --> 00:15:24.100 the medieval Islamic world, Arabic physicians 00:15:24.100 --> 00:15:27.000 utilized it extensively from the 8th to the 18th 00:15:27.000 --> 00:15:29.480 centuries, primarily as an anti -inflammatory 00:15:29.480 --> 00:15:31.820 and a pain reliever. It was everywhere. But its 00:15:31.820 --> 00:15:33.980 introduction to modern Western medicine is typically 00:15:33.980 --> 00:15:36.220 credited to an Irish physician named William 00:15:36.220 --> 00:15:39.460 Brooke O'Shaughnessy. Oh, right. In the 1830s, 00:15:39.460 --> 00:15:41.840 O'Shaughnessy was working in India. He observed 00:15:41.840 --> 00:15:44.519 the local medical use of cannabis, conducted 00:15:44.519 --> 00:15:47.200 a series of his own experiments, and essentially 00:15:47.200 --> 00:15:49.779 brought it back to England with him in 1842. 00:15:50.429 --> 00:15:52.789 And from there, it spread quickly through Europe 00:15:52.789 --> 00:15:55.649 and over to the United States. It was even officially 00:15:55.649 --> 00:15:58.309 listed in the United States Pharmacopeia in 1850. 00:15:58.389 --> 00:16:00.529 So it was just a standard medicine. It enjoyed 00:16:00.529 --> 00:16:03.490 a period of widespread acceptance. But then, 00:16:03.570 --> 00:16:06.350 by the end of the 19th century, cannabis virtually 00:16:06.350 --> 00:16:08.929 vanished from Western hospitals and doctor's 00:16:08.929 --> 00:16:11.600 bags. Just disappeared. And if we connect this 00:16:11.600 --> 00:16:14.419 to the bigger picture, the reason for its sudden 00:16:14.419 --> 00:16:17.580 decline wasn't initially a cultural shift or 00:16:17.580 --> 00:16:20.440 a political ban. It was technological. Let me 00:16:20.440 --> 00:16:22.659 guess. Was there a new miracle drug that replaced 00:16:22.659 --> 00:16:25.750 it? Not a new drug. A new tool. The invention 00:16:25.750 --> 00:16:28.789 of the hypodermic syringe. Oh, wow. The needle 00:16:28.789 --> 00:16:30.809 changed everything. It revolutionized medicine. 00:16:31.029 --> 00:16:33.549 The hypodermic needle allowed doctors to inject 00:16:33.549 --> 00:16:36.269 drugs directly into the bloodstream for an immediate 00:16:36.269 --> 00:16:38.690 measurable effect. This was game changer for 00:16:38.690 --> 00:16:41.690 pain management. But cannabis is highly lipophilic, 00:16:41.690 --> 00:16:45.230 meaning its active compounds bind to fat. It 00:16:45.230 --> 00:16:47.289 is not water soluble. Meaning you can't just 00:16:47.289 --> 00:16:49.490 mix it with water and inject it. Exactly. You 00:16:49.490 --> 00:16:52.269 cannot safely inject a standard botanical cannabis 00:16:52.269 --> 00:16:56.230 extract. So as synthetic drugs and water -soluble 00:16:56.230 --> 00:16:59.110 opium derivatives rose in popularity because 00:16:59.110 --> 00:17:02.230 they could be easily injected, cannabis was largely 00:17:02.230 --> 00:17:04.869 left behind. That makes total sense. It simply 00:17:04.869 --> 00:17:07.750 didn't fit the new, fast -acting medical technology 00:17:07.750 --> 00:17:10.660 of the era. That is a fascinating piece of medical 00:17:10.660 --> 00:17:12.539 history. I had always assumed it disappeared 00:17:12.539 --> 00:17:15.079 strictly because of prohibition laws. No, the 00:17:15.079 --> 00:17:17.000 technology pushed it out first. Of course, the 00:17:17.000 --> 00:17:19.599 political decline followed eventually, culminating 00:17:19.599 --> 00:17:21.980 in the 1970 Controlled Substances Act in the 00:17:21.980 --> 00:17:24.859 U .S., which banned it entirely. Which brings 00:17:24.859 --> 00:17:27.720 us to the complicated, often contradictory modern 00:17:27.720 --> 00:17:30.380 landscape. Yes. Now, as we discuss this next 00:17:30.380 --> 00:17:32.559 part, I want to reiterate our mission today. 00:17:32.759 --> 00:17:35.200 We are looking at the legal and cultural landscape 00:17:35.200 --> 00:17:37.579 strictly through the impartial lens of our source 00:17:37.579 --> 00:17:39.839 material. We're not taking sides. We're just 00:17:39.839 --> 00:17:41.579 reporting the facts of where things currently 00:17:41.579 --> 00:17:44.740 stand. And where things stand is a state of deep 00:17:44.740 --> 00:17:47.019 contradiction, particularly in the United States. 00:17:47.099 --> 00:17:49.700 You have a massive ongoing clash between state 00:17:49.700 --> 00:17:53.289 and federal law. In the U .S., 38 states and 00:17:53.289 --> 00:17:55.450 the District of Columbia have legalized cannabis 00:17:55.450 --> 00:17:58.170 for medical purposes. This wave actually started 00:17:58.170 --> 00:18:01.789 back in 1996 when California passed Proposition 00:18:01.789 --> 00:18:04.730 215. Yet despite the majority of states legalizing 00:18:04.730 --> 00:18:07.569 it at the federal level, it remains a schedule 00:18:07.569 --> 00:18:10.630 illegal drug. By definition, that means the federal 00:18:10.630 --> 00:18:12.809 government views it as having a high potential 00:18:12.809 --> 00:18:17.509 for abuse and no accepted medical use. Internationally, 00:18:17.509 --> 00:18:19.859 the landscape has been shifting as well. For 00:18:19.859 --> 00:18:22.440 decades, cannabis was classified under the highly 00:18:22.440 --> 00:18:24.640 restrictive Schedule V by the United Nations, 00:18:24.859 --> 00:18:27.579 which is the same category as heroin. Wow. But 00:18:27.579 --> 00:18:29.819 in December 2020, following formal recommendations 00:18:29.819 --> 00:18:32.460 from the World Health Organization, the UN voted 00:18:32.460 --> 00:18:35.140 to remove cannabis from Schedule V. So they changed 00:18:35.140 --> 00:18:37.680 their stance. They acknowledged its medical utility, 00:18:38.000 --> 00:18:39.920 though it still remains strictly controlled under 00:18:39.920 --> 00:18:42.279 Schedule V of international treaties. But even 00:18:42.279 --> 00:18:45.019 within the U .S. federal system, there is a bizarre 00:18:45.019 --> 00:18:48.180 paradox that the text points out. While whole 00:18:48.180 --> 00:18:50.519 plant botanical cannabis is federally illegal 00:18:50.519 --> 00:18:53.539 and considered to have no medical value, the 00:18:53.539 --> 00:18:56.319 FDA has actually approved synthetic cannabinoid 00:18:56.319 --> 00:18:59.480 pills. Yes. Drugs like dronabinol, which is sold 00:18:59.480 --> 00:19:02.400 under the brand name Marinol. That is pure synthetic 00:19:02.400 --> 00:19:06.559 Delta 9 THC. Right. There was also nabiloni sold 00:19:06.559 --> 00:19:09.079 as sesame. These were approved all the way back 00:19:09.079 --> 00:19:12.640 in 1985. So the government technically recognizes 00:19:12.640 --> 00:19:15.680 the medical value of the isolated chemical molecules, 00:19:15.920 --> 00:19:18.920 but maintains a total ban on the botanical plant 00:19:18.920 --> 00:19:21.829 that produces them. And this legal gray area 00:19:21.829 --> 00:19:24.269 creates a massive headache for the patients who 00:19:24.269 --> 00:19:26.470 rely on it, specifically regarding insurance. 00:19:26.869 --> 00:19:29.390 Because whole plant cannabis lacks FDA approval, 00:19:29.630 --> 00:19:31.750 health insurance companies rarely, if ever, cover 00:19:31.750 --> 00:19:34.069 medical marijuana prescriptions. Exactly. This 00:19:34.069 --> 00:19:35.789 leaves patients having to pay entirely out of 00:19:35.789 --> 00:19:37.990 pocket for their medicine, which can be prohibitively 00:19:37.990 --> 00:19:40.390 expensive. It is a significant economic barrier 00:19:40.390 --> 00:19:42.670 that stems directly from the regulatory classification 00:19:42.670 --> 00:19:45.630 and is a classification that deeply divides the 00:19:45.630 --> 00:19:48.109 major medical organizations. The source outlines 00:19:48.109 --> 00:19:50.809 this divide perfectly. On one side, you have 00:19:50.809 --> 00:19:53.130 groups like the American Nurses Association and 00:19:53.130 --> 00:19:55.490 the American Public Health Association. They 00:19:55.490 --> 00:19:58.009 strongly support patient access to medical cannabis. 00:19:58.349 --> 00:20:00.190 And on the other side. You have organizations 00:20:00.190 --> 00:20:02.829 like the American Academy of Pediatrics and the 00:20:02.829 --> 00:20:06.150 American Psychiatric Association actively opposing 00:20:06.150 --> 00:20:09.650 its legalization, citing the risks to vulnerable 00:20:09.650 --> 00:20:12.289 populations that we discussed earlier. However. 00:20:12.799 --> 00:20:15.480 Despite being on opposite sides of the legalization 00:20:15.480 --> 00:20:19.079 debate, there is a remarkable consensus among 00:20:19.079 --> 00:20:21.759 these groups on one specific point. Which is? 00:20:21.940 --> 00:20:23.839 Almost all of these organizations, including 00:20:23.839 --> 00:20:25.900 the American Medical Association and the American 00:20:25.900 --> 00:20:29.099 Heart Association, agree that cannabis should 00:20:29.099 --> 00:20:31.420 be rescheduled at the federal level. Not necessarily 00:20:31.420 --> 00:20:33.799 to legalize it for everyone, but to allow for 00:20:33.799 --> 00:20:36.460 better science, right? Exactly. As long as it 00:20:36.460 --> 00:20:38.740 remains a schedule -like drug. Conducting the 00:20:38.740 --> 00:20:41.740 rigorous, large -scale, randomized clinical trials 00:20:41.740 --> 00:20:44.519 that the medical community relies on is incredibly 00:20:44.519 --> 00:20:47.400 difficult due to governmental red tape. It blocks 00:20:47.400 --> 00:20:50.089 our research. Rescheduling the drug would remove 00:20:50.089 --> 00:20:52.809 those barriers. It would allow scientists to 00:20:52.809 --> 00:20:55.150 finally gather the high -quality data needed 00:20:55.150 --> 00:20:57.549 to definitively answer the questions we've been 00:20:57.549 --> 00:21:00.049 discussing today. So what does this all mean? 00:21:00.170 --> 00:21:02.750 We've covered the complex chemistry of CB1 and 00:21:02.750 --> 00:21:05.609 CB2 receptors, the unpredictability of edibles, 00:21:05.809 --> 00:21:08.950 the mixed clinical evidence, the very real psychiatric 00:21:08.950 --> 00:21:12.630 risks, the 10 ,000 -year history, and the modern 00:21:12.630 --> 00:21:15.380 legal mess. What it means is that we have to 00:21:15.380 --> 00:21:18.140 embrace the nuance. Yeah. Medical cannabis is 00:21:18.140 --> 00:21:21.420 not the magical, side effect -free cure -all 00:21:21.420 --> 00:21:24.140 that some advocates claim it to be. The evidence 00:21:24.140 --> 00:21:26.200 for treating mental health conditions like anxiety 00:21:26.200 --> 00:21:28.779 or depression is just not supported by the data 00:21:28.779 --> 00:21:31.259 right now. And the risks of psychosis and cognitive 00:21:31.259 --> 00:21:33.500 impairment in adolescents are real and need to 00:21:33.500 --> 00:21:36.069 be respected. But at the same time, it is clearly 00:21:36.069 --> 00:21:38.829 not a substance without medicinal value. It offers 00:21:38.829 --> 00:21:41.890 genuine documented relief for chronic neuropathic 00:21:41.890 --> 00:21:45.150 pain, specific childhood epilepsies, and severe 00:21:45.150 --> 00:21:48.109 nausea. It's both. Ultimately, it is a highly 00:21:48.109 --> 00:21:51.730 complex botanical cocktail that modern single 00:21:51.730 --> 00:21:54.849 molecule science is still struggling to perfectly 00:21:54.849 --> 00:21:58.589 categorize, study, and regulate. Critical thinking 00:21:58.589 --> 00:22:01.529 and demanding high quality evidence is absolutely 00:22:01.529 --> 00:22:04.289 essential. when navigating this topic. It really 00:22:04.289 --> 00:22:07.210 requires us to hold two competing ideas in our 00:22:07.210 --> 00:22:09.710 head at the same time. It has tangible benefits 00:22:09.710 --> 00:22:12.650 and it carries serious risks. It's a medicine, 00:22:12.769 --> 00:22:14.769 but it doesn't behave like any other medicine 00:22:14.769 --> 00:22:16.890 in the pharmacy. And this raises an important 00:22:16.890 --> 00:22:18.609 question, something for you to think about long 00:22:18.609 --> 00:22:21.559 after this deep dive ends. We know that the cannabis 00:22:21.559 --> 00:22:23.740 plant developed its complex chemical profile 00:22:23.740 --> 00:22:27.240 naturally. Over thousands of years, cultivators 00:22:27.240 --> 00:22:29.579 have grown land -raised strains like Afghani 00:22:29.579 --> 00:22:32.559 and Hindu Kush in specific regions, resulting 00:22:32.559 --> 00:22:35.519 in an intricate web of over 400 chemicals that 00:22:35.519 --> 00:22:37.799 work together in ways we still don't fully grasp. 00:22:38.160 --> 00:22:40.380 Since our modern pharmaceutical model is almost 00:22:40.380 --> 00:22:42.700 entirely based on isolating single molecules 00:22:42.700 --> 00:22:45.900 to treat single symptoms, what other highly complex 00:22:45.900 --> 00:22:49.180 botanical medicines might we be completely overlooking 00:22:49.180 --> 00:22:52.400 or... failing to understand simply because they 00:22:52.400 --> 00:22:54.720 don't fit neatly into a hypodermic needle or 00:22:54.720 --> 00:22:57.220 a standardized pill. That is a brilliant thought 00:22:57.220 --> 00:22:59.839 to end on. It challenges how we view the future 00:22:59.839 --> 00:23:02.759 of medicine itself. We want to thank you so much 00:23:02.759 --> 00:23:04.900 for joining us on this deep dive into medical 00:23:04.900 --> 00:23:07.660 cannabis. We hope we helped clear away some of 00:23:07.660 --> 00:23:10.099 the smoke again, no pun intended, and gave you 00:23:10.099 --> 00:23:12.579 some solid, impartial facts to chew on. Keep 00:23:12.579 --> 00:23:14.920 asking questions, keep thinking critically about 00:23:14.920 --> 00:23:16.900 the information you consume, and keep learning. 00:23:17.059 --> 00:23:18.420 We will catch you on the next one.