Welcome to today's deep dive. We are genuinely
thrilled you could take some time to join us
for this conversation. Today, we're tackling
a subject that you simply cannot escape right
now. No, you really can't. It's debated in politics.
It casually pops up in movies and television.
It's all over social media. And it's highly likely
that you or someone in your immediate circle
has a very strong opinion about it. Oh, absolutely.
We're talking about medical cannabis. It's a
topic that carries a tremendous amount of cultural
baggage. When you look at the landscape of information
out there, you are met with a wall of noise.
Just a total wall. Yeah. You have one headline
claiming it's a miracle cure for just about everything.
And then the very next headline is warning of
dire consequences. It becomes a real challenge
to parse out what is actually grounded in reality.
Which is exactly why we're sitting down to do
this today. Core mission for this deep dive is
to cut right through that static. We want to
bypass the hearsay, the pop culture myths and
the loud political opinions. To do that, we are
going straight to the source material. We're
pulling our insights today from a highly comprehensive,
thoroughly cited Wikipedia article dedicated
specifically to the topic of medical cannabis.
And our goal here is to extract what the rigorous
science. the pharmacology, and the historical
records actually tell us about this plant. We
want to serve this up to you in a way that is
easy to digest and hopefully give you a solid
foundation of facts. So as you are listening
today, I want you to ask yourself how much of
what you currently believe about medical cannabis
comes from a laboratory and how much is just
cultural osmosis. That is the perfect mindset
to carry into this discussion. My goal today
is to look at the evidence with strict impartiality.
We're going to examine the modest potential benefits
and we are going to weigh them directly against
the established documented risks. the actual
science. Exactly. The science we're going to
look at is compelling, but it also serves as
a fantastic exercise in thinking critically about
how modern medicine is evaluated categorized
and ultimately approved. OK, let's unpack this,
because the very first thing that jumps out from
the research is the sheer botanical challenge
of dealing with this plant. It's a huge hurdle.
I mean, think about what happens when you go
to the pharmacy to pick up a typical government
approved medication. You're usually getting something
incredibly precise. Right. You get a pill that
contains one, maybe two active chemicals and
some binding agents, but a cannabis plant. You
are dealing with over 400 different chemicals.
Over 400. Wow. And out of those, about 70 are
classified specifically as cannabinoids. Just
a massive cocktail. Yes. And this chemical density
is the fundamental reason why medical cannabis
is so notoriously difficult for the medical community
to study. Because there's so much going on. Precisely.
Researchers prefer to isolate a single variable
to see exactly what it does. But here, you aren't
dealing with a single isolated variable. You're
dealing with a complex botanical cocktail. I
can imagine that makes running a controlled trial
a bit of a nightmare. How does the human body
even process a cocktail like that? That is where
the endocannabinoid system comes into play. Humans
actually have specific receptors built into our
biology that interact directly with these chemicals.
Okay. The two primary ones that researchers focus
on are known as CB1 and CB2. So we have a built
-in lock. And the plant provides the keys. That's
a great way to put it. But do those two receptors
do the same thing? Not at all. They have very
distinct functions. Okay. CB1 receptors are found
in high concentrations of the brain. When those
receptors are activated, they produce the psychoactive
effects that's the high typically associated
with cannabis. And the other one. CB2 receptors,
on the other hand, are located peripherally throughout
the body's immune system and tissues. Activating
a CV2 receptor doesn't produce a psychoactive
effect. Instead, it's thought to modulate things
like pain and inflammation. So the effect a patient
feels isn't just about the fact that they consumed
cannabis. It depends entirely on which of those
70 cannabinoids are hitting which receptors.
The source material puts a huge emphasis on the
ratio between two specific chemicals, CCD and
THC. Yes, the ratio between those two dictates
the entire therapeutic outcome. Tetrahydrocannabinol,
or THC, is the primary psychoactive cannabinoid.
It hits those CB1 receptors in the brain hard.
Right. That's the one that causes the high. Yes.
Cannabidol, or CBD, is non -psychoactive. What
a major 2014 review pointed out is that CBD actually
attenuates, meaning it reduces or blunts the
psychoactive impact of THC. Wait, so the CBD
actively fights the high of the THC? In a sense,
yes. It changes how the THC binds. So if a patient
uses a product with high THC and low CBD, they
will experience a strong psychoactive effect.
Got it. If the product has high CBD and low THC,
they might get the anti -inflammatory benefits
without the cognitive impairment. The balance
of those two molecules changes the medicine entirely.
That alone makes standardizing a dose complicated.
Highly complicated. But then the source dives
into how the method of consumption completely
changes the equation. The medical field uses
a term called bioavailability. Which is basically
how much of the substance actually makes it into
your system to have an effect. Exactly. If someone
smokes or vapes cannabis, the bioavailability
ranges anywhere from 10 to 35 percent. But if
they consume it orally, like in a brownie or
a gummy, that number drops to about 6 percent.
A substantial drop. Yeah. Here's where it gets
really interesting, though. It isn't just the
amount that gets absorbed. the entire timeline
of the effect shifts. Right. I think a lot of
people assume that eating it and inhaling it
are basically the same thing, just a different
delivery method. But the journey of an edible
cannabis product through the human body is completely
different. It follows a totally different metabolic
pathway. When cannabis is inhaled, the compounds
pass through the lungs directly into the bloodstream
and straight to the brain. Very fast. The onset
of the effect is almost immediate. But when you
eat an edible, it has to travel through your
gastrointestinal tract, and then it goes to the
liver first. And this process is called first
-pass metabolism. Correct. And the liver doesn't
just pass it along, does it? It actually alters
the chemistry. Your liver acts like a chemical
laboratory. It takes the primary psychoactive
molecule, standard delta -9 -THC, and converts
it into a completely new metabolic product called
11 -hydroxy -THC. which according to the text
is far more potent. Think of it as a supercharged
variant. It is highly psychoactive. And this
specific liver metabolism explains a lot of the
confusion surrounding edibles. That makes so
much sense. It explains why they have such uniquely
potent effects compared to inhalation, and crucially,
why they take so long to kick in. a patient might
not feel the peak effects for two to six hours
after ingestion. That delayed onset must cause
so many dosage errors. Someone takes a dose,
feels nothing an hour later, takes more, and
then the liver finally finishes processing that
supercharged variant. It happens frequently.
Eventually, the liver processes it a second time,
breaking it down into an inactive byproduct,
11 -COHTHC, that your body just flushes out.
But that metabolic detour through the liver creates
a pharmacological response. that is distinct
from smoking. So you have this unpredictable
delayed effect with edibles. When you pair that
with the sheer chemical complexity of the plant
itself, it completely reframes why doctors have
such a hard time writing a standard prescription
for it. It's a logistical nightmare for a prescriber.
But left to the million dollar question, what
does the research actually say about whether
or not it works as a medicine? To evaluate that
fairly, we need to look at the highest level
of clinical evidence available in the source.
The text references a scoping review that analyzed
72 different systematic reviews. Just to clarify
for you listening, a systematic review is already
a summary of many individual trials. So a scoping
review of 72 systematic reviews is a bird's eye
view of a mountain of data. A very large mountain.
And the overall conclusion from all that data.
The evidence for cannabis -based medicines is
decidedly mixed. Broadly speaking, it is inconclusive,
and the researchers noted that the underlying
studies are generally of low to moderate quality.
So definitely not a magical cure -all. No, not
at all. But the text does highlight specific
areas where it shows genuine documented promise.
It provides modest relief for chronic pain, specifically
neuropathic pain, where the nerves themselves
are misfiring. Yes. It also showed slight improvements
in sleep and physical function for patients dealing
with those chronic pain conditions. It also has
proven somewhat effective in managing chemotherapy
-induced nausea and vomiting, or CINV. Though
the medical guidelines usually suggest using
it only after conventional anti -nausea treatments
have failed, right? Correct. Primarily because
of the side effects we'll discuss shortly. There
is also a major milestone mentioned regarding
the FDA. Now, the FDA has not approved whole
plant cannabis, but they have approved a specific
purified CBD medication for treating two very
severe rare forms of childhood epilepsy. Lennox
-Gastaut syndrome and Dravet syndrome. Yes. That
represents a tangible, recognized medical breakthrough.
Absolutely. Those are debilitating conditions
and the CBD treatment offers real relief. Yeah.
However, we also need to address the areas where
public perception has heavily outpaced the scientific
reality. The gaps between what people think and
what science proves. Yes. And the most glaring
gap there is in mental health. The mental health
gap. You hear people say casually all the time
that they use cannabis to treat their anxiety
or their depression. It's practically a given
in certain circles. But what does the actual
clinical data say? According to a major 2019
systematic review, there is a distinct lack of
evidence that cannabinoids are effective in treating
depressive disorders, anxiety disorders, ADHD,
Tourette's syndrome, or PTSD. Wait, really? None
of them. The clinical evidence just isn't there.
Now, the relationship is nuanced. Some individual
users will absolutely self -report relief. Sure.
But when researchers look at observational studies
and conduct rigorous clinical trials, the overall
evidence remains inconclusive at best. That is
a stark contrast to the narratives you see on
social media, where it is often presented as
a perfect natural remedy for anxiety. And that
contrast brings up a critical factor in clinical
trials, the placebo effect. Ah. the media attention
and cultural hype surrounding cannabis therapies
are enormous. And while media hype does not correlate
with actual clinical outcomes, researchers have
found that it significantly boosts the placebo
effect in these trials. Because patients expect
it to work. Exactly. They've been told by the
culture that it works, so their brain creates
that relief during the trial. What stands out
to you as a listener when you consider how much
cultural hype might actually be altering medical
results? It really highlights the power of expectation.
It serves as a powerful reminder to question
our expectations versus the cold clinical realities.
Speaking of realities, we need to talk about
the risks. The idea that cannabis is a completely
harmless natural herb is a myth the source material
actively dismantles. It does. Short -term use
comes with common, usually mild adverse effects.
Dizziness, feeling tired, vomiting. At higher
doses, it can impair motor coordination, alter
your judgment, and even induce paranoia or hallucinations.
Those are the acute effects. But we must also
look at the serious psychiatric risks, specifically
regarding psychosis. Right. Exposure to THC can
cause acute, transient psychotic symptoms, even
in completely healthy individuals. But the long
-term data requires careful attention. A 2007
meta -analysis concluded that cannabis use reduced
the average age of onset of psychosis by 2 .7
years compared to non -users. Almost three years
earlier. That is a significant acceleration.
It is. Furthermore, another literature review
from 2004 found that cannabis use is associated
with a twofold increase in the risk of developing
psychosis. Twofold. Yes. Now, the text uses a
very specific phrase here that we should clarify.
It states that cannabis is neither necessary
nor sufficient to cause psychosis on its own.
Let me make sure I have that right. Neither necessary
nor sufficient means that someone doesn't need
to use cannabis to develop psychosis. And just
using cannabis isn't enough to guarantee they
will get it. It isn't the sole cause. Precisely.
It acts as a major catalyst, especially for vulnerable
populations. If someone has an underlying genetic
predisposition to psychotic disorders like schizophrenia,
introducing cannabis, especially high THC doses,
acts as a significant trigger. That's a major
risk factor. It is. This is why the medical community
emphasizes that long -term treatment, particularly
in adolescents, must be weighed carefully. The
developing adolescent brain is much more susceptible
to lasting cognitive deficits. The text also
firmly notes it should not be used during pregnancy.
And while we are on the topic of unexpected medical
outcomes, there is a detail in the text that
blew my mind. We just talked about how cannabis
is used to treat nausea in chemotherapy patients.
Yes. But there is a paradoxical condition called
cannabinoid hyperemesis syndrome, or CHS. The
irony of CHS is striking. Oh, really? While cannabis
can suppress nausea in the short term, Chronic,
heavy, long -term use of cannabis can actually
trigger severe intractable nausea and vomiting.
The very symptom it's famous for treating becomes
the symptom it continuously causes. It just goes
to show how much we still have to learn about
the long -term pharmacology of this plant. We
really do. But ironically, while modern science
is still trying to figure it out, the history
of humans using this plant goes back further
than almost anyone realizes. The historical timeline
is remarkable. It truly is a global story that
stretches back thousands of years. We're talking
ancient, ancient roots. The text traces the use
of cannabis back 10 ,000 years to Taiwan. 10
,000 years. Back then, it was primarily used
for its tough fiber. In Chinese, it's known as
Dama, with the characters roughly translating
to big hemp. And its transition from industrial
fiber into medicine happened quite early. By
2737 BCE, Emperor Shen Nung in China, who acted
as an early pharmacologist, was documenting its
medical benefits. He recommended it for a wide
variety of ailments, including gout, rheumatism,
and my personal favorite, absent -mindedness.
Which is pretty funny. Right. Given the modern
stereotype of the forgetful stoner, it feels
a little counterintuitive today. But it shows
just how differently the plant was viewed and
utilized. It became one of the 50 fundamental
herbs in traditional Chinese medicine. Its use
wasn't confined to Asia either. As civilizations
traded and expanded, so did the medical applications
of the plant. Yes. If we move over to ancient
Egypt around 1550 BCE, there's a medical text
called the Ebers Papyrus. A very famous text.
It reveals they were using cannabis and suppositories
to relieve the pain of hemorrhoids. a very practical,
if unpleasant, application. Then you have the
ancient Greeks, who were using it to dress sores
on their horses. Oh, dang. They would also use
the dried leaves for human nosebleeds, and they'd
steep the seeds to expel tapeworms. It was a
versatile staple of ancient pharmacopoeias. In
the medieval Islamic world, Arabic physicians
utilized it extensively from the 8th to the 18th
centuries, primarily as an anti -inflammatory
and a pain reliever. It was everywhere. But its
introduction to modern Western medicine is typically
credited to an Irish physician named William
Brooke O'Shaughnessy. Oh, right. In the 1830s,
O'Shaughnessy was working in India. He observed
the local medical use of cannabis, conducted
a series of his own experiments, and essentially
brought it back to England with him in 1842.
And from there, it spread quickly through Europe
and over to the United States. It was even officially
listed in the United States Pharmacopeia in 1850.
So it was just a standard medicine. It enjoyed
a period of widespread acceptance. But then,
by the end of the 19th century, cannabis virtually
vanished from Western hospitals and doctor's
bags. Just disappeared. And if we connect this
to the bigger picture, the reason for its sudden
decline wasn't initially a cultural shift or
a political ban. It was technological. Let me
guess. Was there a new miracle drug that replaced
it? Not a new drug. A new tool. The invention
of the hypodermic syringe. Oh, wow. The needle
changed everything. It revolutionized medicine.
The hypodermic needle allowed doctors to inject
drugs directly into the bloodstream for an immediate
measurable effect. This was game changer for
pain management. But cannabis is highly lipophilic,
meaning its active compounds bind to fat. It
is not water soluble. Meaning you can't just
mix it with water and inject it. Exactly. You
cannot safely inject a standard botanical cannabis
extract. So as synthetic drugs and water -soluble
opium derivatives rose in popularity because
they could be easily injected, cannabis was largely
left behind. That makes total sense. It simply
didn't fit the new, fast -acting medical technology
of the era. That is a fascinating piece of medical
history. I had always assumed it disappeared
strictly because of prohibition laws. No, the
technology pushed it out first. Of course, the
political decline followed eventually, culminating
in the 1970 Controlled Substances Act in the
U .S., which banned it entirely. Which brings
us to the complicated, often contradictory modern
landscape. Yes. Now, as we discuss this next
part, I want to reiterate our mission today.
We are looking at the legal and cultural landscape
strictly through the impartial lens of our source
material. We're not taking sides. We're just
reporting the facts of where things currently
stand. And where things stand is a state of deep
contradiction, particularly in the United States.
You have a massive ongoing clash between state
and federal law. In the U .S., 38 states and
the District of Columbia have legalized cannabis
for medical purposes. This wave actually started
back in 1996 when California passed Proposition
215. Yet despite the majority of states legalizing
it at the federal level, it remains a schedule
illegal drug. By definition, that means the federal
government views it as having a high potential
for abuse and no accepted medical use. Internationally,
the landscape has been shifting as well. For
decades, cannabis was classified under the highly
restrictive Schedule V by the United Nations,
which is the same category as heroin. Wow. But
in December 2020, following formal recommendations
from the World Health Organization, the UN voted
to remove cannabis from Schedule V. So they changed
their stance. They acknowledged its medical utility,
though it still remains strictly controlled under
Schedule V of international treaties. But even
within the U .S. federal system, there is a bizarre
paradox that the text points out. While whole
plant botanical cannabis is federally illegal
and considered to have no medical value, the
FDA has actually approved synthetic cannabinoid
pills. Yes. Drugs like dronabinol, which is sold
under the brand name Marinol. That is pure synthetic
Delta 9 THC. Right. There was also nabiloni sold
as sesame. These were approved all the way back
in 1985. So the government technically recognizes
the medical value of the isolated chemical molecules,
but maintains a total ban on the botanical plant
that produces them. And this legal gray area
creates a massive headache for the patients who
rely on it, specifically regarding insurance.
Because whole plant cannabis lacks FDA approval,
health insurance companies rarely, if ever, cover
medical marijuana prescriptions. Exactly. This
leaves patients having to pay entirely out of
pocket for their medicine, which can be prohibitively
expensive. It is a significant economic barrier
that stems directly from the regulatory classification
and is a classification that deeply divides the
major medical organizations. The source outlines
this divide perfectly. On one side, you have
groups like the American Nurses Association and
the American Public Health Association. They
strongly support patient access to medical cannabis.
And on the other side. You have organizations
like the American Academy of Pediatrics and the
American Psychiatric Association actively opposing
its legalization, citing the risks to vulnerable
populations that we discussed earlier. However.
Despite being on opposite sides of the legalization
debate, there is a remarkable consensus among
these groups on one specific point. Which is?
Almost all of these organizations, including
the American Medical Association and the American
Heart Association, agree that cannabis should
be rescheduled at the federal level. Not necessarily
to legalize it for everyone, but to allow for
better science, right? Exactly. As long as it
remains a schedule -like drug. Conducting the
rigorous, large -scale, randomized clinical trials
that the medical community relies on is incredibly
difficult due to governmental red tape. It blocks
our research. Rescheduling the drug would remove
those barriers. It would allow scientists to
finally gather the high -quality data needed
to definitively answer the questions we've been
discussing today. So what does this all mean?
We've covered the complex chemistry of CB1 and
CB2 receptors, the unpredictability of edibles,
the mixed clinical evidence, the very real psychiatric
risks, the 10 ,000 -year history, and the modern
legal mess. What it means is that we have to
embrace the nuance. Yeah. Medical cannabis is
not the magical, side effect -free cure -all
that some advocates claim it to be. The evidence
for treating mental health conditions like anxiety
or depression is just not supported by the data
right now. And the risks of psychosis and cognitive
impairment in adolescents are real and need to
be respected. But at the same time, it is clearly
not a substance without medicinal value. It offers
genuine documented relief for chronic neuropathic
pain, specific childhood epilepsies, and severe
nausea. It's both. Ultimately, it is a highly
complex botanical cocktail that modern single
molecule science is still struggling to perfectly
categorize, study, and regulate. Critical thinking
and demanding high quality evidence is absolutely
essential. when navigating this topic. It really
requires us to hold two competing ideas in our
head at the same time. It has tangible benefits
and it carries serious risks. It's a medicine,
but it doesn't behave like any other medicine
in the pharmacy. And this raises an important
question, something for you to think about long
after this deep dive ends. We know that the cannabis
plant developed its complex chemical profile
naturally. Over thousands of years, cultivators
have grown land -raised strains like Afghani
and Hindu Kush in specific regions, resulting
in an intricate web of over 400 chemicals that
work together in ways we still don't fully grasp.
Since our modern pharmaceutical model is almost
entirely based on isolating single molecules
to treat single symptoms, what other highly complex
botanical medicines might we be completely overlooking
or... failing to understand simply because they
don't fit neatly into a hypodermic needle or
a standardized pill. That is a brilliant thought
to end on. It challenges how we view the future
of medicine itself. We want to thank you so much
for joining us on this deep dive into medical
cannabis. We hope we helped clear away some of
the smoke again, no pun intended, and gave you
some solid, impartial facts to chew on. Keep
asking questions, keep thinking critically about
the information you consume, and keep learning.
We will catch you on the next one.