Cannabis and Psychiatry: Current Evidence and Future Potential - Dr. Ethan Russo
Breakout Session One - Bonni Goldstein, MD Medical Cannabis for Children
Breakout Session Two - Kevin Gray, MD Understanding and Addressing Youth Cannabis Use
Legal/Legislative Panel: Research Panel
a. Senator Tom Davis a. Dr. Jonathan Halford, MD
b. Patrick McLaughlin, Esq. b. Dr. Emma Grace Carter, MD
c. Mark Mason, Esq. Mason Law c. Dr. Ethan Russo, MD
d. Ruth A. Rauls d. Prakash Nagarkatti, PhD
Post Conference Q&A:
1. With the rise of THC concentration in products on the market (some up to 30%), do you still think the cognitive data for THC (which is mostly NIDA product which is around 10% THC) still holds true?
"It may. No medical preparation needs to have a super-high THC concentration. A higher concentration should mean that the cautious consumer would use less. If this is not true, people may push their dose due to tolerance, and this is why I do not recommend cannabis concentrates, especially in medial applications."
2. There have been recent publications correlating the state legalization of cannabis with the rise of reported instances of psychosis. Can you comment?
"The epidemiological evidence suggests that overall schizophrenia incidence has gone down slightly, even though cannabis usage has sky-rocketed over the last 4 decades. There is not a cause and effect relationship."
3. What is the maximum limit milligram quantity to still be considered a “low dose” of THC
"See MacCallum article. 2.5 mg of THC is a threshold dose, 5 mg is moderate, and 10 mg is too much except for those with tolerance."
4. While I understand you do not conduct pre-clinical or fetal studies, I was curious about your statement in slide 20 of your MUSC presentation that results do not support a heightened risk for poor cognitive outcomes in cannabis-using adolescents compared with adults. Until 2 years ago I was involved in fetal brain development studies and the effects of delta-9-THC and we found that exposure of THC to the developing brain caused significant cognitive impairments and an increase likelihood of developing schizophrenia. We also found that a second hit in adolescence caused more deterioration. I was just wondering what your thoughts on this were. While I agree that we should not over exaggerate problems I do not think we should under exaggerate these impairments either.
"See Scott 2018 article regarding recreational cannabis usage by adolescents. Studies of pure THC in animal models typically employ very high dosages without the benefit of mitigating cannabis substances such as CBD and terpenoids that may affect results. No one is recommending recreational cannabis smoking in pregnant women! I do believe that there are proper indications for certain cannabis-based medicines in pregnancy such as treating hyperemesis gravidarum, which is potentially fatal to mother and child. Again, I do not condone chronic recreational usage of cannabis in adolescents! Rather, I am advocating the relative safety of lower doses for proper indications. These are two totally different situations. We have not banned opioids despite 10’s of thousands of annual deaths due to overdoses. "
5. Do you believe the heightened chance of psychosis associated with Marinol can be contributed to the livers metabolic mechanisms of THC? Specificity 11-OH-THC?
"No one said Marinol causes “psychosis.” Rather, 10-15 mg doses of Marinol have been associated with “toxic psychosis,” a temporary, self-limited adverse event of too much THC. As mentioned, it is unclear that 11-OH-THC is significantly different to THC in its intoxicating effects. "
6. Do you feel that regulatory agencies such as the DEA and FDA are able to work together efficiently enough, or is there a need for a new agency to handle cannabis oversight?
"I don’t think there needs to be another agency to regulate cannabis but I would like to see FDA and DEA work better together to assist drug sponsors who wish to study cannabis for potential therapeutic benefit."
7. What are the implications - if any - of CBD products that cross state lines.
"For hemp-derived CBD that is 0.3% THC or under, there wouldn’t be an issue crossing state lines under federal law. However, some states still treat hemp-derived CBD as a controlled substance under their state laws, and state controlled substances laws are not preempted by the federal Controlled Substance Act. So, there could be an issue crossing state lines if you are crossing into a state that considers the product to be illegal."