Speaking of Psychology - Understanding medical marijuana, CBD and more, with Ziva Cooper, PhD

Episode Date: October 26, 2022

Over the past few years, the number and variety of cannabis products legally available to American consumers has soared. Ziva Cooper, PhD, of the UCLA Center for Cannabis and Cannabinoids, talks about how researchers are exploring both the potential health benefits and the risks of marijuana, CBD and more, aiming to make sure that the science keeps up with policy changes and the evolving marketplace. Links Ziva Cooper, PhD Speaking of Psychology Home Page Learn more about your ad choices. Visit megaphone.fm/adchoices

Over the past few years, the number and variety of cannabis products available to American consumers has soared. Recreational marijuana use is now legal in 19 states and the District of Columbia, and it has been decriminalized in 12 others. Medical marijuana use is legal in 37 states plus D.C. Meanwhile, other cannabis products, such as CBD and CBG are available in oils, candies, lotions, and mure. Myriad other products sold everywhere from dispensaries to gas stations. Americans are taking advantage of this new availability. An August Gallup poll found that 16% of adults currently smoke marijuana, up from 11% in 2013,

and 14% say they consume marijuana edibles. Amid this rapidly changing landscape, researchers are exploring both the risks and the potential health benefits of cannabis, aiming to make sure that the science catches up to the policy changes and the marketplace. So what are cannabinoids and how do they act on our brain and body? What are the differences among THC, CBD, CBG, and the other cannabinoids on the market? What potential do cannabinoids have to help treat anxiety, ease pain, and address a long list of other maladies?

And on the risk side, is marijuana dangerous? Is it addictive? What's its relationship to do? schizophrenia and other mental health disorders. And what does the research say about CBD, CBG, and other substances that sometimes fall in a legal gray area? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. My guest today is Dr. Ziva Cooper, director of the UCLA Center for Keele, Center for

cannabis and cannabinoids and an associate professor in the Department of Psychiatry and Biobbehavioral Sciences at UCLA's David Geffen School of Medicine. She holds a PhD in biophysiology from the University of Michigan. She studies both the therapeutic potential and the possible adverse effects of cannabis and cannabinoids through double-blind and placebo-controlled studies. Some of her projects include looking at differences between men's and women's responses to cannabinoids and exploring the potential for THC and CBD to ease pain. Dr. Cooper also served on the National Academies of Sciences Committee on the Health Effects of Cannabis, which released an influential report on the topic in 2017. She is author of dozens of studies in peer-reviewed journals and speaks

frequently to the media about cannabis and cannabinoid research. Thank you for joining me today, Dr. Cooper. Kim, thank you so much. It's wonderful to be here. I mentioned several types of cannabinoids in the intro a minute ago, marijuana, CBD, CBG. So let's start by getting straight what all these things are. What are the main cannabis products available today? What are the differences among them? What are they called? Great. This is a wonderful question to start out with. Essentially, what is cannabis and what are these different products? And so the cannabis plant, which is sometimes called marijuana, if it has a certain amount of Delta 9 THC in it. So THC is the primary intoxicating component of the cannabis plant.

Marijuana. And then we also have hemp, which is also cannabis, but hemp has less a very small amount of THC in it. And in this cannabis plant, whether you're talking about hemp or marijuana, there's over hundreds of different chemicals that comprise this plant. Some of these chemicals are unique to the cannabis plant, and we refer to those unique chemicals as phytocannabinoids. You mentioned some of these phyto-canabinoids before. In short, we call them cannabinoids because phyto-canabinoids can be too cumbersome to say.

So, again, one of the most popularly known phyto-canabinoid is Delta 9 THC, so THC for short. And again, this is the component of the cannabis plant that is responsible for, getting people high when they use cannabis, but it's also known to have therapeutic effects, which I'm sure we'll talk about over the course of this session. Another cannabinoid that people know about is cannabodial, which is abbreviated to CBD. And we're really starting to see an uptick in its popularity. In fact, I wouldn't say we're starting to see to see an uptick in its popularity. It is popular right now. And part of the reason why it's so popular is because unlike THC, it is not intoxicating, and there are several hints suggesting that it might be therapeutic

for a wide range of indications. Other cannabinoids you mentioned are CBG, cannabigerol, and I think that you might have also mentioned CBN or CBC, and so there are many different cannabinoids that are being marketed to people who are interested in the medicinal properties of this plant. And in addition to those cannabinoids, there are also turpines and flavonoids in the cannabis plant. And turpines and flavonoids are not unique to the cannabis plant. But it is thought that these different chemicals, again, over 100 chemicals in the cannabis plant, might add to its potential therapeutic effects. So how are each of these regulated?

Are all of these legal, illegal? what does the landscape look like right now? Yeah, so the landscape is actually really confusing right now. Right now in the United States, marijuana, which is cannabis that has more than 0.3% THC in it, is still considered to be federally illegal. Okay, so again, this is the cannabis plant that has measurable amounts of THC that the government thinks might be have detrimental effects or might have abuse potential, so on and so forth. However, even though marijuana is federally illegal, as you mentioned before, it is legal in 37 states

for medical use. So again, states have developed their own policies with respect to marijuana. So 37 states plus Washington, D.C., have legalized the use of marijuana of this cannabis plant, with measurable amounts of THC in it for therapeutic purposes. Of these 37 states, there are 17 plus Washington, D.C, that have legalized marijuana, cannabis, with more than 0.3% THC, for non-medical use. And so some people call this adult use or some people call this recreational use, but it's essentially use that is not specifically for medical purposes. So we have that legal standing, which differs on the federal level and the state level for

cannabis that's also called marijuana with measurable amounts of THC. Then we have cannabis that has very, very low levels of THC that the government refers to as hemp. And in 2018, a bill was passed that essentially legalized hemp. So this is cannabis with very low levels of THC. So at a federal level, hemp or cannabis with lower than 0.3% T.C is now legal. And certain states have different regulatory frameworks for how these different plants and the products that come from these plants are regulated. If you're in a medical state, that means that what types of indications you can get marijuana prescribed or recommended from your physician. And this varies too.

So, for example, California legalized medical cannabis in 1996. And I believe that there are 12 indications for which your physician can recommend the use of medical cannabis, including a 13th indication, which essentially is if your physician thinks that you might benefit from it. Other states have much more stricter regulations with respect to medical cannabis. And so right now, what we're seeing across the United States is really a patchwork. of legal frameworks at the level of the state with very little federal oversight with respect to how are these products, how is this plant being regulated from a federal standpoint? That's very complicated and confusing, but let's talk at the federal level and the work that you do because marijuana is classified as a Schedule I substance under the Controlled Substances Act.

So that has an impact on your research, right? I mean, how do you, how are you able to do research on marijuana if it's federally illegal? Kim, this is a really important point that sometimes people get tripped up about. So people think that because marijuana, again, this is the cannabis plant with more than 0.3% THC, because marijuana is what's called Schedule 1, meaning that it has no appropriated. approved therapeutic use, and it has high risk for abuse. Because the government has put this in this Schedule I category, so federally illegal, people think that it is pretty much impossible to research, but this really isn't the case. And what's especially interesting to note is that

because people think that it's federally illegal and we cannot research it in the United States, people have a tendency to believe that other countries are able to study marijuana more than we can because of this legal standing. But the truth is, is that while it's very challenging to study a federally illegal substance in the laboratory and in my case to actually administer it to volunteers in the laboratory, it's difficult to do this. It is not impossible. So there are many types of regulatory approvals that have to be obtained in order to do this research. So I have to have a Schedule I registration, a license, to be able to receive this Schedule I material, marijuana. I have to have this license to be able to store it, and then also to be able to use it in

research. Now, a critical question to ask is, well, if it's federally illegal, where, as a researcher, do I actually get the study drug? If I'm interested in studying marijuana, where do I get it from? So what if I have a license or a registration to be able to store it and use it? Where do I get it from? And so up until very recently, there was only one source in the United States that was allowed at the federal level to cultivate and produce marijuana. This was a farm in Mississippi, University of Mississippi,

and they essentially provided the study drug for all the marijuana studies that were happening in the United States. And they have been doing this for decades since before 1970. And they were able to create a product, marijuana product, that researchers could use that had different levels of different chemicals, different cannabinoids in it. And importantly, as a, a researcher, you know, the marijuana that I use for one participant and one volunteer, I want to make sure that that marijuana is very, very similar, almost identical to the marijuana that I use in the next volunteer in that same study. And so the University of Mississippi was able to produce this product and it was able to be reliable and consistent and also reached the standards for human

research as put forth by the FDA. So this was a very important. So this was a tremendous undertaking, and they really helped to provide the study drug that essentially all studies in the United States of marijuana were using at the time. Now, in 2021, the Drug Enforcement Administration granted licenses to additional growers and cultivators. So this was really exciting because in 2016, the DEA opened up for application. of new growers and producers, but it took five years until the DEA was able to go through all the applications and be able to sift through which ones they were going to be able to grant a license to. And so right now we're at a point where there are additional cultivators

who are working on making more diverse products, let's say, than what the University of Mississippi has available, or looking at niche products or niche cannabinoids, so that they can be able to provide researchers a full breadth of study material that can be used for research and asking the question, what is the impact of cannabis on brain and body? I want to get back to that question, but before we do, my other question is this, which is you're studying something that was created under government supervision, which isn't really the same thing as, say, I could buy if I went into downtown D.C. to a dispensary,

and bought some products there. So is it comparable? I mean, if you're doing research on that particular type of THC, the cannabinoids that you're getting under federal law with the license that you have, is it really applicable to what's happening to me if I'm buying edibles or getting buds

or whatever I might be buying at a dispensary? Right, and so this is a quandary essentially. So I'm at UCLA right now, and if I stood up and looked out my window, I could see two dispensaries out of my window. And I know that what's in those dispensaries is very different than the type of products that I am studying in the laboratory. Now, is what I'm studying in the laboratory, can it be generalized to what people are using? And we believe that, first of all, the types of products that people are using are ever evolving and they are evolving quickly.

So we are attempting to be able to study the types of products that people are using, but we understand that it's very difficult to keep up with the industry and with commercialization of these products. That being said, there are creative ways to be able to essentially understand what are some of the most common products that people are using. So, Kim, you mentioned that 14% of the population are using cannabis orally. So they're using edible products. So can we study that in the lab? Can we study differences between how people smoke cannabis or inhale cannabis, which is the most popular way that people use cannabis versus oral? And there are ways that we can actually address this in the lab in a very controlled and systematic way.

Now, something that's interesting also to consider is that while people often say the product or the study drugs that we get from Mississippi or some of these other licensed cultures, cultivators might not be identical to what people are getting in the dispensary. Something to keep in mind is that even if we were to look at dispensary products, I can guarantee you that the dispensary products that I would be able to, if I were able to get the dispensary products from the dispensaries I see outside of my window, they would actually be different, Kim, than the dispensary products that are available in your dispensary down the street, right? Because every state has different regulations and every state essentially has a different cannabis market because the products can't go from one state to the next because, again, that's interstate commerce and requires, you know,

federal oversight there, right? And so what happens is every state kind of has different types of products. So our job as researchers who are interested in looking at these types of products is to understand what are some of the most popular products that people are using, whether it be for medical purposes or for non-medical purposes. How can we figure out a way to study those types of products in the lab and then figure out where can we get those types of products so that we can study them in the laboratory for a range of endpoints that we'll talk about probably later on in the session? So while the products I get are not identical necessarily to what you are seeing in the dispensary, we think that these types of products can be generalized.

to the types of products that people are using. So let's go back to this other question I wanted to ask you, which is essentially what you alluded to a moment ago, how cannabinoids work on the brain and body. What systems do they affect and why are people so interested in using cannabinoids for what purposes at this point in time? These are two kind of different questions.

Okay, so the first question is, where do cannabinoids act in the brain and the body? And the second question is, Why are people interested in using cannabis and cannabinoids to help with a range of medical indications? I think that maybe those two questions can go hand in hand, but they can also be answered separately. So it's thought, I think, at the general level, a lot of people believe that cannabinoids,

cannabinoids in the cannabis plant act on our body's own cannabinoid system. And this is called the endoc cannabinoid system. meaning endogenous and cannabinoid system. So our bodies have a system that are related to our own cannabinoids. This system comprises two specific receptors, so proteins that bind drugs, in this case are endogenous chemicals that are, in this case, are usually lipids. And when these chemicals bind to these receptors, the cannabinoid 1 and the cannabinoid 2 receptor, downstream effects happen.

And there's chemical signaling, which lead to a variety of outcomes. Now, the cannabinoid receptors, the CB1 and the CB2 receptor, so two main receptors, they're located in the brain and also in your organ systems. And what's interesting what a lot of people don't realize is that we have a lot of different types of receptors in the brain. Your audience might have heard of the dopamine receptors or the serotonum receptors, the opioid receptors. What's interesting about the cannabinoid receptor is that it is the most abundant receptor in the brain, more abundant than dopamine or serotonin or opioid receptors. And so this is usually very surprising because a lot of people don't realize that we have these in our brain. And that these specific receptors are the ones that THC bind to and activates and produces their effects.

We also have other receptors, this cannabinoid two receptors. The cannabinoid two receptors, again, they're not as much located in the brain, but they're located in the body across all different organ systems. And they're thought to modulate more the immune responses of the body. So we have these two receptors, and we also have our body creates natural chemicals that bind to these receptors to produce a variety of effects. Now, the cannabinoid plant, the cannabis plant, excuse me, the cannabis plant, which has cannabinoids in it, a lot of people believe that all these different cannabinoids that I was talking about in the beginning of the podcast, CBD, THC, CBN, CBC, CBG, people have a tendency to think that they interact directly. with our cannabinoid system, our endogenous cannabinoid system, probably because, you know, they share the same terminology. We have the phyto-canabinoids and we have the indigenous cannabinoid system. But this isn't necessarily the case. So we know that THC, Delta 9-THC, does in fact directly interact with

this endogenous cannabinoid system. It directly interacts with the CB1 receptor and the CB2 receptor. these other cannabinoids, the pharmacology, how it interacts with these receptors and other receptors in the brain and body, it's a lot less known at this point. So for example, CBD cannabodial, a lot of people think that it acts directly with our cannabinoid receptors, but it's not that clear at this point. In fact, cannabodial is thought to have tens of different ways that it interacts with all these different other receptor systems in the body. So it's important that people understand this distinction. Now, how is it that cannabis can be helpful for all these different indications that people

might be using it? So one way, and you can think of it for just thinking about the THC and the cannabis plant, I already told you that THC acts at these two receptors, cannabinoid receptors, is the CB1 and the CB2 receptor that are abundant in the brain and the body and across organ systems. And so just by nature of the fact that THC interacts with this receptor system that's all over the body, it can potentially have an impact on disease states that impact all these different organ systems. Now, how do some of these other cannabinoids act to have medicinal properties? We're just starting to work that out at this point in time.

So, for example, CBD is a big puzzle. A lot of people are using CBD for a range of indications, and it's not quite clear the science behind how CBD might be helpful for reducing anxiety or it might be helpful for reducing pain. In fact, it's not even quite clear yet in humans that CBD might be helpful for a range of the indications that people are using it for. And so this is something that we're trying to work out in our laboratory and other scientists. that are associated with the APA are also trying to work this out. And yet, the product is ubiquitous.

I mean, I have to say with CBD, for example, I have an elderly dog. We give her CBD every day. The vet said, give it to her. It's supposed to make her feel better. Does it? I don't know. You know, my father had arthritis in his leg. We got him this CBD cream.

He used it. He said he felt better. Was it the CBD? Was it the placebo effect? Who knows, right? I mean, we don't know. We don't know, and it's going to take time to figure out, is it a placebo effect, or is it because of the CBD in that topical product? Maybe there's also another ingredient in that topical product that might actually be helpful for arthritis.

And so we actually have a study here at UCLA where we're looking at CBD's effects specifically for rheumatoid arthritis. So we know that arthritis is related to inflammation. and we think based off of animal studies that CBD might be helpful in reducing this inflammation. And so right now we're doing a placebo-controlled study to understand this very question. And Kim, I'm in the same boat as you. I hear all the time when I'm going to parties with, you know, dinner parties with my in-laws and their friends or my parents and their friends. And I always have somebody at those parties share with me the success that they've had with CBD and their arthritis. Now, if it's placebo, does it really matter?

You know, like if it's in effect, if they're getting relief, if their quality of life is improving, then great. And will we ever be able to tell that that specific topical CBD cream that your dad is taking is actually more effective than placebo? I can guarantee you that we probably will not be able to get that far. But we can approximate. We can be able to say, well, you know, we can do a study. Is topical CBD helpful for our third?

What is the type of dose that's required? How many times does it have to be applied? If we're looking at oral administration, you know, not only can we look at the potential therapeutic effects, but we can also begin to understand, well, what are some of the potential adverse effects that we should be mindful of, right? Which is very important when we're thinking about using these products as medicine. Now, you study the differences in the way men and women respond to cannabinoids. What have you found? How do we react differently and why is it important to look at those differences? One reason why I think it's really important to look at these differences, again, is going back to consumer behavior and what are people doing. So it was interesting.

A couple of years ago, I read a report about how traditionally people who use cannabis, males always outweigh females two to one. For whatever reason, we can talk. about that probably in another podcast. But always males outweighed females for cannabis use. But then I started noticing that, you know, there have been several surveys of medical cannabis patients. And what I was noticing more and more was that the ratio of or the proportion of males of females were equal. Or in some cases, there were more females using medical cannabis products for indications compared to men. And it made me, realize that, okay, well, here's a significant part of the patient population that's using

medical cannabis that is now female. How much work has been done in the field with respect to understanding the effects of cannabis and differences between males and females? So we've learned from animal studies that males and females are quite different in their response to specific cannabinoids. For example, in female rodents, there is a heightened sensitivity to THC's pain relieving effects. Now, there's also a heightened sensitivity to adverse effects, such as what's called abuse potential or addictive potential in female rats. So this raised the question to me.

Well, if we're seeing this in animals, and this doesn't happen all the time, but there is, there does tend to be some nice translation from what we see. see in animals to humans. So if we see this in animals that female rodents are a lot more sensitive to THC than males, what do we see in humans? Is that the same situation? Are females, are women more sensitive to THC's pain relieving effects than males? Could this be a reason why we're seeing more women gravitate or more women show up in surveys who are using medical cannabis for pain? And so I decided to look at that in a couple of studies that we had run looking at the effects of THC and pain in our volunteers.

And what I found Kim was really interesting, actually. It was kind of the opposite of what we expected. And what we found, you know, based on the animal work, I thought that females were going to be a lot more sensitive than males to the pain relieving effects of THC. But what I found was the total opposite. What I found was that the males were sensitive to the test. pain relieving effects of THC. And when I looked at the females, essentially the females had no response.

They did not show pain relief to THC in our studies. And, you know, I was clearly disappointed because I thought I was going to show a nice representation of how the animals translate to humans, but it didn't work. And I dug a little bit deeper. And around that same time, some preclinical researchers, some animal researchers, Rebecca Kraft and her colleague came out with some really. interesting data showing that although the female animals are a lot more sensitive to THC's pain relieving effects when they first get THC, after about like three weeks of repeated THC exposure,

the females develop tolerance at a much faster rate than the male animals. And so I went back to look at our data and I realized at the time that the people I was looking at in this particular study were people that were using cannabis every day. So, I was comparing females who are female volunteers who are being exposed to THC almost every single day, to male volunteers who are being exposed to THC almost every single day. And I was looking at their response. And I was seeing this dramatic difference in their pain relief, which kind of mapped on to what's happening in the animals. So we now have a study where we're comparing.

We're looking at people who use cannabis infrequently. So they wouldn't be tolerant to THC's effects, the same way that people are talking. tolerant to THC's effects if they're using it every single day. And we're comparing. We're seeing how does a pain response differ? If somebody uses THC, but they don't use cannabis regularly, they're not exposed to it every single day, well, we see that women's response is more heightened to the pain relieving effects of cannabis with THC than males in that population. And then what happens when you have people who are using cannabis every single day. Well, we see accelerated tolerance in those women.

So in other words, will we see that in women who are using cannabis every day, will they essentially not show the pain relieving effects of THC compared to men? And so this has become a really important question to ask because as we're seeing, we're continuing to see that more women are using cannabis specifically for pain. And in fact, there are products that are geared towards females, towards women, specifically for issues related to women's health. And so what are the impact of those products in women? Will they potentially be effective for those indications that people think they might be effective for?

Will there be faster rates of tolerance? So should people be more mindful of how much THC they're using? should they take breaks to help reduce any tolerance over time? How did their responses compare to men's responses? And then also on the flip side, what about some adverse effects? So there was an interesting paper put out by Collies at Johns Hopkins, who showed that females, again, women who are not regularly exposed to cannabis, when they take THC, either inhaled or when they use it orally, and you compare them to men, they actually show a heightened reaction to the anxiety promoting qualities of THC. So in their sample, in that sample, they show that females were more susceptible to, you know,

how you can become more anxious when you use cannabis. And those audience members who are listening right now, they might have had that experience where even though a lot of people use cannabis with THC to help reduce anxiety, sometimes it actually increases anxiety. And so if that's an effect that we're seeing in females, again, that should really help to guide how women might approach cannabis and THC for therapeutic use. You mentioned working with subjects who are taking THC every day, which raises a question in my mind, which is, can marijuana cannabinoids be addictive? I mean, is that a risk? How does this compare to other substances such as alcohol, or do you become dependent or addicted?

I mean, there is a difference. Right. And so generally speaking, when we talk about problematic cannabis use, we usually refer to a DSM-5 diagnosis, so a psychiatric diagnosis of what's called cannabis use disorder. Now, cannabis use disorder can be diagnosed when somebody hits criteria for meeting a range of symptoms that are markers of cannabis use disorder. And so one prominent symptom that people have, if they have cannabis use disorder, one symptom is developing what's called dependence, right? So in a subset of the population that uses cannabis with high frequency, when they stop using cannabis, Specifically cannabis with THC, by the way. We can talk about CBD in a second.

But cannabis with THC, that primary intoxicating component of the cannabis plant, in a subset of the population that uses cannabis regularly, every day, essentially, when they stop using it, they might experience symptoms of withdrawal. And that's a hallmark of what dependence is. And so some of these symptoms of withdrawal are more subtle than others, but essentially some core features of withdrawal include reduced appetite, disruptions in sleep, irritability. Those are some of the core features of withdrawal.

Now, what's interesting is that withdrawal doesn't necessarily happen right away. So you can imagine that other types of substances that can induce dependence, such as opioids, you know, withdrawal can happen pretty soon after somebody abstains from using that type of product. With cannabis, it's a little bit different. It can take a day to start those withdrawal symptoms, and the withdrawal symptoms don't necessarily peak until three days after abstinence. And this is based off of studies that were done at University of Columbia, Columbia University, with Meg Haney and her group. And they showed very elegantly that you can get consistent withdrawal symptoms in people who are using very regularly and who abstain. Now, for the most part, people who are using cannabis every day, they're not necessarily going to come into contact with these withdrawal symptoms because they are using cannabis more frequently than required to actually experience withdrawal.

So frequently, people don't necessarily endorse those withdrawal symptoms unless they've had a period of abstinence. Other types of symptoms that are hallmarks of cannabis use disorder involve tolerance. So is more cannabis or more THC required over time to achieve a certain effect? Okay. So this is tolerance like what we just talked about before where the female animals required more THC to get that analgesic response, the pain relieving response when they were exposed to THC every single day. So that's an example of tolerance.

Other examples of does your cannabis use interfere with your everyday activities? is it infringing on your professional life and your personal life? And so there are a number of other symptoms that are hallmarks of cannabis use disorder. Now, people can have cannabis use disorder and only endorse two of these symptoms. And so they would only have mild cannabis use disorder, whereas other people might endorse many more symptoms, and then they might be classified as having severe cannabis use disorder. And it really becomes an issue when a patient, with cannabis use disorder wants to try and cut down.

Once to try and cut down their cannabis use, they're noticing that it's causing issues in their personal life or professional life. They're developing withdrawal symptoms when they stop using it. And at this point in time, there actually isn't a FDA-approved medication, a pharmacotherapy, to be able to help people who have cannabis use disorder.

So unlike alcohol use disorder, or unlike opioid use disorder, or people who want to cut down on smoking cigarettes, there are pharmacological strategies to help with those use disorders. For cannabis use disorder, we're not there yet. We do not have a treatment that's been approved to help with people who want to cut down with their cannabis use. So around the time that I was in college, which was a long time ago,

one of the things that we would be warned about regarding marijuana was it was a gateway drug, that it was going to open the door to your doing terrible things. And some of our listeners may remember the movie, Reefer Madness. You know, some really bad things were going to happen to you. Is there any truth to that? Is cannabis somehow different from other drugs that is a gateway to you're doing something even more addictive, perhaps? Right. So I think that the fear was that, you know, if you use cannabis, then you're going to be led down this pathway. You're going to use harder drugs. And you're going to, you know, reach a point of no return, essentially. And I think at this point, we can say that this is not a cannabis thing. You know, if you look at other abuse substances,

let's say alcohol or tobacco and other environmental and social factors that go into what contributes to somebody initiating a certain, initiating use of a certain substance and continuing their use. We know that there are a lot of different variables that go into play here, that it is not just cannabis, that, you know, cannabis, if somebody is using cannabis at a very young age, what are other factors that are happening there that might also increase the chances that they will be exposed to other substances of abuse and continue to use those other substance of abuse? So I think we can say that, you know, an animal model has shown this as well where THC isn't necessarily special. So there are other drugs where if a animal is exposed to that particular drug early in life and then expose an adulthood to another novel substance of abuse, you know, that will increase their drug taking of that other novel substance of abuse.

So there are a lot of other factors that go into substance use in populations, even. even beyond just what types of substances that individual is exposed to. Again, I think social, environmental variables play a significant role in how people initiate substance use and if they maintain that substance use to a point where it adversely affects their life. So last question, just to wrap up, what are the next big, most important research questions that we need to answer to keep up with what's happening in the world and the marketplace around cannabis?

I think that some of the biggest questions that really need to be answered is first getting a sense of what are people using? What are people using in the United States at what frequency? What is their pattern of use? What are they using these types of cannabis and cannabis-related products for? What are the types of populations that we should be most interested in? For example, vulnerable populations, pregnant women. Are pregnant women using cannabis when they are pregnant to help with X, Y, and Z condition, nausea, vomiting? Are they using it more than traditional medications? That is a really important question to ask. Older adults, so we see a significant increase in the rates of cannabis use among people age 55 and older. What are older adults using? What is the frequency of use in this population. In the general population, what are some of the other products that are coming out that seem to be taking hold? So of course, there's going to be, you know,

a little fad here or there. But then other times there are products that are being produced that are not just a fad. They become a trend. For example, high potency cannabis products. These extracts that are essentially made from the cannabis plant that are almost 100% THC. And And they're available at dispensaries in many different states around the country. So at first, I think some people thought maybe this was just a fleeting fad and maybe, you know, people were experimenting with it. But from where we stand at UCLA, we interview a lot of people who use cannabis on a daily basis. And we're finding that, no, this is not a fad. People are using these extracts, these high potency extracts frequently, almost every day.

And they've been using them for a couple of years at this point. what are the effects in real time? What happens when somebody uses these high potency extracts, these high potency dabs, wax shatter? And then over the long term, what are some of the consequences? One would guess that maybe the effects would look very different than, you know, smoking a cannabis cigarette, which has less milligrams of fewer milligrams of THC in it. But we actually don't know.

And so this is a really important empirical question that we need to ask. And then with respect to therapeutic effects, what are some of the statistics related to the most popular indications for which people are using cannabis? And what type of cannabis products? So we know that people are using cannabis for three specific indications, at least the most popular reasons that people use cannabis is pain, anxiety, and to help with sleep. Are people using more CBD for these indications? How are they using it? Are they smoking?

Are they using it orally? Are there other ways that people are using it? And so first, when we get a finger on the pulse of what people are doing, then we can start drilling down and asking the important questions that are really rooted in filling in the holes with respect to what is the information we can share with people that is most relevant. What is the information that we can tell them about the potential adverse effects and the potential therapeutic effects? and also how can we share this information to, let's say, practitioners who are talking to their patients on a daily basis and whose patients are telling them that they're using X, Y, and Z cannabis product for this indication. And this is a really important area that I think we're going to see grow over time. But again, it's going to be hard to catch up with the cannabis marketplace and the types of products that are available. And so at this point in time, we just have to figure out what are the most pressing.

questions to ask based off of what are the most popular or prevalent modes of use and for what indications. Well, this is all really fascinating. You're right there on the cutting edge of something that is just sweeping our country. And I thank you for the work that you're doing and for joining me today. Thank you, Dr. Cooper. Thank you so much, Ken. This is really fun. You can find previous episodes of Speaking of Psychology on our website at www. www. speakingof psychology.org or on Apple, Stitcher, wherever you get your podcasts. And if you like what you hear, please leave us a review. If you have comments or ideas for future podcasts, you can email us at speaking of psychology at apa.org. Speaking of psychology is produced by Lee Weinerman. Our sound editor is Chris

Kondayan. Thank you for listening. For the American Psychological Association, I'm Kim Mills.