Premature birth is linked to an increased risk of autism spectrum disorder (ASD) in both males and females, with those born earliest carrying the highest risk, according to a large and definitive new study in Pediatrics from the Icahn School of Medicine at Mount Sinai. ASD, a disability associated with social, behavioral, and communication challenges, affects nearly one in 54 children in the United States.
The research found that children born between 22 and 27 weeks gestation had nearly four times the risk of developing ASD than children born full-term, between 39 and 41 weeks. Even babies born early-term—at 37 to 38 weeks—carried a 10 percent to 15 percent higher risk of ASD when compared to full-term births.
According to the Centers for Disease Control and Prevention, most children are diagnosed with ASD after the age of four, and boys are more likely to be diagnosed than girls. But an important takeaway from the Mount Sinai study is the need for parents and pediatricians to carefully monitor all premature babies, says the study’s lead author, Casey Crump, MD, PhD, Vice Chair for Research in the Department of Family Medicine and Community Health, and Professor of Epidemiology, Department of Population Health Science and Policy, Icahn Mount Sinai.
Casey Crump, MD, PhD
“Both preterm and early-term births should now be recognized as independent risk factors for autism in both males and females,” say Dr. Crump. “Children born prematurely need early evaluation and long-term follow-up to facilitate early detection and treatment of autism. Hopefully, our findings will help raise awareness of that.”
Dr. Crump and researchers at Lund University in Sweden examined the population records of more than 4 million Swedish individuals across a 30-year period and found the prevalence of ASD was directly related to gestational age. While the risk of ASD in children born between 37 and 38 weeks gestation is relatively modest, he says, the high numbers of children born during that gestational window make it notable.
In reaching their conclusions, the researchers compared siblings within families and were able to control for genetic and environmental factors, which strengthened the link between prematurity and ASD. The researchers also paid attention to these patterns in premature females, a group that had not been studied as extensively as males.
According to Dr. Crump, the study is meant to raise awareness but not alarm parents of premature babies. “Most of these children do very well across their lifespans,” he says.
Yet, “Preterm birth can interrupt or delay the development of all organ systems, such as the cardiovascular system and kidneys, as well as the neurological system,” he adds. For example, the weight of the human brain increases by nearly one-third between 34 and 40 weeks gestation, with significant increases in the volume of white and grey matter. Additional research has shown that the preterm brain is exposed to an inflammatory environment, which could result in a cascade of neuronal injury and alterations that occur prior to birth.
“Parents of children born preterm should be extra careful that their children have close clinical follow-up with physicians who are aware of these issues and can refer them to specialists,” says Dr. Crump. “Earlier detection leads to earlier treatments, which can improve outcomes. Gestational age at birth should certainly be tracked in the medical records to facilitate identification of these people across their life course.”
Everyone feels anxious now and then. Sometimes it’s a particular situation that makes your stomach clench, like visiting the doctor or meeting someone you don’t know; other times, you may experience a wave of anxiety for no particular reason.
There are some simple steps you can follow to relax. Rachel Kaplan, LCSW, a clinical social worker at The Mount Sinai Hospital, shares three tools you can use anywhere—without signaling your distress to everyone around you.
Breathe mindfully
You’ve probably heard that breathing can help you relax. But mindful breathing is more than just holding your breath.
What is mindfulness?
Mindfulness involves being aware of the moment and not judging yourself. Just notice how you feel and allow yourself to feel that way. Try not to force yourself to be relaxed as that can backfire and make you feel more stressed. You want to remind your body that you are safe
When you’re anxious, you tend to take shallow breaths. This is part of our ‘fight or fight’ response that kicks in when our brains sense a threat. To counteract this and help relax the body, try a technique called belly—or diaphragmatic—breathing. Start by placing one hand on your chest and one on the lower stomach area. Take a deep breath, inhaling through your nose, for four counts. Hold your breath for three counts. Then exhale slowly, through your mouth, for six counts. Deep breathing helps to ground us and signals to our brains that we are safe, lowering our anxiety level.
As you breathe, watch to see which hand is rising and falling—you’ll want it to be the hand on the belly. Take another deep breath and imagine that you’re pushing air into that lower hand. Repeat this exercise 10 times.
Focus on your senses
Use all your senses to focus on small details of the here. This will help you ground yourself and will take your mind off your anxious thoughts.
Think about the small details of your surroundings:
Start by naming five things you see around you. This could be the table you’re sitting at or your water bottle.
Name four things you can touch: your sweatshirt, hair, necklace, or shoes.
Acknowledge three things you hear, such as a car horn honking outside or the click-click of someone typing.
Name two things you can smell, maybe the remnants of last night’s dinner or your cat’s litter box.
Finally, acknowledge one thing you can taste.
By focusing on the exercise, you don’t have enough brain power to analyze and worry. Your concerns drift away, and you feel calmer.
Use your peripheral vision
This isn’t easy and requires concentration.
Start by looking straight ahead (not on a phone or computer screen) and pick one spot to stare at. It can be a mark on the wall, a doorknob, a tree branch—whatever jumps out at you. Focus your gaze on that spot for 5 to 10 seconds. Keep that focus, then widen your field of view without looking away from your focal point.
Notice what you see in your peripheral vision. Start on the right side and observe what you can see without moving your head or straying from your focal point. You may just see colors and movement or you may see objects. Do this for about 10 seconds. Then, for about 10 seconds, notice what you see on the left without looking away from your focal point.
By focusing on your peripheral vision, rather than your anxiety, your breathing will slow and your face muscles will relax. When you feel calmer, you can bring your attention back to the view straight in front of you.
On the evening of Tuesday, September 11, 2001—with fires burning at the site of where the twin towers had stood that morning and several thousand people still unaccounted for—a group of physicians from the Mount Sinai Selikoff Centers for Occupational Health met to discuss a plan of action for treating survivors and first responders who had rushed in to help.
Protégés of the late Irving Selikoff, MD—a pioneering researcher who was the first to definitively link asbestos exposure to lung cancer—these physicians knew how dangerous the air was at the site of the attack, which had been reduced to 1.8 million tons of burning rubble. The toxic stew of chemicals would later be found to include major hazards to human health, such as lead and other heavy metals, benzene, dioxin, and asbestos. The physicians also knew that serious illnesses could develop decades after an individual’s initial exposure, lessons they had learned from Dr. Selikoff and his groundbreaking research in the 1960s.
Over the course of their first meeting and several subsequent ones that included colleagues such as David Prezant, MD, Chief Medical Officer of the Fire Department of the City of New York (FDNY), the Mount Sinai physicians established a blueprint for what is now the World Trade Center (WTC) Health Program.
Today, 20 years later, the WTC program continues to receive new patients. It consists of six New York City-area medical centers, including Mount Sinai, and a separate treatment center exclusively for FDNY members. Together, the centers treat more than 80,000 emergency responders—firefighters, police, recovery and cleanup workers—as well as 30,000 people who worked, lived, or went to school near the disaster zone in lower Manhattan. Their medical care will be funded through 2090, under the federal James Zadrogra 9/11 Health and Compensation Act, which was signed into law in 2011.
“The Selikoff Centers had exceptional doctors and they worked their fingers to the bone getting this program off the ground,” says Michael Crane, MD, MPH, who joined Mount Sinai in 2006 as Director of the World Trade Center Health Program Clinical Center at Mount Sinai. “Their incredible dedication got this going. It was hardscrabble, making phone calls and asking people to speak out about the program. They were helped by community and civic leaders and members of Congress who got behind this. Their story is really an inspiration.”
Dr. Crane, whose program at Mount Sinai cares for roughly 23,000 responders, was medical director of Con Edison’s health program on 9/11. Immediately following the attacks, he was down at the site making sure Con Edison’s recovery workers had proper masks and breathing protection. But that was not the case for many other responders. The filters on their masks clogged up after an hour and workers were either too busy to replace them or could not find extra masks.
Sandra Lowe, MD, talks about what we’ve learned about trauma and resilience from treating responders. Her answers have implications for COVID-19 and beyond. Dr. Lowe is Medical Director at the World Trade Center Mental Health Program Clinical Center of Excellence at Mount Sinai.
“You’d see the masks hanging off their faces,” says Dr. Crane. “They were running in to save people’s lives. They ran in without appropriate equipment and suffered the consequences.”
The dedication of the recovery workers was inspiring, says Dr. Crane. “So many of them had friends or relatives or people they knew or had trained with down there. Guys who ran down there had built the towers. So it was a tremendous emotional shock. They were energized by this passion to do something about it. So many of them said the same thing: ‘It’s family. I want to find them.’ It was deep and personal and real.”
Michael Crane, MD, MPH, left, and Julia Nicolaou Burns, Administrative Director, Selikoff Centers for Occupational Health
On 9/11, Craig L. Katz, MD, was the newly appointed Director of The Mount Sinai Hospital’s Psychiatry Emergency Room. But it was his leadership of the nonprofit organization, Disaster Psychiatry Outreach, which he had founded during his medical residency, which led to his direct involvement with the families of the victims, survivors, and responders. Almost immediately, Dr. Katz helped organize volunteer psychiatrists who met informally with these groups down at Ground Zero or at the Family Assistance Center that New York City had established downtown.
At the time, lung screenings for responders were being funded by the National Institute for Occupational Safety and Health (NIOSH), but no federal funding had been allocated for mental health. Yet the psychological effects of the troubling rescue and recovery mission were beginning to show.
A few months after the attacks, Dr. Katz says Mount Sinai’s Psychiatry Department received a phone call from the late Stephen Levin, MD, then Medical Director of the Mount Sinai Selikoff Centers for Occupational Health, who said, “ ‘I have all these rescue and recovery workers coming into my office and they’re crying. I don’t know what to do with them. I’m looking at lung exposures and they’re crying.’”
Craig L. Katz, MD
Looking to assist the workers, Dr. Katz, currently a Clinical Professor in the departments of Psychiatry, Medical Education, and System Design and Global Health, at the Icahn School of Medicine at Mount Sinai, wrote a three-page grant proposal to the private Robin Hood Foundation requesting funding for mental health. “That was the birth of the mental health program for recovery workers,” he says.
The Robin Hood Foundation would go on to provide the program with more than $6 million until 2011, when the Zadroga Bill was enacted, according to Dr. Katz. “Robin Hood typically funds underserved populations,” he says. “They agreed the rescue and recovery workers were an underserved population. They were largely men who don’t readily seek help for mental health issues. These blue collar guys were not our usual customers.”
Today, Mount Sinai’s World Trade Center (WTC) Mental Health Program actively treats close to 700 individuals under the leadership of Sandra M. Lowe, MD, Medical Director. “The people involved in the recovery and restoration operations were exposed to so much trauma,” says Dr. Lowe. “Some individuals developed post-traumatic stress disorder (PTSD), major depressive disorder, all kinds of anxiety disorders, and some developed substance misuse problems because that was one of the ways they tried to manage the symptoms they had.”
These mental health conditions, combined with the aero-digestive disorders, lymphoma, or lung cancer, which also stem from their work at Ground Zero, have created a complicated set of issues for this aging cohort of responders, many of whom are now in their 50s.
Sandra M. Lowe, MD
“Some members of the public may question the relevance of the WTC Health Center 20 years later,” says Dr. Lowe. “It is very relevant and needed. People are not aware of the ongoing physical or psychological struggles. We see an increased number of patients coming in for help. They have developed worsening physical conditions or now they’re retiring from the New York City Police Department. They may have been suffering PTSD for 20 years, but now they’re no longer afraid of the stigma associated with seeking help. They’ll say, ‘Doc, this is the first time I’ve told anyone about my nightmares.’ We hear the appreciation from the patients and their families.”
As time goes on, Mount Sinai’s clinical team also sees new health issues arising among responders, including the possibility of early cognitive decline. NIOSH is funding studies to determine whether exposure to toxins at Ground Zero is actually associated with this decline and whether there is a need for an early intervention program.
Kathryn Marrone, LCSW, Director of Social Work for the World Trade Center Mental Health Program, joined Mount Sinai in the summer of 2002 for what she was told at the time would be a one-year job monitoring and assessing the needs of responders. Almost two decades later, she is still working with these men and women. Only now, she says, they are aging and require a shift in services.
The responders “recovered bodies, saw people jumping from buildings, and watched the buildings collapse,” she says. “The level of trauma these individuals experienced was quite severe. They were completely confused about how to manage that emotionally.” But over the years, in their dealings with social workers, doctors, and other colleagues in the program, “Mount Sinai has become a lifeline for so many individuals. It is a place where they can turn because no one else quite gets what they’re experiencing.”
With the start of the new school year, many kids may be relieved to return to in-person learning. But others may feel more anxious.
In fact, experts at the Mount Sinai Adolescent Health Center anticipate that this transition may be especially challenging and anxiety-provoking.
Rachel Colon, LCSW, a social worker at the Center who treats young people ages 10-26, says that her case load has nearly doubled as adolescents seek help for anxiety and depression.
Rachel Colon, LCSW
“Young people are feeling a great deal of anxiety about returning to school,” she says. “They don’t know what they’re stepping into, who their friends are, and they’re nervous about the lack of predictability in an environment that has always been safe and provided routine.”
Ms. Colon offers some steps you can use to help your kids with the transition to in-person learning this school year:
Have lots of conversations with your kids; keep the lines of communication open.
Empathize with your children; let them know they are not alone if they feel anxious.
Reach out to your child’s school to ask what steps are being taken to familiarize students with their surroundings.
Look for signs of withdrawal, isolation, stomach aches, headaches, irritability. These can be signs of depression and/or anxiety.
If your child is headed to a new campus, or stepping up from middle school to high school, offer to take a walk to school before the first day of school.
Heading back to school can be stressful even in normal times. Over the years, the Mount Sinai Adolescent Heath Center has compiled a list of seven things for kids and adults to do to start the year off right. Click here to see them on the Center’s kid friendly blog.
One potential new issue this year is that kids may feel they have lost touch with their group of friends, or that they don’t belong, and masks, while a critical safety tool, may make things more difficult.
“Many kids are telling me they don’t have a friend group anymore. They don’t know how their classmates will look,” she says. “With the potential requirement of masks, this will likely compound social anxiety because it’s hard to read expressions when a person is masked. Are they happy or sad? Are they smiling at me? Though masks are a crucial safety tool right now, kids really need simple cues—like a broad smile—to maintain social relationships.”
The Mount Sinai Adolescent Health Center is a comprehensive, integrated health center that provides nonjudgmental and confidential care to young people ages 10-26 in New York City—all at no cost to patients, regardless of insurance or immigration status.
Brian Sweis, MD, PhD, logging his clinical rounds notes while keeping an eye on the mice in his latest experiment.
The past few decades have seen a surge in neuroscience breakthroughs, but translating those findings into better outcomes for patients has been slow and, in some cases, non-existent. Neuroscientists who train as clinicians can narrow that interdisciplinary divide.
Brian Sweis, MD, PhD, a second-year psychiatry resident and post-doctoral researcher at The Mount Sinai Hospital, is learning that discoveries in the lab can help inform how psychiatrists conceptualize the biology underlying complex emotions. In his most recent experiments, he investigated where in the brain emotions like regret stem from, and how this could go awry in mood disorders.
“We learned that there may be two distinct types of regret in the brain: one linked to depression, and another linked to resilience, which differ based on how people view their own mistakes and what could have been done differently,” he said. “I realized that we may even be able to access the root of some of these seemingly similar but fundamentally distinct thought processes if we structure psychiatric interviews with patients more precisely. This could help us identify which type of regret a patient is experiencing—either an emotion that is healthy and adaptive (and should be reinforced) versus one that may be pathological (and targeted for treatment).”
Dr. Sweis anticipates that as he continues to grow as a budding psychiatrist, the connections between his research and clinical experience will help him better bridge the worlds of science and medicine.
An indirect path to psychiatry Dr. Sweis was first introduced to neuroscience as an undergraduate at Loyola University in Chicago, where he worked in a research lab studying how stress can affect the body and brain in rodents. At the same time, he was drawn to a psychology professor who was studying similar concepts in humans. He realized that neuroscience lay at the intersection of the two. “I fell in love with neuroscience when I learned that something as intangible and abstract as a psychological concept could have concrete biological underpinnings,” he said.
He decided to double major in psychology and biology, and minored in neuroscience and philosophy. “I was a total nerd about everything neuroscience,” he said. “I remember thinking at one point that I definitely didn’t want to go to medical school. Instead, I wanted to be a professor, run a research lab, train my own students, and be a full-time scientist.”
He was most interested in areas of science where multiple fields overlapped. “That’s where the most exciting innovation happens,” he said. Towards the end of college, he learned he could pursue his research passions while in medical school and work at the intersection of two often separated career paths as a physician-scientist.
Dr. Sweis enrolled in the dual degree MD-PhD program at the University of Minnesota Medical School (UMN), which splits the four years of medical school and adds a four-year PhD program in the middle. For his PhD in neuroscience, he explored the complex cognitive processes around how the brain makes decisions. “I was fascinated by how we could take abstract concepts like thought, memories, and imagination, and boil them down to the physical properties of a brain cell that you can touch and directly measure,” he said.
Most of the breakthroughs in basic neurobiology occur in animal studies because the technologies available in that space are more advanced, but this is often far removed from affecting patient care. However, Dr. Sweis set out to work across species with rodent and human subjects in parallel in order to accelerate the “bench to bedside” process of translational research.
At UMN, Dr. Sweis was part of the first group of researchers to discover that humans are not the only species that are capable of experiencing regret. Combining elements from decision neuroscience with behavioral economics, he found that even rodents are sensitive to the mistakes they’ve made when realizing that alternative actions could have led to better outcomes. He also found that avoiding future regret can be a strong motivator for learning—mice will even sacrifice food to do so.
Related to this work, Dr. Sweis was first author on a Sciencepaper showing that rodents also tend to overvalue rewards they’ve already invested in, even when it’s clear they should cut their losses. This well-studied cognitive bias is known as the sunk cost fallacy, and it was thought to be a psychological phenomenon unique to humans. Importantly, Dr. Sweis helped craft a way to study these concepts so that they could translate to animal models of psychiatric disorders. His work in comparative biology and evolutionary neuroeconomics landed him on the 2020 Forbes 30 Under 30: Science list. He has also received best PhD awards through UMN, nationally through the Council of Graduate Studies, and internationally through the Society for Neuroscience.
As a clinician, Dr. Sweis originally planned to train in neurology. But over the course of his PhD, he learned that the applications of what he was studying aligned more with the depth of training he could gain from a residency program in psychiatry.
“I realized psychiatry was more in line with the questions I found to be the most fascinating, and tied back to my philosophy interests in undergrad,” he said. “How does the mind work? Where does motivation come from? What happens when the machinery in our brain that controls the way we make decisions starts to physically break down? Whether it’s the result of a neurological insult like a stroke or psychiatric event like trauma, I wanted to know more about the biology that causes us to behave and think the way we do. To fully unpack all of the ways a clinician can deconstruct the origins of behavior, I knew I needed to be formally trained as a psychiatrist.”
Mount Sinai’s physician-scientist residency track Dr. Sweis chose The Mount Sinai Hospital because “the institution as a whole values research at every level, not just a certain department or an individual or two,” he said. “Mount Sinai was built around accelerating and providing robust training experiences and research opportunities, and that’s one of its biggest strengths toward innovating new treatments for patients.”
“They readily identified that my talents lie with being a scientist,” he said. “They told me they would do everything they could to powerfully launch my career as a physician-scientist because that’s where I would thrive the most.”
To that end, during his first year of residency, he split his time as an intern seeing patients (including in the ICU and ER during the height of COVID-19), and the other half initiating experiments on how regret-related processes in the brain are altered in depression.
“I began working on this experiment the first day I moved to New York,” he said. “My training directors saw the clear path forward, entrusted my vision and drive, and supported me in every way. We’re working to publish these discoveries right now.” Within the first six months of residency, Dr. Sweis was awarded third place for best research by a psychiatry resident in New York City by the American Psychiatric Association.
Finally, Dr. Sweis chose The Mount Sinai Hospital because of the faculty he wanted to work with, including Eric Nestler, MD, PhD, Scott Russo, PhD, and Denise Cai, PhD. Dr. Sweis launched his first set of experiments in Dr. Nestler’s and Dr. Russo’s labs studying how regret may be processed differently in rodents that develop depressive-like symptoms following exposure to stress (stress-susceptible individuals) versus animals that are more stress-resilient.
“Dr. Nestler and his colleagues provided a home for me to continue my research from UMN in an independent manner,” he said. “The opportunity for collaboration was obvious: I took a well-validated model of depression their labs and others developed, and combined it with my expertise in neuroeconomics, which was quite new to their labs.”
Now that he completed his first set of experiments and has hit the ground running, Dr. Sweis is expanding his research horizon and learning from other expert faculty including Dr. Cai, a leader in the field of memory research. Dr. Cai’s lab leverages cutting-edge technology that she and others developed to image the living brain in ways never before possible in order to ask deeper questions about how experiences are dynamically processed and stored.
The microscope and raw footage of a rodent’s brain. Image credit: Daniel Aharoni, PhD, and Denise Cai, PhD.
Her group developed a miniature microscope the size of a penny that can be implanted into a rodent’s brain. The microscope can record videos of individual neurons that together look like stars in the night sky, where each flickering light represents a biological event. This electrical cellular activity is engineered to be converted into a visual signal that can be captured with a camera. Hidden in this display are coordinated “constellation-like” patterns that together represent aspects of a memory distributed across a network of neurons.
“This type of work is truly incredible,” said Dr. Sweis. “Information represented this way in the brain—in networks—would have previously otherwise gone unseen without this technology. Identifying new ways in which these complex processes break down is only the beginning toward developing a richer understanding of psychiatric illnesses.” Dr. Sweis and Dr. Cai together recently published a review article on the current state of this research and where these new technologies are taking the field.
Career plans A fundamental issue in brain research is that animal work and human work can be very disconnected, but Dr. Sweis plans to keep a foot in both worlds. He sees his translational research ultimately extending back into clinical patient populations, where he has aligned interests with another mentor: Helen Mayberg, MD, director of the Nash Family Center for Advanced Circuit Therapeutics. As a neurologist who works in neurosurgery to advance next-generation treatments for psychiatric disorders through deep brain stimulation, she emulates the type of neuroengineering approach to psychiatry Dr. Sweis is aiming to grow further into with his research and clinical background. While certain techniques and questions can only be investigated in mice, he hopes some of the insights he gains by studying animal behavior in complex ways can bring a different spin or new elements to questions being asked on the human side (such as Dr. Mayberg’s research).
For example, deep brain stimulation doesn’t work for every depressed patient. “Why is that? Is the implanted device slightly missing the intended target? Or does this person have a fundamentally distinct sub-type of depression in which treatments would be better tailored toward a different pathway in the brain?” said Dr. Sweis. “One of the primary goals of my translational research is to be able to differentiate sub-types of a psychiatric disease by refining the way in which we understand how behaviors come about in the first place—and to be better at describing those processes.”
Scientists trained as physicians, like Dr. Sweis, are in a unique position to understand and enhance the links between preclinical research and clinical applications in humans to advance patient treatments. “During my residency interview, my program directors told me that the toolkit of a psychiatrist lies in the interview,” he said. “It’s a surgical interview—much like a scalpel is to a surgeon, so is the art of interviewing a patient to a psychiatrist.”
He hopes that his research in neuroeconomics will equip psychiatrists with a new language to dissect the multifaceted drivers of behavior and sharpen the precision of a surgical interview such that it can tap into the different circuits at play. This is one of the goals of the emerging field of computational psychiatry, and he knows his training as a clinician is making all the difference as he moves toward that goal.
“By learning how to practice psychiatry and working directly with patients, I can begin to identify what needs to change the most in this field and where to best direct my efforts as a neuroscientist,” he said.
Mount Sinai’s Department of Psychiatry is one of the largest and most prolific in the world. With our new series, Inside Mount Sinai Psychiatry, we showcase stories from every corner of our Department including our training programs, patient care teams, and scientists. We believe psychiatry and mental health are the building blocks to fulfilling lives and thriving societies; via these stories about our faculty, trainees, and staff, this series shows the myriad ways we work toward that. Whether it’s manning the front desk of an opioid treatment clinic, researching how psychedelics work in the brain, or training future clinician-scientists, our team is relentlessly pursuing the best for those suffering from mental health issues.
Dr. Hurd is an internationally renowned expert on addiction and related psychiatric disorders who has been at the forefront of research into cannabinoid (CBD), a substance derived from the hemp plant that is now seen in many retail stores. In this Q & A, she explains what you need to know if you are heading to the cannabis dispensary and why disclosing marijuana use to your primary care physician is critical.
What advice do you have for those new to marijuana who are interested in partaking now that recreational use is legal?
You have to really be careful about where you obtain your cannabis. There are bad actors out there, and we have seen that some items which have been marketed as cannabis can actually contain products that are not. Recently, we have seen cannabis that has been laced with fentanyl, which is a highly potent and highly addictive opioid. So, the source from which you obtain your cannabis is critical. For now, the safest way to get marijuana in New York is to get a prescription from a physician and buy it in a state dispensary.
Should I tell my doctor that I am using marijuana? Why?
It is critical to tell your doctor if you are using any cannabis product. Like any drug, cannabis is broken down into various active chemicals that your body can use by liver enzymes. If you are taking any other pharmaceutical drugs, cannabis may interact with the same liver enzymes and either diminish or increase the activity beyond its intended use. So, your doctor absolutely has to know to avoid a potentially dangerous drug interaction.
One of the benefits of legalization is that there should not be any risk in being honest with your doctor about your cannabis use. The more honest that you can be, the better medical care you can receive.
Is it true that marijuana is non-addictive?
Many people don’t realize that you can become addicted to cannabis. In fact, the rate of diagnosis of “cannabis use disorder” is about 30 percent in people who frequently use the drug. That percentage is not much different from highly addictive drugs like cocaine and opioids even though cannabis is not as highly addictive.
The reason that we have such a high prevalence of cannabis use disorder being diagnosed is that a greater number of people use cannabis, so more people can convert into addiction. Often, the higher addiction is due to the higher potency of today’s cannabis.
What specifically is different about today’s marijuana?
Today’s recreational cannabis has a very high concentration of THC (short for delta-9-tetrahydrocannabinol), which is the main psychoactive ingredient in cannabis. It has gone from approximately four percent THC to, in some products, nearly 24 percent. And certain products, even those obtained from dispensaries, could have 70 percent THC. This is much higher than 10 or 20 years ago.
The greater the THC concentration, the greater the potential impact on a user’s mental health, and the greater the potential to become addicted. For a safer, higher-quality product, look for cannabis that has a verified certificate of analysis—this indicates that the product has been thoroughly checked for contaminants, pesticides, and other harmful materials, and it allows you to view its THC levels as well as other ingredients.
Is hemp-based THC safer than cannabis-based THC?
In short, no. THC is the same if purified in a safe manner for human use, whether it is derived from hemp or cannabis. However, the amount of THC that can be produced from hemp is low—the plant contains less than .3 percent THC—, so most THC is obtained from cannabis.
It is important to understand that even though marijuana may be legal for recreational and medicinal purposes in New York, on the federal level it is still a Schedule 1 drug which means that it is considered to have no accepted medical use and a high potential for abuse.
However, CBD—which is derived from hemp—is federally legal. There are some who try to get around cannabis’ federal status by selling a hemp-based THC product under the name ‘delta-8-THC.’ In the cannabis plant, it is delta-9-THC that causes the ‘high’ and, large concentrations of the substance can cause mental health issues. While there is not a lot known about delta-8-THC, we do know that it can cause euphoria, though milder than delta-9-THC.
Many companies are marketing delta-8-THC as the safer—and legal—option, but that is not true. For example, since the amount of THC in the hemp plant is low, some manufacturers try to forego the natural process of deriving the substance and use chemicals to artificially increase the amount of delta-8-THC. Additionally, some bad actor companies are faking their certificate of analysis to say that their product is delta-8-THC, when it turns out that it contains delta-9-THC and harmful materials like lead and heavy metals.
Are there any other drawbacks to frequent cannabis use?
In addition to potentially developing an addiction to cannabis, with use of highly potent cannabis products, we see mental health related problems. For example, issues with attention, memory, and cognition. Those are a side effect of chronic cannabis use, and even occasional use can impair motor issues. We also see the risk for psychosis, especially in certain younger people, when they use cannabis.
And, for any drug that is being consumed by smoking, you also incur the risk of pulmonary issues as smoking which is not good for your lungs.
Has marijuana been proven to alleviate any medical conditions?
There are certain synthetic THC products that have been approved by the U.S. Food and Drug Administration (FDA) for anti-nausea purposes to help increase the appetite of people going through chemotherapy. The FDA has also approved the use of CBD, in particular Epidiolex®, for two rare childhood forms of epilepsy.
Other than that, neither cannabis nor CBD have been approved for anything else. But there are a lot of clinical trials currently being done. So we’ll see how those pan out in a few years.
How does legalizing marijuana benefit the medical community?
Legalizing marijuana is a double-edged sword for the medical community. We want to make sure that people are healthy, and any time you take a drug that you most likely do not need that can have negative effects on mental health, that’s not great. But the legalization of marijuana makes it easier for patients to be honest with their doctors about their cannabis use, which overall gives patients better outcomes because a physician will know exactly what their patient is taking and can, therefore, guide their care in a much better way.
Also, for my fellow researchers, the fact that cannabis is no longer illegal in some states makes it easier for us to investigate what may be the benefits and adverse effects of its use for certain disorders. It also allows us to better guide physicians and their patients about how to use cannabis, if they choose to use cannabis.
Premature birth is linked to an increased risk of autism spectrum disorder (ASD) in both males and females, with those born earliest carrying the highest risk, according to a large and definitive new study in Pediatrics from the Icahn School of Medicine at Mount Sinai. ASD, a disability associated with social, behavioral, and communication challenges, affects nearly one in 54 children in the United States.
