Now that New York and many other states around the country have decriminalized medicinal and recreational cannabis, some are interested in partaking. To those people, Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai, advises that marijuana is just like any other drug, even if it’s now legal.
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.
Yasmin Hurd, PhD, is the Ward-Coleman Chair of Translational Neuroscience and the Director of the Addiction Institute at Mount Sinai. She is currently the principal investigator on a clinical trial of CBD for treating opioid use disorder, a neuroimaging study of CBD’s effects on the human brain, and a study looking at neurodevelopmental effects of cannabis and its epigenetic regulation.