 Now I'm really going to talk about the developing brain and so as I said earlier, your brain is constantly developing, you know some animals when they're born their brain is fully developed but the human is not so it's constantly developing up into mid-20s and during puberty is a really important time because this is when the brain is making a decision what are we keeping getting rid of. So some neurons that are chosen to strengthen by myelinating them and other neurons are chosen to be pruned and so there's a lot of stimulatory neurons going on during adolescence like the glutaminergic and dopaminergic and there's a lot less of inhibitory neurons and as I said they're mostly in the prefrontal motor cortex this thing like this that calms things down and so that is why a lot of kids go through periods of anxiety, depression, or puberty. That is a normal part of development and I think we rush too quickly to try and medicate that. I think the purpose is to try and support kids through that period of time because it's a normal part of development and so this is why this is such a high risk time for developing an addiction because they're stepping on the gas all the time very low ability to step on the brake and there's decreased parental monitoring which you want and then there's increased peer affiliation and I think that's the only place parents can really intervene because you really need to know what your kids are doing and who they're hanging out with. So then we have this endocannabinoid receptor system and this is actually the best thing that has come out of legalization of marijuana is our better understanding of this system. We did not really even know why people liked marijuana until the 1960s and that's when this lab in Israel and I think we didn't know because people just didn't pay attention to it. They said it's just marijuana and who cares but there was this lab in Israel that was taking apart the different cannabinoids injecting them into animals and they found that when they injected THC into rhesus monkeys they became calm and sedate and then they discovered there was a receptor that THC fits right into and that's how it got called a cannabis receptor and I'm really sad that it ever happened because that makes people believe we have receptors in our brain that says we're supposed to smoke cannabis but that isn't true because it's that same lab along with other people around the world in the 1990s discovered why we have those receptors and they discovered that we have this thing now called the endocannabinoid system and this is our homeostatic system it says our mood regulation system so this is something that we naturally have and they found that there are two chemicals that they named 2AG and anandamide. Anandamide is a Sanskrit word for supreme joy or bliss so this is basically our happiness stuff and what happens in our brain the brain makes a decision when we need these chemicals and when we don't so if we need the chemicals we have the enzymes to make them and they're made immediately they're made locally they're used immediately and then they're destroyed because we have enzymes that destroy these chemicals and so this is our own natural mood regulation system THC is a fat soluble substance that sits in that receptor and doesn't allow your own natural anandamides to work and so that becomes a problem because these receptors play a very important role during puberty to determine what are we pruning so what neurons are we going to get rid of because they're causing interference this is a really excellent webinar and I encourage people to watch it this is a phenomenal researcher who's at Mount Sinai and she's looking at the intergenerational effects of marijuana on the developing brain and so she talks about how the endocannabinoid system plays a role in the entire development system and she didn't say this in so many words but what I got out of her research was no one should be smoking marijuana unless you're 25 years of age or older and you never plan to have kids because it affects the gametes so it affects the O-um the sperm and so then that affects the developing brain of the offspring so this is the synaptic pruning and there are two receptors responsible for this one are the nicotinic cholinergic neurons it is not called nicotinic because we're supposed to smoke tobacco it's just that nicotinic works on these receptors and so those receptors and the CB1 receptors the cannabinoid 1 receptors are responsible for the pruning of the brain and this happens during adolescence so the nicotinic cholinergic neurons are all in the reward pathway the CB1 receptors are everywhere in the brain and one of the problems is is the THC has a stronger binding capacity to the receptor than our own natural amandamide so it can then prevent the our own natural system from working which may explain why we have research like this so this is this is out of Europe where they looked at high school students who have used only one or two times compared to kids that never used cannabis and they found that the kids that used cannabis had greater gray matter volume in these parts of the brain responsible for learning and memory gray matter volume are neurons so that to me means these kids didn't get pruned like the other kids got pruned and maybe this is why we have this kind of research this is a very long perspective study looking at over a thousand people who they picked up at 13 before they were using any kind of substances and then they followed them until they were 38 and they found that the people that never used marijuana had a pretty stable IQ over that period of time those who use marijuana persistently like regularly daily had a drop in eight points in their IQ which is pretty significant if you think about the average bell curve being a hundred and you drop eight points that's a pretty significant drop and then this group has continued to follow these people so this is brand new data they published where they followed them age 45 and the interesting thing is what I've highlighted in yellow so the long-term cannabis users had a drop of 5.5 average IQ points the non-cannabis users didn't have a drop at all and then this is compared to long-term tobacco users which can affect your intellectual capacity but it wasn't nearly like marijuana and then alcohol which we think of as the worst was actually better than tobacco or cannabis for recreational users had a pretty significant drop in IQ and those who quit their IQ didn't respond come back so that's kind of scary and this is part of the problem because when we legalized marijuana in Colorado for medical purposes the highest potency was 5% and we had no concentrates so concentrates didn't show up until like 2010 and now we have these things are 99.9% pure people are smoking with blowtorches marijuana has been around for centuries and always up to about the 1980s the average THC potency was less than 3% but has continued to increase and now the average potency is 20% in the plant and you know we have these huge things that have no research on them for medical purposes and yet they're sold as medicine if you increase the concentration potency of a drug you increase the addiction potential we know that about all drugs we've definitely experienced that with the opiate epidemic because codeine is not nearly as addicting as Oxycontin or Esfetanyl and so the more powerful the drug the more addicting it is and we absolutely see this now with marijuana so alcohol is like the number one drug used by most people and at any one time you could estimate that 90% of the population have tried alcohol however only like 10 to 15% actually ever developed alcohol dependence people can ship heroin you don't have to get addicted to heroin it's a much higher addiction potential than alcohol the drug that has caused the most addiction to date is nicotine and nicotine is the one that kills people it just takes a long time and so nicotine has been the most difficult drug for people to quit and in my treatment program that's what everybody would say because we're tobacco free and they're going it is so much easier to quit heroin than it is tobacco however what I'm seeing now with the high potency PHC it's identical to tobacco in fact it's even worse I find people that just cannot quit no matter what they try and so they need inpatient treatment to be able to be away from it so that they can experience a time you know where they can actually quit but the problem is insurance doesn't pay for inpatient treatment for cannabis use disorder I mean most people are still looking at it like well it's just can't it's just marijuana you know that shouldn't be a problem people should just quit it but I'm finding that and NIDA is supporting that so NIDA is saying that one in three people who use the current marijuana get addicted to it you know if you're using before the age of 18 you really are susceptible even more to the addictive potential and we definitely see a withdrawal syndrome and it's pretty marked and it can last for some time because it's fat soluble and it can sit in your fat and leech out over time I had people in my program that were still spilling out THC in their urine a month or six weeks later and I know they're not getting it because they're in a very controlled environment and so it and I was seeing really serious withdrawal I mean people are miserable like they're really irritable they're really angry they're really anxious they can't sleep and we don't have any medication that works for that there's nothing to help with that really and then we have this risk for psychosis and this is one of the landmark studies that was out of UK that looked at high potency which they call skunk so it's anything higher than 15% THC and they found that the people that were using it had a three times increased risk of psychosis if they were using it daily there was a five times increased risk but if they were using the stuff that was less than 5% there was no increased risk of psychosis and I think that's why we haven't seen that until now because we didn't have all this high potency stuff but now we do and so they replicated this study in multiple sites around Europe and in Brazil and they found the identical outcome except for it was 10% were higher and in the medical literature supporting medical treatment for using marijuana none of the studies show any benefit while they haven't studied anything greater than 10% so all of the studies that support its use in medical is less than 10% and all of the studies that are showing problems are greater than 10% so really the cap should be 10% but nobody's going there because the industry fights that tooth of nail because the industry is really this isn't an industry that depends on addiction no different than the tobacco industry the alcohol industry and even you could say the pharmaceutical industry because they need people to be addicted to it to buy their product marijuana is a hallucinogen so it can cause psychotic symptoms in anybody but they're usually mild and transient so somebody could be really paranoid when they're using and then they stop using and it goes away or somebody could use and have a hallucination like they see something that nobody else sees or they hear something nobody else sees that's transient and that's considered normal what first episode psychosis is when somebody is using a substance and then all of a sudden they have a totally altered perception of reality and so they're kind of stuck in a situation where they are seeing things and nobody else sees or they're hearing things and nobody else sees they're extremely paranoid they get extremely delusional and that's what I was seeing in my program was with the increased potency I was seeing worse and worse psychotic symptoms you know they were hanging on and then what you know what you have to encourage people to do is they have to quit and so that's called first episode psychosis because it's a bad situation but it is time limited potentially but then they have to quit and the problem is they don't quit and then it can become permanent and so then somebody can turn into having schizophrenia which is a really devastating illness because it's not going away and so this is a study out of Denmark where they were looking at well if the high potency is really causing our problem we should be seeing it because we definitely have higher potency products and so they did this huge population based study looking at over 7 million individuals and they definitely saw that so there was a significant increase in cannabis use disorder and the diagnosis of schizophrenia in their population and then this is speaking to what you were talking about because all drugs of abuse can cause psychosis they all have the potential alcohol can cause psychosis cocaine and amphetamine I remember when I worked with somebody who became psychotic from too much nicotine however what is the conversion rate to schizophrenia after somebody has a psychotic episode and this study shows that marijuana cannabis is the number one drug that increases the conversion to schizophrenia so almost 50% of people that developed a cannabis induced psychosis then went on to schizophrenia that's really scary and I've had that experience with numerous patients I had one young gentleman who was 20 and he was dabbing and he developed a severe psychotic episode where he became very violent and he tried to strangle his mother which was totally against his character so he was hospitalized for two months and it took two months to stabilize him nobody says he's in the psych hospital two months anymore but he required three anti-psychotics to stabilize his psychosis and then he was discharged and I ended up following him up and I get the medical record and they can't believe this is just marijuana because the only thing in the system was THC and so they were pretty sure they must have missed something that caused this but they didn't ask the right questions and so when I got him I said what were you doing and he admitted he was dabbing so he was dabbing this really high potent stuff and he was stable he was no longer psychotic but he had horrible symptoms from his anti-psychotics so he had a really terrible ecathesia which happens with anti-psychotics where you cannot sit still so it was up and down, up and down, up and down so I agreed to take him off so we slowly taper him off his anti-psychotics and he was doing really well and I gave him this lecture about never go back, never use it again but within a month or so my parents had brought him back he was psychotic again and I said what are you doing? and he said well I went back to dabbing he ended up developing schizophrenia and that's really, really sad and this is just a brand new study looking at global drug surveys so this is around the world just showing that the higher potency plants and the higher potency concentrates are really causing people to have more psychotic symptoms and they estimate that actually 1 in 200 people who use cannabis may have a psychotic episode that's kind of scary and these are all the other consequences that we are seeing in Colorado and that I'm sure you're seeing too from these high potency products and I don't want to go into all of them in depth but if you have any questions about them we definitely see increased violence this cannabinoid hyperemesis syndrome do you all know what that is? because that's just bizarre it's an idiosyncratic reaction to cannabis cannabis is supposed to help with nausea and vomiting but we're finding with the higher potency which is causing people to use more addictively and using regularly then they're getting this opposite effect where they have severe abdominal pain and nausea and vomiting that they cannot control and it's been coined scromitin because they come into the emergency room screaming and vomiting and we don't have medication to help the normal things you use for nausea, vomiting and the emergency room are things like a dance at front and it doesn't touch the nausea so what people have to have is they have to get Haldol which is a major antipsychotic ant with a lot of side effects but it's used for people with chemotherapy and use nausea and vomiting and it does work for that so people are getting put on Haldol just for cannabis-induced vomiting and people are getting full medical work-ups that are costing hundreds of thousands of dollars trying to figure out what is causing their abdominal pain and the solution is to quit using marijuana it's very hard to convince these people that marijuana is causing their problems and so that's what I spent a lot of time doing is trying to educate people about that again the biggest problem people not being able to quit and what do we do with that so I had a young lady who she was discharged from the hospital for me to follow up on she had been in the hospital with a very serious suicide attempt and she was diagnosed bipolar and put on a bunch of meds for bipolar disorder and so I'm supposed to follow her bipolar disorder her medications and so when she comes to see me I do a thorough history and I don't get a history for bipolar disorder she doesn't fit it at all and I said I don't think you have bipolar disorder but what happened with the suicide attempt and she said I have no idea I've never had thoughts of suicide it just came out of the blue and I really felt like I had to kill myself and so then I'm trying to find out well what would cause that so I'm doing a more thorough history than they did in the hospital because they didn't ask her these questions and they didn't do a drug screen but I find out she's using 60% vaping 60% hash oil every day and I said what is that for oh that's my medical card I use that for my migraine headaches and I said are you telling me that the doctor actually told you to vape 60% hash oil and she goes well no he just gave me the card and it's the bud tender that told me to do that so we have bud tenders with no medical education that are you know practicing medicine without a license but I said so I said you know I think that played a role in your suicide attempt because there's so much research out there now showing it's links to suicide so I gave her all these articles to read about cannabis and suicide and she then said I think you're right I think this is what caused it I need to quit and I said you do can you and she said oh yeah that should be easy so I see her in follow up in a month and she has not been able to quit at all she's been trying and trying and trying what do I do with someone like that because there's no place to put her I mean there's no inpatient or there's nothing to do with that and so that's just really sad so I do believe that recovery is completely possible from addiction I just think that there's a lot of things that need to happen to help somebody do that and I really think that treatment should be tobacco free I mean it should be all substance free to put up all possible I mean I have used some of the medications we use to support people like Suboxone, Methadone but I think we need to be on the lowest dose possible for those so they don't kind of do what I just talked about I think you need to give the brain a chance to heal and neuroscience has shown that it takes 90 days for a stem cell to grow and differentiate in your hippocampus so once you stop using substances your hippocampus can totally recover AA has known this intuitively forever so if you think about what AA tells people if you want to quit drinking you need to go to a meeting every single day for 90 days 90 and 90 and then you're going to start getting it and that works however the reason why AA doesn't work for a lot of people in my opinion is because it ends up being a cup of coffee in one hand and a cigarette in the other hand and so they're still shrinking their hippocampus I think that's why it's hard for people to get a handle on what they need to do and they have to keep doing it over and over again then you want to promote exercise because that increases neurogenesis so there should be voluntary exercise and then you want to rewire new neurons because you've got 100 billion neurons in your brain each neuron has over 10,000 connections when you learn something new you just use a few of those neurons they get wired together and then they fire together and so you want to wire some new neurons together so they become your go-to neurons so instead of just because my example is people can sit in jail for a very long time where they can't get anything and you would think that would cure them but it doesn't cure them if they haven't done anything to rewire their brain this is why I believe there should be treatment in incarceration so jails and prisons should have an intense treatment program but they don't because you have to wire new neurons if you don't what happens is all they do in jail is talk about connections they talk about who they use and where they go and what they do in any jail even if they've thought to themselves you know I really feel so much better I'm not smoking and I'm not using drugs I should continue to not do that they walk out of jail they walk by the 7-11 and their brain goes cigarettes and they go in and get cigarettes without even thinking about it they went into their dealer and without even thinking it they make a buy because all that has been hard wired in there and they haven't wired anything new and you got to remember they're putting the drug back in your body just stimulates those neurons to work again so the drug actually drives the behavior because the drug is a hijack the brain and it drives the behavior and this is why then people have difficulty in learning anything new we do have these medications but they should be looked at as an aid not a standalone treatment and so lots of places are just thinking these are standalone we have a lot of jails that are putting people on Vivitrol the minute they leave jail great drug to help somebody stay away from opiates but if you haven't taught them anything and they don't learn anything new the minute it wears off or they can't get another shot they go right back to doing what they were doing we have these medications that are helpful but they are an aid they should not be used as this is the goal so we have these medications I only use a nicotine patch I don't use nicotine replacement of any other form in my treatment program mainly because they're all very addicting because they engage the prefrontal motor cortex the patch is not addicting it puts nicotine in your system that helps with the withdrawal but the gum, the lozenge they're extremely addicting and so I have to use the patch to help people get on the gum we don't have any pharmacologically treatments for marijuana there are some companies working on that they're trying to come up with a medicated assisted therapy like Suboxone IV marijuana that's not available yet there is this drug that's available over the counter that actually has research on it and I never got to try it myself because I could only use FDA approved substances in the state hospital but I recommend people try this you just have to do a high dose of it and it is available over the counter to help with marijuana withdrawal but these are the things that have to happen these are the things that I used in treatment and these are the things that I will kind of go into but you kind of have to have a healthy diet we didn't have a healthy diet at the state hospital because they gave us minimal amounts of money for it we got like 18 cents a day per person to feed three meals but we got a $2 million pharmacological push for drugs and so that's how I got into micronutrients I actually really support using those and have used them with patients in place of psychiatric medication and so all of these things I'm being told I have to quit so we'll move on to this the next session