 Hello, welcome to the Judge Ben's show. My name is Ben Joseph. I'm a retired Vermont trial judge This is a program in which I interview people about subject Relate to issues in Vermont law Today is December 17th as we're recording this I've already interviewed one person today about the legal aspects of the cannabis control board and Now I'm going to interview Catherine Antley a physician Who's Here she's a member of the Vermont Medical Society. We're going to talk about the things that the society has proposed that relate to the advertising and sale of marijuana or cannabis is The proponents like to call it That's going to start in 2022 Catherine has been very much involved with this for a long time really and knows a lot about What might be done to control the harms that can be caused by the increased use of this drug What do you think? Thank you. Thank you for having me. Oh, it's a pleasure to have you here. What would you like to tell the public? I think I think maybe we should start with some go through the slides And it sort of gives a background about where the doctors the perspective of the physicians coming Approaching this issue. All right. I think you know as a summary Physicians want vermonters to be informed decision makers so if you're a consumer that you are an informed consumer so you can make informed decisions and You might even make a decision not to consume It's appropriate to know the risks. Okay, if you if it's for sale in your state And and as communities to make decisions about whether they're going to have Just you know Shops selling cannabis drug in their town or not It's important for them to know what the ramifications of that might be And some of which they may have no idea. So this is the the physician's perspective. I think it's very Different from what the public sees generally We're informed as a public. We're informed By advertising by what's on the internet where we are influenced by all these things Physicians who interact with the public who are now as you'll see consuming in Vermont Because it is legal So their perspective is different. They see We're not talking about the physicians as consumers. We're talking about people they deal with his patients, right? Right, right? Although I mean it's Yeah Okay, so if we're gonna go to the slides, okay, and the first question is sort of why why are we talking about cannabis now that? Vermont has already, you know decided to commercialize. Are we once and done? Well, no, not really The first thing that informs us is we look at the 2019 usd I'm sorry in SDUH survey Which is a nationwide survey and there's Vermont number one in past use You know rate of marijuana use Those percentage of the population using that's right So now, you know those first three Vermont Oregon Colorado flip around a little bit, but we 2019 number one. So this is when we wrote the resolution. This is concerning Why is it concerning? Well, obviously we have a number of issues That that we're seeing in the ERs and in our urgent cares and otherwise psychosis, suicidal, ideation Scrobbing which is the screaming and vomiting because it's not just a vomit. It's a painful It won't stop it goes on if I guess if folks thought saw the video You see people and it really extreme pain And sometimes get hooked on opiates later because to deal with the pain, which is another another problem You can get seizures, cardiovascular you know, obviously a lot of vehicle accidents and And so addiction so there are a number of issues that we are seeing So we focused on 15% THC you might say well, why why did why does the medical society care about the potency? You know once it's there it's there and actually the reason is we'll just go through this slide a little bit more carefully In Holland, which has had a liberal Cannabis policy for a very long time about 10 years ago They proposed first this idea of limiting everything above THC 15% is a hard drug and There's science to that Should be considered a hard drug like cocaine according to the Dutch. Well, why is that what they saw was as the potencies increased? There's a lag time, but then later on As that that as that increase Yet gets manifest in the population you see an increase in psychosis and ER visits so so So this was the first indication that we were dealing with a different drug when you're getting up to 60% or 30% Which is double this and I think it's important to realize that in Colorado when they voted in California when they voted It was a population level vote, right? And so they were voting on what they experienced in the 70s and 80s, which was very low Potency so people individual people not doctors not physicians not scientists We're making this decision based on their largely their own personal experience or sort of a libertarian view if someone wants to use no big deal what happened after that vote was that the concentration of THC has gone up just to Concentrations that really almost unprecedented so that now a large percentage of the Cannabis that's sold in Colorado is the super high potency THC and It's there's a reason for that high THC high concentration THC creates addiction More quickly in in in individuals. We know that from science and so because Just you know not at 80% or more of the of the of the THC that's sold of the product that's sold is consumed by just 20% or less of the consumers the industry is very invested in creating Consumers who have a use disorder? So this high potency THC fits right into the industry playbook But it has serious problems for the population in terms of the the side effects This is a great slide. That was I'm sorry that last slide was created by Dr. Libby stout from college a psychiatrist from Colorado and this one is by dr. Bertha Madras, and it is an excellent slide has a lot of information One thing I want to point out is that this is in in Europe. So in Europe they looked at different In Locations and the places that had high potency THC had more cannabis induced psychosis less potency if your average potency in your city is low you have a less psychosis and this was a very well done study very powerful and Their conclusion was in Amsterdam If high potency cannabis use were no longer available So if you can roll back the clock ten years or so we're not that far, right? And you can get rid of the high potency THC 50% of the Of the first episode psychosis could be prevented So right now in the in Vermont. We're having a crush in the years We have you know wait people being warehoused in years for not just hours, but days Often times adolescence often times for psychiatric reasons Now we have Vermont has the highest use in the nation 2019 if highest percentage of people using the drug that's right and if we are if the United States uses more than other countries which is At least conceivable It's possible that we're the highest in the nation in the world We're certainly up there. So So this study showed that 50% of those ER visits for first episode psychosis or Presentations first episode psychosis would be prevented and I would postulate that that's probably true in Vermont Just because of our high use rate that we have Documentation up. Well, it's in the interest of the people who are selling this stuff To create consumers who are addicted to the drug Who consumers who develop a use disorder? Yes Yeah, if they're addicted and they simply must be using it. They're more likely to have bad consequences, right? I mean What you know if you have a use disorder that means you use even though your health is impacted That means you use even though your husband wife or child is impacted adversely You use even though you can't pay your rent you use even though you need to drive your car or truck So it's you know, you use even though you need to do a responsible job. So use disorder means you're using Even though there are problems in your life that are documented. So that's and that's and those you're right those folks who suffer from a use disorder are the Consumers that the industry is interested in creating and it's been documented that they can create Because the high-quotency THC is more addictive Okay, so this I think is a really important slide This is a new article that came out in March and it's by Dr. Volkov and one of the things that it showed is that in teens They're demonstrating and a very well-done study again that for teens Marijuana can be as addictive as opioids Now that is a super sort of new thought And it's talking about heroin and cocaine the pills, you know So So that's very powerful statement. It's a very concerning statement. It's kind of a scary statement I think in my opinion But I think it's important for us to recognize that our teens are very vulnerable To to creating to the creation of a use disorder So so you have high potency which is going towards use disorder You have targeting children or youth if possible, which is also a use disorder now The other issue is a couple other articles have come out Cannabis use increases the frequent the risk of developing opioid use disorder We know that the predominant predictor of an adult opioid misuse is having marijuana having used marijuana before the age of 18 And the number one risk factor for adolescent opioid use is ever having used marijuana and that's the yrbs 2022 And what kind of treatment is possible just tell them to be abstinent or well I think that's you know, that's an issue. I mean they have lots of lots of treatments out there and and But I think one of the issues is that your environment really affects whether you will have success in recovery So if you have an environment where you smell it if you have an environment where all your friends are using if you have an environment where you go by the place where you bought it every time or you see the person who sold it from you then those Triggers all make it, you know more difficult and so in a place like Vermont with very high use rates and very high There's also a diagram that the health department has That I've seen that shows not only is our use rate high, but also our perception of harm is not going up but going down So we have this paradoxical situation in Vermont and actually all over the country Where use is going up and the consequences of use are going up, but the public's perception continues to go Okay, that so we've talked a lot about the social determinants of health social determinants Our health are if you if you you know have poverty if you've been sexually abused if you've been you know Suffered child abuse if you you know don't have enough to eat these things are are a series of 20 questions or so you can give to any group of people and The results of that quiz will can predict those people's lifetime So their life expectancy So you'd think that taking their blood and seeing if they have chai cholesterol or if their dad had you know Colon cancer would be a high predictor But this is the social determinants of health given the simple quiz can give you an indication of who's at risk for Health problem, so this is a powerful thing We're talking a lot about that in the legislature right now and people are trying to make changes That's very admirable to decrease poverty to decrease all these things and to increase things like a trusted A trusted adult is would counteract that so this survey looks at you know positive and negative predictors of health so that's important What we're not talking about in Vermont, which is very important is the commercial determinants of health and the commercial There's a there's a literature on the commercial. I just heard this term a few months ago About a month ago But you can actually do a literature search on the commercial determinants of health This is this is a you know a body of work and I think the answer to your question is Why is the perception of harm going down as our harm is going up? Because the commercial determinants of health health Trump You know knowledge of of the of the risks knowledge of the risks that the Vermont Medical Society is trying to get out there So I think that's and that means the advertising the internet Well the political what you hear is the are you suggesting that the medical society could be sponsoring Advertising on the subject. I don't know but I think that someone It would be nice, you know, I mean we have a new infrastructure bill So it would be good if we spent some of that on the social determinants of health and countering the You know corporate determinants of health. This next slide is really important too. I want to So this is right now Vermonters are Confronted with you know, are we gonna put? cannabis drug stores in our town and And they're being informed Largely by folks wishing to sell it, right? So the local person who's wants to open up a shop is putting out a lot of he's investing or she a lot of money in Advertising or hiring lobbyists to put his their message sure for message out and this is an example Yes to question number three is from one of these lobbyists who put it out there And I'll just read it for you what while so they're saying, you know, one of the questions that folks bring up is is Youth use rate and they say well, this is well-intentioned every study ever conducted in any study any state on Underage cannabis use following legalization has concluded that legalization does not Lead to an increase in underage cannabis use. So this is What we have on the right-hand side of the screen are three excellent large powerful studies which Demonstrate the opposite so here we have an example of where the public is being informed by people who wish to sell to them and The science is largely unknown is that it's obscure. It's and it's not being Reported now you might ask well, why is that and there are a couple things when you have a vote All of our government employees in Vermont people who worked for the state of Vermont and or federal government largely withdraw from from Engaging active they don't put ads on the radio saying hey, you know that you know If you have a marijuana drug shop next to your kids, they're more likely to use like they won't Put that kind of counter to someone who's wanting to open up a shop So when there's a vote people in government generally step back and Those health department. That's our content experts. So who do we rely on who do we rely on and the other issue is You know, who do we rely on to inform the public? So the other issue is That we have a lot of nonprofits who are experts so our prevention professionals And they you know because they're nonprofits, they are to rely on grant money They're often 501 C3's 501 C3's risk their grant funding So if you are 501 C3 you may risk your funding risk your job if you stand up and say I want to tell you the facts about a Marijuana drug shop next to your kids are within 500 feet of your school or less than you know less than 500 feet of a daycare or playground So I think this is part of the reason Why the corporate determinants of health in this situation are trumping are really overshadowing overpowering The content experts in this field So this is this brings us to you know, why did we do this? This is our warning from our medical society warning on THC may cause psychosis Impair driving addiction Suicide attempt uncontrolled vomiting and harm to a nursing baby or developing fetus and Importantly psychosis and suicide or self-harm can occur in individuals with no previous history of psychosis or mental illness We're seeing in Colorado You know this high potency THC that they didn't vote on so now they're sort of rebelling You know the the people are saying well my kid is sick legislators kids are psychotic legislators kids are Schizophrenic from marijuana people who would otherwise be well talented attractive young you know young people and so they're angry and so they've passed this bill You know we need to look at the high potency and this is part of you know Chris Rogers the medical director for the child and adolescent services and one of their hospitals psychiatric hospitals He says you know person after person refuses to accept that marijuana could be bad for them How could it be they're taught to believe this is a harmless plant and yet? you know They're just seeing tragic Repeatedly treat kids who are too psychotic to know what's real who they can trust are where they are the rates of adolescent psychosis have risen steadily since legalization so that's because it's being More of it's being used and what's being sold legally has higher contents of THC Then we're available in the past right right right and the regulation that was promised hasn't happened So we're having kids who use are using very high potency THC, which they really shouldn't be getting their hands on Shouldn't be getting their hands on any of it, but they're using very high potency and they're getting very sick but another important thing that the medical society said this is not just a kid problem in other words You know part of the the studies that inform that cannabis causes You know is linked to the development of psychosis are hundreds like that they're numerous studies and It fulfills the Bradford Hill criteria for causation which we use for tobacco You can't you know take a group of kindergartners and divide them in half and give half tobacco and half not and see which one's developed You know lung cancer or the same thing with THC and and psychosis So you take a number of things that if you could give them higher doses Do they develop quicker if you give it to them when you're they're younger do they develop it quicker? So you see over All these different studies and you can come to the conclusion as we did with tobacco that there is a link to this disease and that's the sort of of Really clear evidence medical evidence that we have the marijuana is associated with psychosis in Vermont medical society really wants people to understand that it's so curious that the public knows that Then abuse of this drug and high high potency of the drug Hurts people People don't think do they understand the public doesn't really grasp. No. No, I don't in fact I've heard a proponents say, you know people will use use less because it's more potent and that's that's just yeah No, it's it's a lie. You know, it's not true, but we're seeing we're seeing This you know dissembling type statements quite a lot. Here's the summary for the Cannabis hyper-remissus project, which I hope you'll show the video maybe again after this And this is I just wanted to go through again This is why the medical society is concerned before we had legalization I heard doctor, you know what that one of the legislators get up in the you know In the legislature and and give a talk about why they were voting. No because you know, they said the Hospitalization rates would go up in the medical society Put that information and our resolutions out them at those ER Visits would go up and indeed now, you know here. This was 2014 What we predicted came true 2021 now we're seeing kids and mental health care waiting for days in the emergency road In the digger, but there's no mention in five different articles that this could be related to cannabis And so then I'm getting back to your point Why is it that we're seeing more harms medically, but the population is is not aware or not And this is one where we you know wrote and said please add this You know to the reporter and he said oh no one in the state is talking about cannabis as part of a psychosis They're part of mental illness and so the head of you know Vermont Department of Mental Health child and help help Family division wrote back and said as someone who works on calling the psychiatric inpatient units and an emergency room I can tell you the cannabis plays quite a large role in why people go to the eds and the hospital that The Department of Health and the Department of Mental Health are also well aware of the role cannabis is playing in psychosis and suicide and of course the ER is crowded with people who are there because of the Pandemic I mean it's not coming at a good time And quite frankly I didn't have time to put this in there But there's a new article that I discussed Via email with Dr. Levine Which shows that but if you're using cannabis you will not have as strong a reaction in other words You your immune system won't react positively to the Vaccines if you're using cannabis that you don't mount as strong that that yeah That's a new article that's come out and I think you know you could speculate That may be impacting clearly people should know you know that if you're smoking marijuana it may Prevent or impede your your immune system from mounting as robust a response to the vaccine COVID vaccine as you would otherwise This is just showing that even a little bit of marijuana apparently affects the thickening of the of the prefrontal cortex in children or in teens It affects your head It affects it well the brain is it affects the anatomically So they're taking an MRI picture of the brain over time and they're following if it's a large study and they're and it's low potency And they're they're seeing that the prefrontal cortex prematurely sins and Along with that there's changes in these behave in these kids behavior, which is controlled for the social determinants of health that we were talking about So we have the highest use rates in the in the United States So we're experiencing those consequences like the first study for example the er over utilization We haven't talked about health care costs the Green Mountain Care Board is looking into this But you know have do we need to call the Green Mountain Care Board and and have a lecture with them too? I don't know how much they're following this topic Addiction of course is expensive decrease perception of harm impacts all levels of Vermont society And as a driver for increasing marijuana use so This is just an example with the Colorado child and adolescent psychiatric society came up with and This is our recommendation. We want everyone to be aware Cannabis THC may cause psychosis impaired driving addiction suicide attempt uncontrolled vomiting Farm harm to feed us a nursing baby. So we want something that every school nurse can show to their class And that every you know physician can can show to their patients So this is the island with this slide This is just as a sort of side-by-side on the left you see what the cannabis control board warning what they're recommending And on the right you see what what the medical society is and he says there's a lot more that can be done than just trying to pack a whole bunch of information on a tiny little label and so I Think what's important is that for example on their label? They say can be habit-forming and ours say Can cause addiction so addiction is something That you know when you have a use disorder you continue to use even though you may lose your job or your wife or your husband or whatever Habit-forming brushing my teeth. It's habit-forming it taking a walk taking a walk with a loved one is Habit-forming or you're spending time with your dog is habit-forming So we feel like this is and really an inaccurate it in in adequate warning It does not mention psychosis, which is a recognized But the the wordy thing on the left on the slide has been approved by the cannabis. Yes That's the recommendation to the legislature. Oh my god So we really would encourage you know if if you're a vermonter if you use or you don't use But if you feel like it's important for vermonters all vermonters use and not to know the risks of psychosis suicide Suicide attempt uncontrolled of arm-eating harm to use please, you know call that cannabis control board because these these risks are not listed On their label right now Catherine I want to thank you so much for coming in today. This has really been great. I Don't want to thank all of you for looking in Play please consider what Catherine's proposing here I think there has to be a better understanding of the dangerous involved with the use of this stuff whether you want it sold or not there should be a an effort made to warn people about what what this is what this involves so that they can make an educated choices to whether or not to use this stuff and It's it's really a it's such a very major It's a major issue. It's going to really affect a lot of people and how bad it is is going to depend upon how well people are Educated about what they're getting involved with Thank you all for looking in I look forward to seeing you again sometime. Thanks, Catherine. Thank you