High5 with Dr. Igor Grant, MD

Cannabis Smoke & Cardiovascular Health with Matthew Springer, PhD

Summary In this episode of High5 with Dr. Igor Grant, Dr. Matt Springer explains how inhaling smoke from combusted products such as tobacco and cannabis, as well as inhaling aerosol from e-cigarettes and cannabis vaping devices, may impair endothelial function, an early marker of cardiovascular risk. Drawing on rodent and human studies, he reports that chronic tobacco smokers, e-cigarette users, and cannabis smokers all show reduced vascular function. He also discusses evidence that chronic THC edible users may have impaired vascular function through a different mechanism than inhaled products. A central message is that “cannabis use” is too imprecise a term, because smoking cannabis and ingesting THC are very different exposures. His public health takeaway is simple: be aware of cardiovascular risks, practice moderation, and avoid exposing others to secondhand smoke. Key Topics * Endothelial function and its role in cardiovascular health * Effects of tobacco, cannabis, and e-cigarette smoke on blood vessels * Mechanisms of smoke-induced vascular impairment * Differences between inhaled and ingested cannabis effects * Public health implications of secondhand smoke exposure Chapters 00:00 Preview 01:24 Dr. Springer's Background 03:43 Exploring Cardiovascular Effects of Cannabis 03:43 Personal Anecdote - Paul McCartney Concert 05:13 Understanding Endothelial Function 09:33 The Role of Endothelial Cells in Cardiovascular Health 09:58 Understanding Vascular Health and Flow Mediated Dilation 12:03 Translating Rodent Studies to Human Health 14:20 The Impact of Cannabis and Tobacco Smoke on Vascular Function 16:53 Chronic Use: Comparing Cannabis, Tobacco, and E-Cigarettes 20:15 The Science Behind Smoke and Its Effects 24:48 Distinguishing Cannabis Use from Smoking Effects 29:08 Moderation and Public Health Messaging 34:31 Secondhand Smoke: Risks and Recommendations

Cannabis for Migraine Headache with Nat Schuster, MD

Summary: In this episode, Nathaniel Schuster, MD, Professor and Medical Director of the Center for Pain Management at UC San Diego Health, explores the potential role of cannabinoid therapy in migraine care. Join us as Dr. Schuster shares insights into the benefits, limitations, and practical considerations of this approach, and discusses his latest research on vaporized cannabis for acute migraine treatment, including clinical trial findings and future directions. Key Topics: Overview of the first placebo-controlled trial of vaporized cannabis for migraineThe scientific rationale behind using THC and CBD in migraine treatmentStudy design: crossover methodology, dosages, and use of research-grade cannabisPrimary and secondary outcomes: pain relief, pain freedom, and bothersome symptomsSurprising findings on nausea, photophobia, and sound sensitivity improvementsSide effects, safety profile, and optimal dosing strategiesPractical considerations: vaporized vs. oral formulations and patient preferencesRecommendations for patients with refractory migraines considering cannabinoid therapyFuture research directions: preventive treatments and guidelines incorporation Timestamps: 00:03 - Introduction to Cannabis Study 00:56 - Welcome Dr. Nathaniel Schuster 01:41 - Dr. Schuster's Background 02:29 - Understanding Migraine 03:18 - Current Migraine Treatments 04:14 - Defining Migraine 05:11 - Genetic Factors in Migraine 06:01 - Cannabis as a Treatment Option 07:54 - Study Hypothesis and Design 10:45 - Study Design Details 13:41 - Crossover Study Explanation 16:51 - Study Findings 20:36 - Most Bothersome Symptom Freedom 23:01 - Side Effects and Safety 26:40 - Participant Demographics 28:34 - Future Research Directions 30:00 - Practical Considerations 32:09 - Advice for Migraine Patients 33:50 - Safety Considerations 34:03 - Closing Remarks ⁠Read Dr. Schusters's study [https://pubmed.ncbi.nlm.nih.gov/38405890/]. Bio: Dr. Nathaniel Schuster is a pain and headache neurologist and is Professor and Medical Director at the UC San Diego Center for Pain Management. He has served as Treasurer of the American Academy of Pain Medicine, Senior Vice President of the World Headache Society, and as Vice Chair of the Guidelines Committee for the International Pain and Spine Intervention Society. He has received the American Academy of Pain Medicine’s Rollin “Mac” Gallagher Award, the American Academy of Pain Medicine’s Distinguished Service Award, the American Headache Society’s Harold G. Wolff Award, the International Pain and Spine Intervention Society’s Outstanding Volunteer Award, and the Migraine Research Foundation’s Impact Award. He is section editor for the Neuropathic Pain section for the journal Pain Medicine. He graduated from University of Michigan Medical School and completed a neurology residency at UCLA, headache fellowship at Montefiore Headache Center, and pain fellowship at Massachusetts General Hospital. He conducted the first placebo-controlled trial of cannabinoids for acute migraine and his ongoing research includes clinical trials studying treatments for migraine and neuropathic pain.

Terpenes in Cannabis: Are they therapeutic? with Catherine Cahill, MD

In this episode, Catherine M. Cahill, PhD, Professor of Psychiatry at the UCLA Brain Research Institute, delves into the fascinating world of terpenes—natural aromatic compounds found in cannabis and other plants—and their potential therapeutic effects, especially for pain relief. Join us as Dr. Cahill shares her expertise on the mechanisms, research findings, and regulatory status of these promising molecules.es.   Key Topics Covered: * The basic chemistry and role of terpenes andterpenoids in plants * How terpenes differ from cannabinoids like THCand CBD * The most studied terpenes in pain relief:myrcene and beta-caryophyllene * Preclinical evidence for terpene analgesiceffects in nerve and inflammatory pain * The endogenous cannabinoid system and howterpenes may modulate it * Evidence for sex differences in terpene responseand receptor distribution * The regulatory status of terpenes as foodadditives and their availability * Emerging research on terpene interactions withother cannabinoids * Potential for opioid-sparing effects andreducing adverse outcomes   Timestamps: 00:00 - Introduction to cannabisterpenes and their therapeutic promise 02:30 - Basic chemistry: what areterpenes and terpenoids? 06:00 - The role of terpenes inattracting pollinators and plant defense 09:30 - Key terpenes studied:myrcene and beta-caryophyllene 13:00 - How terpenes influence theendogenous cannabinoid system 15:45 - Differences betweenterpenes and cannabinoids 17:30 - Conditions potentiallybenefitting from terpene treatment and current research 21:00 - Preclinical findings:analgesic effects in nerve and inflammatory pain models 26:00 - Modulation of emotionalaspects of pain through the cannabinoid system 27:30 - The entourage effect: doterpenes enhance THC and CBD efficacy? 31:00 - Regulatory status andsafety of terpenes 34:00 - Sex differences andhormonal influences on terpene receptor expression 36:00 - Future directions:combination therapies and opioid-sparing potentials 38:00 - Final thoughts

Cannabis & Schizophrenia A causal link? with Deepak D'Souza, MD

In this episode, Dr. Deepak D'Souza, a renowned psychiatrist from Yale University, discusses the complex relationship between cannabis and psychosis. He explores the potential causal links, the role of environmental factors, and the implications of cannabis-induced psychosis as a precursor to schizophrenia. The conversation delves into the evolving landscape of cannabis potency and its impact on mental health, drawing parallels with historical public health challenges like smoking and lung cancer. Takeaways • Cannabis can induce transient psychotic symptoms during intoxication. • Cannabis-induced psychosis may be a precursor to schizophrenia. • Environmental factors, like cannabis use, can impact schizophrenia risk. • Cannabis potency has increased, affecting psychosis rates. • Cannabis is a modifiable risk factor for mental health disorders. • Not everyone who uses cannabis develops psychosis. • Cannabis use during adolescence may increase schizophrenia risk. • Genetic predisposition plays a role in cannabis-related psychosis. • Cannabis and schizophrenia have a complex, multifactorial relationship. • Preventing cannabis use in youth could reduce schizophrenia cases. Chapters 00:00 - Intro 01:19 - Professional Background - Deepak Cyril D'Souza 02:29 - Understanding Psychosis and Cannabis 03:15 - Background on Schizophrenia 05:06 - Symptoms of Psychosis vs. Psychotic Disorders, Causality 10:31 - Cannabis Induced Psychosis 12:28 - Causality: Cannabis and Schizophrenia | The Bradford Hill Criteria for Causality 23:20 - The Role of Genetics and Environment 29:30 - Risk Factors Associated with Schizophrenia 32:29 - Advice for Healthcare Providers and Families

Delta-8-THC: A public health perspective with Eric Leas, PhD

Summary In this conversation, Dr. Igor Grant and Dr. Eric Leas delve into the complexities surrounding Delta-8-THC, exploring its differences from Delta-9-THC, consumer demand, regulatory challenges, and safety concerns. They discuss the implications of state regulations on the market, the need for compliance in cannabis research, and the future of Delta-8-THC regulation. The conversation also touches on the broader landscape of cannabinoids and psychoactive substances, highlighting the ongoing evolution of cannabis regulation and public health considerations. Takeaways * Delta-8-THC is structurally similar to Delta-9-THC but less psychotropic effect. * Consumer demand for Delta-8 is driven by its legal status as a hemp product in states without medical or recreational cannabis use regulations. * Regulatory challenges exist due to the lack of standardized safety measures. * States with legal cannabis markets are concerned about competition from Delta-8 products. * Research on Delta-8 is limited, necessitating further studies on its effects. * The market for Delta-8 is largely unregulated, raising safety concerns. * There is a growing interest in other cannabinoids and psychoactive substances. * Compliance checks in cannabis retail are complicated by federal laws. * The patchwork of state regulations creates confusion for consumers and manufacturers. Chapters: 00:00 Introduction to Delta-8 THC 02:51 Understanding Delta-8 THC: Differences and Similarities 05:15 Consumer Demand: Supply and Demand Dynamics 09:48 Regulatory Challenges and Safety Concerns 17:01 Research Background and Interest in Delta-8 THC 19:33 Compliance and Regulation in Cannabis Sales 21:50 Redesigning State and Federal Cannabis Policy 24:24 The Future of Delta-8 THC Regulation 27:39 Exploring Other Cannabinoids and Their Implications 32:25 The Broader Landscape of Psychoactive Substances