[A Zoom screen with the three panelists and BTW Peer Educator Denezia Fahie.]
Denezia Fahie: Next question is what are the long-term effects of use/consumption and what is the difference between using a lot or only using once in a while? And there's been a special question with special attention to fertility. So has there been substantial research into how marijuana or cannabis use can affect fertility in women? And we are going to first direct this question to Dr. Gruber, but of course as precedent and anybody can participate.
Dr. Staci Gruber: So it's a great question about long-term effects regarding sort of how long you use and how much you use. As I mentioned before, I think a lot of this has to do with the age at which you begin. In fact much of it has to do with the age at which you begin, because your brain is still quote under development or come on, it's 420, half-baked right? So, we know that, we know that, and there may be some negative effects. We do not have tremendously great long-term outcome data on people who use, so our studies initially were based on what we call chronic heavy hitters, people who are using every day, multiple times a day very often for many years. And we contrast those data with people who use far less frequently, or who used to use, and who no longer use or who don't use at all. And the bottom line is the earlier you begin using, and in the more frequent and heavier quote use users, if you will, the more likely you are to potentially have negative effects. That's the deal. Tom alluded to this early on. We're going to keep coming back to it 'cause that's just where it is. Interestingly, when you get to medical cannabis patients who are by and large over the age of, let's just say the magic age is 25, by and large, over that age, except for some very special carve-out pediatric populations. They are beyond the quote developmental period of vulnerability and they do not seem to have the same difficulties. We have the very first longitudinal data ever that follows patients over the course of at least a year. And I got to tell, and they're choosing their own products. We just chart what they're using, and we test what they're using, or we have it tested. And actually not only are they not showing decrements, they're showing improvements. That's very different from someone who's 14, and hitting it six, seven, eight times a day, okay? And does that for 10 years, they're very different. So I want you to consider the age, the frequency, and the amount, all those things add into the equation. And of course, big picture, what's in the weed? If it's primarily a high THC product, unfortunately given the affinity for THC and what we call CB1 receptors throughout the brain, CB1 and CB 2 receptors are throughout the brain and body, that's how they exert their effects and while you feel something so quickly if you smoke or vaporize cannabis, you're more likely, unfortunately with higher amounts, perhaps, to have some downstream effects. So, when you use once in a while, what's once in a while? Do you know that in the cannabis world, in my world, our colleagues, we have no accepted lexicon of what, I swear to you. What does regular consumption mean? So we have to define it in every paper. What does infrequent consumption mean? I reviewed a paper where somebody was trying to publish a paper that said, you know, "Infrequent users still demonstrate tremendous difficulty." Their infrequent users used five times a week. Okay, I think some people don't think that's infrequent. You know, so I think it's important to understand what we mean when we say regular. For us, a frequent cannabis user is anybody who is using more than a couple of times, at least weekly use is considered regular use. And that's becoming sort of well-established. But I have to tell you this is a lexicon that is not well-defined and should be, should be the way that we deal with these things in my opinion. So I think once in a while, after a certain age is going to have a very different impact from someone who's 11 or 12, 13 using high THC products all day every day long-term, potentially.
Tom Fontana: And I think I'll just add in, particularly in a college setting and in the age, it's really interesting, Will was talking about this earlier, we know that it's a general rule, right? 20% of the people are consuming 80% of the product. That's true in a lot of things. So industries based on misuse, that's where their money's coming from. That's true with a lot of substances. It's really interesting to look at cannabis. I don't love comparing it to alcohol generally, but in terms of college campus and those being frequent substances, it's worth looking at the profile. And I'll throw these links in. Generally more people have tried alcohol than have tried cannabis. And it seems that perhaps of the people who use cannabis, there are way more people who are using it far frequently than with alcohol. If you ask people on a college campus how often you use alcohol, it'll create a bell-shaped curve, and if you ask them how many days a month. Some people are using zero, some people using thirty, but it's probably one, two, three days a week. Thursday, Friday, or Saturday they're going out. If you ask people on how much they use cannabis and I'll throw this link in there too, right now there's that link. This is from a big international candidate in America study of 30,000 people. You'll see always a reverse bell curve. Of the people who use cannabis, and there's lots that don't at all, but of the people who do the most common days a month are 1 and 30. And so it's important to see that dip. We know that there's a lot of people using frequently, and then some of those will be medical users. So we don't want to always define that as a problem, but it's certainly still high frequency. There's certainly still the reality of tolerance. And then it's a question of like, so what does it mean? And lastly, just bringing this idea of, what research has sometimes called marijuana motives. Why are you smoking, right? Or why are you consuming, really, partaking, but there's sometimes, there's vaguely, there are certainly medicinal reasons, but there's just like, yeah I'm fuckin' hangin' out with my friends, I'm chillin', there's an idea of spiritual reasons why you might be using, creativity, enhancement, expansion, these different ideas, they all come together. And it's really hard for people to sort that out. So when we speak of this idea of medicinal, and to the plant it doesn't matter, like what we talk about medicinal cannabis, there are a few products that you might get like Marinol that are particularly medicinal, but really the plants just a plant. It doesn't know whether it's illegal or not. Whether it's legal, whether it's medicinal, it's side effects are going to be at side effects. And we need to, that increased use takes away the subtlety of the plant. People who like cannabis talk about the subtlety of it, the beauty of it, when you're fuckin' rippin' a 80% dab that's this massive, like the subtlety is gone, and people will talk about that it moves from something special to something routine to maintenance. And you just want to think about that role in your life and where that is, and just your own balance. I think balance is an important concept. Just leave it at that.
Dr. Staci Gruber: About fertility, I think we missed that part. I don't know if Tom had any comments about it, but there is some data, unfortunately that demonstrates a relationship between increased cannabis use and changes in fertility rates, that is successful fertility attempts if you will. Lower sperm count in men, and compromised or complications in pregnancy in women who are chronic cannabis users. Not everybody, just some cannabis users.
Will Jones III: Interesting, and again, the perspective that we come from as an organization is more of a watchdog perspective, but in Colorado and this was published in CNN I believe last year or the year before, they did kind of a survey of recreational cannabis dispensaries in Colorado, where they had people posing as pregnant women call in, and cannabis was recommended to, I believe it was 70% of, it was 70% of pregnant women, or what they believed to be pregnant women, without warnings or anything, just, you know, just a general encouragement to use so again without warnings of potential impacts of use. And again, I think in pregnancy we should be very careful with the substances that we use particularly regularly and recreationally. And so again, from a watchdog perspective, these are industries that have a bottom line, that unfortunately do not, and we've seen the history of alcohol and tobacco, they're not very scrupulous about how they make their money. And so we have to make sure that we do not allow another industry to do the same thing that we've already seen established with alcohol and tobacco.