Latest / The Mental Health Evolution / Ep 59: High-Potency Cannabis and the Developing Brain with Libby Stuyt

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Ep 59: High-Potency Cannabis and the Developing Brain with Libby Stuyt · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast
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Network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about
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what's changing in mental health and why it
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matters.
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I'm your host, Rachel Harrison, inviting you into
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honest conversations with people from all perspectives in
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the field, clinicians, tech founders, investors, insurance companies,
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and all the folks in between.
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Let's explore what's working, what's not, and what's
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next.
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Welcome to the Mental Health Evolution podcast.
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I am so excited to share with you
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today this conversation with Dr. Libby Stout.
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The first time I had Dr. Stout on
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my podcast, we talked all about ear acupuncture
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to treat addiction, and it was a very
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fascinating conversation.
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But recently, there have been articles that have
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been coming out and warnings about the impact
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of THC on the developing brain.
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A lot of articles specifically talk about adolescents,
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but as Libby brought up today in the
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conversation, this also applies to developing fetuses.
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There's a couple really interesting points in here
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about how the cannabis of today is different
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than the cannabis of the 60s through 80s,
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and what she is seeing in terms of
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medical symptoms as well as mental health symptoms
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in people that are using cannabis, because everything
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has changed.
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And it is now a pretty big industry,
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and opening up the doors to saying that
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it's legal has maybe made it more accessible
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to young people.
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And the impact on their brain is very
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different than the impact on an adult brain.
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So with that, listen in.
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I hope you will enjoy this conversation as
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much as I did.
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I definitely learned some interesting takeaways, and hopefully
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it gives you some food for thought.
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Welcome back to the Mental Evolution podcast, where
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we talk about how the landscape is rapidly
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evolving in the mental health industry.
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Today, we are welcoming back a guest many
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of you may remember from our previous podcast,
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the mental health entrepreneur.
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Dr. Libby Stout is a board-certified psychiatrist
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and senior instructor at the University of Colorado
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Health Science Center.
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She also is a trainer for the People's
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Organization for Community Acupuncture.
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When she joined us before, we had a
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fascinating conversation about the use of acupuncture in
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addiction treatment.
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We will link that previous episode in the
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show notes, so you can listen to that
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one as well if you are interested.
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Today, we're going in a different direction.
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Dr. Stout has spent over three decades working
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in Colorado with people who have co-occurring
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mental illness and substance use disorder.
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And she has been watching something unfold in
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real time that she says not enough people
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are talking about.
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And that is the mental health consequences of
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today's high-potency cannabis on young people.
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Colorado was one of the first states to
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legalize recreational marijuana, which means Dr. Stout has
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had a longer window than most to see
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what happens in a community when cannabis becomes
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normalized, commercialized, and increasingly potent.
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She has become one of the most knowledgeable
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voices in the country about what this means
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for adolescents, and we are grateful to have
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her back.
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Welcome, Dr. Stout.
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Thank you.
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I'm really glad that you're bringing up this
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conversation.
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It's really important.
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Definitely.
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All right.
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Well, let's go ahead and just dive in.
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Since this show is all about what's happening
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in the mental health industry, I would love
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to hear kind of an update.
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What are you seeing in mental health treatment
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in regard to cannabis?
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Some have said it's a treatment for anxiety
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and PTSD.
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Some have viewed it as a harmful substance.
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What are the current trends that you are
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seeing?
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Well, it really depends on the population you're
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talking about.
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I think the worst harms are for anyone
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with a developing brain.
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That would include babies in utero, so mothers
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using cannabis can really affect their child, and
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then going all the way up until mid
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-20s, because your brain is still developing, until
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mid-20s.
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There's a great deal of research showing that
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cannabis can be very detrimental to the developing
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brain.
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So most recommendations are that if you are
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going to use cannabis, then you should wait
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until you're like mid-20s before you even
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start, and then you're going to reduce a
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lot of the potential risk factors, problems that
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are associated with many mental health conditions.
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It doesn't eliminate them, though.
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I mean, people are still very susceptible to
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this, and it depends on how much they're
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using, what they're using.
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And that's part of the problem is that
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the general public has not really been educated
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on this.
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They don't know about marijuana.
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They just, you know, a lot of people
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are thinking about the marijuana of the 60s
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and 70s.
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They might have used then, and it was
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just something that helped them chill out and
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have the munchies.
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But the marijuana of today is very, very
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different.
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It has dramatically increased in potency, and that's
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what we're dealing with.
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So the higher the potency, the higher the
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risks for developing addictions.
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The high-potency products are extremely addicting, whereas,
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you know, the old-time marijuana wasn't really
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considered addicting.
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But this stuff is extremely addicting, and once
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people are using it regularly, it's very difficult
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to quit.
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So can you talk a little bit about
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those potency differences?
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I mean, I can just keep going on
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and on.
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I'm curious, like, when you talk about the,
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in the past, sort of what the levels
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were and versus now, what, can you give
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us, kind of, quantify some of those differences?
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Sure.
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So back in the maybe 60s through 80s,
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the highest potency of THC in the plant
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was 2% to 3%.
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And of course, it's been around for centuries,
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and that was all really the content of
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THC.
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However, once we got things legalized, like, you
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know, the first states that legalized medical marijuana,
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and I think that was California, and then
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we legalized recreational marijuana, that was, the first
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state was Colorado, we started seeing significant increase
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in potency.
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So the people in the industry who were
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doing the plants did a lot of genetic
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modification of the plants to increase the production
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of THC.
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So they made it where the plant spent
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all of its energy making THC, which then
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it couldn't really make the other components like
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CBD very well.
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And so CBD, which is, you know, considered
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possibly something that might be helpful, has really
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never increased.
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And so it's stayed relatively level in terms
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of its content in the plant, and the
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THC is dramatically increased.
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And so now, we have an average of
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THC in the plant up to 20%, depends
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on where you are in the country.
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But we have plants that they say go
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up to 30%.
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And then we have the concentrates.
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And the concentrates didn't really hit the market
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until 2010.
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And it's been since then, we're seeing more
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and more problems.
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And that's when they started using things like
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butane and propane and carbon dioxide to isolate
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THC from the plant material, and then they
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can make it ultra concentrated.
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And they make these products like different names,
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wax, chatter.
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These are very high concentrated products that then
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people smoke with blow torches.
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I mean, basically, you put a tiny little
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piece of this on the head of a
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nail, and you heat it to very high
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intensity and suck in the vapors, and then
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you're getting very high potency THC.
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And some of these go all the way
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up to 90.
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So there's even crystalline THC 99.9%
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pure, that's available.
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And many of these things are available in
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the medical market.
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And of course, there's been no studies demonstrating
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these are helpful for anything medical, but they're
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in the medical market.
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And so people believe that they must be
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safe, they must be healthy, they must be
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good for you.
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And, you know, this includes things like edibles,
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this includes things like drinks, because there has
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been attempts to put caps on things in
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terms of how much milligram dose of TA
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is available.
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Many places have not done that.
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And it really hasn't helped much.
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And then the other problem we have is
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not just the cannabis industry, the marijuana industry,
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but it's also the hemp.
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And so that has been a really new
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emerging problem because of the Farm Bill.
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So the Farm Bill back in 2018, actually
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legalized hemp nationwide.
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And it was supposed to be that you
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could only have delta 9 THC, less than
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0.3% by dry weight.
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But the industry figured out how to get
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around all that, because they found out that,
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you know, a lot of people are growing
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hemp for the CBD, but they found if
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they take CBD, and they heat it and
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add some acid, they can turn it into
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THC.
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And so that's how we've developed delta 8,
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delta 10 THC acetate called intoxicating hemp products
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that are just as devastating.
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So any THC is a problem in the
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developing brain.
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And so many states have actually decided to
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make these products illegal, intoxicating hemp products, which
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then, you know, that's still a lot of
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CBD because that's not an intoxicating product.
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But all the other ones have been made
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illegal.
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And that has varied by state.
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I mean, there are many states where you
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still can get them in gas stations, convenience
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stores, kids can easily get them, and kids
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are having significant problems from these.
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And they're mostly mental health issues, you know,
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where people become psychotic, they become suicidal, they
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have worsening depression, they have severe anxiety, panic
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attacks.
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And kids are ending up in the emergency
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room with these.
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And that's really problematic.
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Yeah, it is.
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And I love this recent article, actually, that
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came out this month, and we will attach
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it in the show notes for our listeners,
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but really flagging some of these concerns for
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adolescents specifically.
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And I love that you're identifying the developing
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brain in a couple of ways, both for
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a developing fetus as well as adolescents.
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That makes a lot of sense to me
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when we look at marijuana's impact on a
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developing brain and some of these higher concentrate,
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higher, actually chemically induced strains, really, that we're
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talking about here.
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What are some of the things that you're
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seeing in terms of patterns?
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I hear a lot of teens, especially, you
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know, the phrasing out there is like, hey,
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at least this is all natural.
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Hey, it's better than drinking.
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These are all things that I think are
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commonly put out on social media or whatnot
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that teens are saying to support their cause.
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What would you say to all of that?
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Yep.
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I mean, that that is a significant problem.
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The perception of harm is significantly reduced in
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young people.
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And I basically say that is on the
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hands of the industry and our government, which
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basically allowed the industry to heavily market and
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advertise these substances as medicine.
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And so that's what we saw in Colorado
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before we legalized recreational.
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We had medical and they were touting it
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for everything.
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I mean, they're saying it helps everything.
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Most states have multiple indications for medical marijuana
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where there's no research behind it or the
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research doesn't support it.
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A good example is post-traumatic stress disorder.
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That is something that multiple people think is
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very helpful.
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And I'm sure you can talk to many
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veterans who say that it's been a godsend
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for them, that it really helped them.
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However, research doesn't support that.
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So there has been no well-designed, long
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-term study supporting the use of cannabis for
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PTSD, because what they're finding is it just
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makes people worse.
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Yes, it seems to work initially.
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Yeah, it does, because what it does is
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it numbs people.
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So people who are having symptoms of PTSD,
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like intrusive thoughts or hallucinations or severe delusions
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that that, you know, things are happening and
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they're very scared, easily triggered, they use marijuana,
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especially the high potency products.
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And yes, they're numb.
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And so it takes away all of those
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symptoms.
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And so they feel much better.
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Problem is, in order to keep those symptoms
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at bay, the person has to use every
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day, if not all day long.
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And then that sets them up for cannabis
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use disorder, which is basically addiction to cannabis.
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And so what they find is, you know,
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they're using regularly and then they try to
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stop and they're having really bad withdrawal.
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But they think the withdrawal is really just
15:10
their symptoms coming back and that the medicine
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has worn off.
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So they have to keep taking the medicine.
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And this becomes very like a vicious cycle.
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And then they have increased problems.
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So then they start developing problems with suicidal
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ideation or suicide attempts or psychotic symptoms.
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So if you look at the literature, the
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scientific literature, organizations like the Department of Defense
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and the Department of Veterans Affairs have come
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out with their recommendations for people treating post
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-traumatic stress disorder.
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And they recommend totally against using any cannabis
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or any cannabinoid products because they have seen
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the problem.
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And most of the studies show that the
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people just get worse in the long run.
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And so that is something I think people
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need to know.
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And I saw that myself all the time
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in the treatment program I was running because
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kind of the biggest diagnosis we ever saw
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was complex post-traumatic stress disorder with substance
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use engaged in that.
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So the kids are definitely getting these messages
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that, oh, it's good for you.
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It's good.
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It will help you.
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And so they're very attracted to using it.
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And even though some people do think, well,
16:32
if you legalize it, that'll take away the
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think that this is something they could do
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to get away with it.
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That doesn't seem to do anything.
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I mean, the legalization has made it seem
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safer.
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And that's one of my concerns about this
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recent attempt to reschedule medical marijuana from a
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Schedule 1 to a Schedule 3.
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And that will go further in this to
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make people think, oh, there's nothing wrong with
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it.
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It's really good.
17:02
It's healthy.
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And it isn't.
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Yeah.
17:06
And I just think about how really the
17:08
doors have been so opened.
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Like now you have this whole industry, right,
17:14
around medical and recreational marijuana.
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And there's a marketing component to that, right,
17:24
of going in.
17:25
And I mean, you can go into these
17:27
places and do just what you want it
17:30
for.
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And these are what's recommended if you're of
17:34
a legal age to do it.
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And yeah, they're now in the business of
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wanting to sell you something which is a
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different position than like a doctor, right.
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Or somebody kind of saying this is what
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it would be potentially good for.
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I don't know.
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It seems like there's no going back.
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So how do we help?
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I guess that's my question.
18:00
Yeah, no, I don't think that we can
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go back.
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I do think that the government could put
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in much stricter regulations and that would have
18:11
to be state by state.
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The states have, I think, very poor regulations.
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And I really do think the potency cap,
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there should be a cap on the amount
18:22
that people can take at any one time,
18:25
the potency of the THC in the product.
18:29
But that has been something the industry has
18:32
fought tooth and nail.
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They really are not supporting that.
18:37
And of course, many legislators do get money
18:40
from the cannabis industry.
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And the hemp industry.
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And they have worked very hard to keep
18:47
these organizations still going.
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I see these companies as really addiction for
18:54
profit companies because they know their product is
18:57
extremely addicting.
18:58
However, they have not acknowledged that.
19:03
I mean, many times I say, oh, these
19:05
things are not addicting at all.
19:07
And, you know, if you're thinking back to
19:08
the old time marijuana, well, yeah, it wasn't
19:12
that physiologically addicting, but now it is.
19:15
And, you know, we're seeing more and more
19:18
health consequences, not just mental health, but, you
19:21
know, effects that make sense because, you know,
19:24
we know these things about tobacco.
19:25
If you're smoking tobacco for years and years,
19:28
you have cardiac problems, you have lung problems.
19:30
We're starting to see those things with chronic
19:33
use of marijuana.
19:35
But one of the really big concerning ones
19:38
is this cannabinoid hyperemesis syndrome.
19:41
And this is something that is relatively new.
19:46
I mean, it's been around for centuries.
19:48
I've actually seen reports of it in the
19:50
ancient literature, but it was extremely rare.
19:54
And what that is, is this idiosyncratic reaction
19:57
to marijuana because marijuana is supposed to help
20:01
with nausea and vomiting.
20:03
So, you know, that's one of the FDA
20:05
approved indications for the cannabinoids that have been
20:09
pharmaceutically created, like dronabinol, for people with have
20:14
chemotherapy induced nausea and vomiting.
20:17
However, what we're seeing, and this is especially
20:20
with the high potency products that people are
20:22
using regularly, the exact opposite where people are
20:26
having extreme abdominal pain, nausea and cyclical vomiting
20:32
that they cannot stop.
20:34
So it's actually been coined the term scrommeting,
20:38
because when people come into the emergency room,
20:41
they tend to be screaming and vomiting because
20:43
they're in so much pain and they're vomiting
20:45
excessively.
20:47
And this used to be, like I said,
20:50
extremely rare.
20:50
It happened occasionally.
20:52
Now it is flooding emergency rooms.
20:54
Most emergency room doctors I talk to say
20:58
that they're seeing at least one every shift.
21:01
And this is something that has taken a
21:04
while for people to recognize.
21:06
So even health care professionals, physicians are not
21:09
recognizing this right away and they're not diagnosing
21:12
it.
21:13
And so we just recently got finally an
21:17
ICD-10 code for cannabinoid hyperemesis syndrome.
21:21
And the research is showing that there is
21:23
dramatic increase in these diagnoses because people are
21:27
finally looking at it and thinking about it.
21:31
And, you know, when I work with patients
21:33
that have this, it's very hard to convince
21:36
them that their, quote, medicine could be doing
21:40
that to them.
21:41
And so they don't accept it.
21:43
They don't really want to know that that's
21:46
the case.
21:47
But because they keep doing it, this has
21:51
actually killed people.
21:53
And the marijuana industry has always said that,
21:55
you know, one of the things good about
21:57
marijuana, different from alcohol, is that it can't
22:01
kill you.
22:02
Well, yeah, it can.
22:04
I mean, it doesn't kill you with the
22:05
overdose.
22:06
However, in people like this who have this,
22:09
if you vomit enough to get rid of
22:12
all your electrolytes, you actually can kill your
22:15
kidneys and die from that, or you can
22:18
have a heart attack and die from that.
22:20
And so there have been more and more
22:22
people dying from cannabinoid hyperemesis syndrome.
22:26
And the simple solution is to stop using
22:29
cannabis.
22:30
And that's what people have a really hard
22:32
time understanding.
22:33
And when I work with people who have
22:35
this, you know, and I finally convince them
22:38
that it is the cannabis causing it, well,
22:41
then they can't quit because the withdrawal is
22:43
so uncomfortable.
22:45
And we don't really currently have anything available
22:48
for cannabis withdrawal.
22:50
You know, there are companies working on medications
22:52
to help with this, but they're still in
22:55
phase two, phase three trials.
22:57
And so we're kind of away from that.
23:00
And what I've found, the only thing that
23:02
really helps somebody who really can't quit is
23:05
getting into an inpatient treatment program where they
23:08
can be isolated from the drug.
23:10
It is really, really difficult.
23:13
And then another interesting thing is I just
23:16
saw a case report.
23:18
This is a new case report on a
23:20
15 year old who developed Warnake syndrome from
23:25
cannabinoid hyperemesis syndrome.
23:28
And that that's very troubling.
23:30
And it made me think, how many of
23:33
these have people been missing?
23:35
Because I don't know if you know anything
23:37
about Warnake, but Warnake-Korsakoff is a syndrome
23:40
that happens mostly in very severe alcohol dependence.
23:46
So people who are heavy, heavy drinkers and
23:48
they don't quit and they drink for years
23:50
and years, what happens is they develop this
23:53
syndrome where they become confused.
23:57
They develop a really bad nystagmus where their
24:00
eyes are moving back and forth and they
24:02
could be delirious.
24:03
I mean, it's really a problem cognitively.
24:07
And that is usually because the person is
24:10
drinking so much, they're not eating properly and
24:13
they haven't, they don't have enough vitamins.
24:16
So the biggest problem is thiamine.
24:18
So they lack thiamine.
24:20
And I've actually treated people like this with
24:23
alcohol induced Warnake's.
24:25
And it's amazing when you give people thiamine,
24:28
how you can reverse it.
24:30
If it's not gone too far, you can
24:32
reverse it pretty quickly.
24:34
So this is now showing that these are
24:36
young people.
24:37
This is a young person who has, you
24:40
know, been using marijuana, developing cannabinoid hyperemesis syndrome,
24:45
where so somebody is vomiting all the time,
24:47
they can't eat.
24:48
And so developing this kind of syndrome that
24:52
is usually happening only in very old people
24:55
with alcohol problems.
24:57
So that is just something people need to
25:00
be paying attention to.
25:02
The other place you can see Warnake's in
25:04
the mental health field is people with severe
25:07
eating disorders.
25:08
So people who have severe anorexia and are
25:11
not eating anything, they could end up having
25:14
this as well.
25:15
Gotcha.
25:16
Well, this has been very enlightening.
25:19
I think there are so many implications, certainly
25:22
for substance abuse treatment and for folks that
25:26
are working with adolescent populations.
25:29
If you had something to just leave our
25:32
listeners with a final thought or encouragement or
25:37
action step, what would that be, Dr. Stout?
25:40
Well, I think the biggest thing is going
25:41
to be with more education.
25:43
There are many organizations working, trying to educate
25:46
young people and their parents and trusted adults,
25:51
many organizations.
25:52
One I work with is called One Chance
25:54
to Grow Up.
25:55
They do an awesome job.
25:57
Johnny's Ambassadors do a good job.
26:00
Every Brain Matters does a good job.
26:02
These are all about educating people about the
26:04
problems with cannabis, especially the brain.
26:07
And I think that if more people were
26:11
aware of this, then we might, because I
26:14
do think this is helping.
26:16
I think a lot of the education that
26:19
is happening now has helped decrease youth use.
26:24
So most of the studies like Healthy Kids
26:27
in Colorado and different studies around the country
26:30
are showing that less and less kids are
26:33
using drugs.
26:34
The one place that kind of changes is
26:37
with vaping.
26:39
Vaping is still a big problem.
26:42
And of course, you can vape nicotine, you
26:44
can vape THC, you can vape pretty much
26:46
everything.
26:48
And another problem are the edibles.
26:51
But I do think that the more we
26:54
educate people, the better it's going to be.
26:57
I really like this.
26:58
Another organization says educate before age eight.
27:02
And I agree with that completely because I've
27:05
seen so many young people that by the
27:07
age of nine are already engaged in using
27:10
substances.
27:11
And it usually is because their parents are
27:14
using or the people they're living with are
27:16
using.
27:17
And they're getting the message that this is
27:20
OK to do.
27:21
And we really want to see if we
27:24
can't change that.
27:25
And then we need treatment that, you know,
27:29
this is why I think the problems like
27:31
harm reduction have not been working very well.
27:35
They're not working as intended.
27:37
I mean, there is a good side to
27:39
harm reduction where I think where we supply
27:41
needles and clean needles, clean syringes, that kind
27:45
of thing, because that has really helped reduce
27:48
public health problems like diseases.
27:51
Many people think that encourages people to use.
27:53
I don't think so, because people can use
27:55
no matter what.
27:57
And if they have dirty needles, they're going
27:59
to use dirty needles.
28:01
So it's not encouraging people to use.
28:04
But what the problem with harm reduction is
28:06
they don't go far enough to do things
28:08
to try and get people into treatment.
28:13
And so there was a recent Atlantic Monthly
28:15
article talking about how harm reduction doesn't seem
28:19
to be working and how all these problems
28:21
and shouldn't seem to be more that we
28:24
need to be do more coercive treatment, like
28:27
coerce people into treatment.
28:29
And in my experience, that doesn't work.
28:31
I have never been able to get somebody
28:34
to accept treatment who was forced to go.
28:37
What I think works is you offer people
28:39
alternatives.
28:41
And like the treatment program that I ran
28:44
for 20 years before they closed it was
28:48
this program where people, you know, they would
28:52
come in and tell me, oh, they made
28:53
me come here.
28:54
And I said, no, I think the judge
28:56
actually said, go to jail or you could
28:59
go to treatment.
28:59
And you chose treatment.
29:01
And so you're actually here voluntarily and you
29:03
can leave at any time.
29:05
And so we had really good success.
29:07
We have many, many people doing really well
29:11
in that form of offering treatment.
29:14
But the other thing that I really think
29:17
helps, and I talked about this on the
29:19
last podcast when I was there, was the
29:21
ear acupuncture.
29:23
That is something that really has shown in
29:26
research to increase retention and participation.
29:30
And so I think that harm reduction centers,
29:33
in addition to handing out clean supplies, should
29:37
offer ear acupuncture treatment where these people then
29:41
can feel like it because it does help
29:43
with withdrawal symptoms.
29:44
It does help people calm down and relax.
29:48
And people then start feeling better about, well,
29:51
maybe I can go to treatment.
29:53
I've seen it happen because I was working
29:55
with a harm reduction program in Southern Colorado.