Issue 42: Marijuana Exposed and More

Whats up with weed? Here's the science you need to know. 

Growing medical cannabis 

Definitions:
Buzz around medical cannabis warranted a brief summary article for those straight laced people out there. Cannabis is actual name of the plant, while marijuana is a pejorative nickname from Mexico that we got used to. Hemp is basically a weak af cannabis and has been legal. Cannabinoid (CBD) is a compound that has systemic, therapeutic effects mostly for pain and seizures. Tetrahydrocannabinol (THC) is a psychoactive compound that targets one’s brain and cause the ‘high.’ CBD and THC are found in different strains of cannabis in different concentrations, and because of THC’s effect in altering sensorium, its concentration is often regulated. Patients with neuropathy can benefit from CBD because the receptors are throughout our body while those with anxiety can benefit from THC. Recreational users favor THC; you get the point.

DEA & FDA Classification
As we speak, CBD is a Drug Enforcement Agency Schedule 1 Drug. Up there with LSD and heroine, and by definition has no medicinal use and can only be dispensed for research purposes. Senator Booker and others are fighting to change this category; opioid drugs are schedule 2 for comparison. Food and Drug Administration has only approved one drug, epidiolex, for epilepsy so far. This means the non-approved CBD/THC products cannot make medical claims. FDA is waiting for the DEA to change the classification.

Clinical Research

Balding scientist

Bunch of randomized control trials say medical cannabis are effective for patients with anorexia, neuropathy, arthritis, inflammatory bowel disease, multiple sclerosis, and anxiety. They’re basically trying to say cannabis has medicinal use and should no longer be schedule 1 drug. Just this week, the Fed gave the green-light to Canada-based cannabis company Tilray to export their products to UC San Diego for a double blind study for effects of cannabis on essential tremor. You ask why do we need to import foreign plants for research on our soil? Because the only federally approved grower is in University of Mississippi and their plant quality sucks. Oh, and of course the TLRY stocks skyrocketed and made hedge fund owners busy. On the flip side, there have been studies that warned against cannabis use in pregnant women and growing children for possible cognitive delay.

Indications
This is tricky, but its use has been recommended for additional therapy, not as a replacement for indications above. Cannabis is no panacea and will not cure acne or cancer. Some states, however, are expanding their indications and will cover for any pain from cancer, not just terminal. You don't have to be on your deathbed to qualify. The most well studied known indication perhaps is epilepsy; Lennox-Gastaut and Dravet syndrome in particular. Veterans with PTSD are pushing for it, too.

Access and Dilemma

Snoop

Fast forward, 31 U.S. states allow some concoction of CBD/THC for medical use, and 9 states allow recreational use as well. Most states discourage smoking in general, but do allow vaping, pills, oils, topicals, lozenges for adults, and edibles for children who qualify. One can register if having a qualified symptom, and look for a dispensary. There are many unanswered questions, however. Is cannabis going to replace opioids? Is there a catch to CBD despite the low side effect profile ? Is it going to increase recreational/black market so much that the state governments will not capitalize from its proposed taxes and make them change their mind? How do we detect THC in drivers who are impaired ? ( or would they drunk drive less often?) Are our kids going to get dumber?

US Life Expectancy down again. We now rank almost dead last against developed nations

Image from addictions.com 

The opioid epidemic and rising suicide rates are taking it's toll on US life expectancy. From 2014 to 2016 US life expectancy declined from 78.9 to 78.6 years. That might not be a big drop to you, but you gotta realize that the last time out life expectancy dropped was all the way back in 1993. Also we are almost dead last compared to other developed countries which is crazy since we spend wayyyy more on healthcare than them. So any decrease is not good news for us Americans.  Clearly we have a problem! According to the CDC deaths due to heart attack and cancer have actually been on the decline during this time which means there has been a pretty big increase in overdoses, suicide, and chronic liver disease (influenced by bad diet, drinking, and drug use). Between 2006 and 2016 deaths due to OD increased by 72% while suicides increased by 23%. It should also be noted that suicide was on the rise in almost every demographic group and in every state. Clearly we gotta take better care of ourselves. 

Teens who vape up 75% since last year

Image from NYT

Yep you read that right. According to the most recent numbers it's estimated that 1/5 of teens in high school is vaping. Unfortunately that number may be on the lower end of the spectrum. According to the WSJ the percentage of teens age 13-18 who have vaped in the last 30 days is closer to 1/3. Parents where the F are you? Don't let your kids Juul. 

Green Tea is a freaking cellular ninja 

Image from Healthline.com

Green tea is back at it again with its many disease-fighting super powers! We’ve all heard so much praise for its ability to combat heart disease, improve brain function, and reduce the risk of cancer. But now we also know that it has stealthy ninja capabilities. Epigallocatechin gallate (aka EGCG) is a compound found in green tea that can help with sneaking therapeutic small interfering RNA’s into cells. These siRNA’s can then reduce the expression of disease associated genes. Until now, siRNA’s have had a lot of potential but struggled with actually entering the fortress known as the cell membrane, and even upon entry they’re often neutralized by RNAses. But it just so happens that EGCG is the perfect accomplice! It can bind snugly to siRNA and facilitate its quiet infiltration into cells. Pairing EGCG with siRNA showed promising results in down regulating proinflammatory enzymes in a mouse model of intestinal injury, where weight loss and reduction of intestinal inflammation were observed. I guess green tea really can fix everything!