IamA Neuroscientist who studies how cannabis interacts with opioids… AMA!

Hey, I'm 8 months clean off of heroin, living in Seattle. Have there been any long term studies into the effect of using marijuana during cravings? That's what I've been doing - smoke a big bowl and sleep through it til tomorrow. But am I actually just putting off an inevitable relapse without learning better coping mechanisms?

Edit: Holy wow! I was not expecting such a response from my little throwaway comment. I am totally overwhelmed by this show of support and I'm going to send the day getting to everyone. Thank you!

Oh my god, thank you THANK YOU THANK YOU for sharing your story. There are absolutely ZERO long term studies about this, but I hope to be the author of those one day!!! Based on the literature, the only things that could definitely enhance your recovery are social support (being meaningfully connected with humans around you) and mindfulness meditation. YOU CAN DO IT.

what if theres no one out there to connect to for me?

There is always someone.. all these fine folks, for instance! A new hobby maybe?

I'm currently baked. Any questions for me LUL?

How does your cannabis use affect your craving for alcohol? Would you rather just smoke another bowl?

The more cannabis I started to smoke, the less alcohol I felt like drinking. When i became a daily smoker, my cravings for alcohol are pretty much zero to none.

Thank you for your feedback! I'd love to hear from more of you about this!

Hello. I was a homeless alcoholic by 19. I managed to weasel into the military, where my alcoholism was accelerated to comical levels. Just, hilarious. Upon separation, I took up smoking pot to try and replace the alcohol with something else. It worked.

Marijuana quite literally saved my life. I now hold multiple degrees and have a very nice University desk job. If anyone ever says it's just replacing one addiction with another, they're right. But only one has negative consequences. The other has been an unimaginable boon to the successes I've had over the past decade.

This is exactly how I've phrased it before! In my opinion, and granted, I am not a recovery professional: One addiction has major life consequences, the other far less so. Harm reduction has very real value! Thanks so much for sharing. Edit: disclaimer.

I've had two board certified, well respected pain doctors recommended it (in certain words, and with the caveats they can't and won't prescribe it, etc etc) to me over my alternative pain regimen: Norco. I'm totally off opiates now, something I never thought possible and don't have to go through grueling monthly withdrawals anymore, since I started using cannabis. It's been a godsend, and I was devastated to move from CA to TX.

I'm so sorry you don't have access to the medicine that has been working for you. Our healthcare system has failed you, it shouldn't have to be this way.

If you'd like more feedback, come join us over at /r/trees

Oh, you think I haven't been lurking there for like, ever? But yes, I will take you up on your offer to participate in scientific research. My compensation for your contribution will be witty quips and gracious thanks.

I would definitely rather smoke a bowl. In fact, i choose not to smoke hours before going out to a bar.

Thanks for your answer, I have a hypothesis that cannabis reduces ethanol craving, this is great!

I'd love to see a study done on this.

Personally, I've stopped drinking alcohol completely. It just doesn't interest me as much anymore.

I'd love to see this too! QUICK, SOMEONE GET SOME MONEY!

I started drinking socially in my late teens and through my early 20s. Nothing out of the ordinary for that age group, but I could drink a fair bit when I was partying or whatever. I started smoking cannabis at about 22/23 and have now not touched alcohol for 5 years. Never made a conscious decision to stop drinking, I just completely lost any desire to.

Awesome! thanks for sharing!

Cannabis kills my craving for food(can make me hungry sometimes) and alcohol. How do you feel about teenage use of cannabis? or teenage use of non-psychoactive cannabis extracts such as CBD?

TL;DR: Don't mess with your developing brain, unless you absolutely have to because of medical reasons (intractable epilepsy etc).

Research has clearly shown that consistent adolescent use of cannabis (under 21 yrs of age) is strongly associated with cognitive deficits as an adult. The human brain does not finish developing until approximately 21 years of age, and intervening with its normal development is usually not worth the short-term benefits of cannabis.

If you or your child are considering medicinal cannabis for your condition, you should have lengthy discussions with your doctor about short vs. long term effects of cannabis. This includes CBD, which we don't fully understand.

What do you mean specifically by cognitive deficits?

Retention of information. Reaction time. Learning new tasks and the like.

What about how combining the two effects you? I know that if i've had a few drinks, having a puff will immediately make me puke ! (Getting the spins, etc)

Hyperemesis is a very well documented side effect of cannabis. It affects some people more than others, most likely because of the differences in people's endogenous cannabinoid systems. Lucky you?

Holy crap you guys, have you seen the comments on imgur? That place is the sewer of the internet.

If that's your bar for "sewer of the internet", do yourself a favor and keep that bubble unburst.

Also: Thank you so much for everything you do to improve the accuracy of our public knowledge and perception of cannabis. Over the last year or so, I've really had my eyes opened to what that drug actually is. It's so strange to me now to think about how many people hold completely unfounded beliefs regarding that plant, and I really respect people like you for doing everything you can to see how far this medical goldmine goes.

1. HA! Bubble shall remain intact, thank you kind bagelmeister!
2. Thank YOU for being open minded and allowing knowledge to trump stigma! It's only by "coming out on cannabis" that we can truly begin to have progress on this issue!

What are your thoughts concerning use of cannabis in the NFL?

Man, I can't even express how much this issue means to me. From a brain/concussion perspective, a chronic pain perspective, as well as a cannabis perspective.

There is clear evidence that these guys experience REALLY nasty consequences of bodily trauma and chronic pain. CTE is a devastating disease. Based on the data, cannabis appears to be a safer alternative to opioids for chronic pain relief. In my opinion, it's irresponsible for professional sports leagues to allow their athletes to engage in activities that would endanger their lives and livelihood, while also preventing them from utilizing safer alternative therapies. Edit: for clarity.

So if these things can be proven by someone who has researched it for over 10 years, what more steps need to be taken to change the law?

The DEA is expected to follow the advice of the Food and Drug Administration (FDA) when new drugs come onto the medicine market (which is basically what’s happening here). The FDA, rightly so, has very strict rules about this process (clinical trials), to ensure our health and safety. Here’s the rub: The FDA’s criteria is so stringent, that whole-plant cannabis will never, by its definition and nature, live up to these requirements. It will take an act of congress or an arbitrary decision by the POTUS or attorney general to change the law.

Could you go into why it wouldn't pass fda approval? If it is safe it should be fine right?

The FDA can only approve a new drug based on the safety and efficacy data that results from a clinical trial. Clinical trials can't be done on cannabis, because it is an illegal schedule I substance: catch 22. Also, the FDA requires that a drug company provide a single symptom or disease (indication) for which the drug should be used... which would we choose? Furthermore, a number of processes are in effect to ensure all participants in a clinical trial receive the exact same drug/molecule at the same dose. Even if we COULD do that for the clinical trial phase, it wouldn't ever apply to the real world of cannabis medicine, due to the vast variety of strains/plants that are in use. The best we could ever get from the FDA would be approval of a clone of one specific mother plant, refined/extracted to a specific dose/chemical profile, and approved for one specific ailment. In theory.

Many of my fellow physicians use urine drug screens as part of pain contracts with patients receiving opioid narcotics. They will refuse to prescribe narcotic medications if patients test positive for any illegal drugs, marijuana included. I've always found this odd because they rarely screen for alcohol use, nor do they refuse narcotics to patients who use alcohol.

My question is, what are the effects of marijuana on opioids from a patient safety perspective? Does marijuana interfere with the metabolism of opioids?

From a safety perspective, all signs point to cannabis LOWERING the opioid risk. When patients have access to cannabis, they self-taper their opioid intake by roughly half. In states with medicinal cannabis laws, there is a 25% drop in opioid overdose deaths.

In terms of basic pharmacology, cannabinoids and opioids interact synergistically to produce pain relief (the two together provide much greater relief than they do alone). However, this does not appear to be true for the side effects like sedation and motor coordination (cannabis enhances the good effects of opioids, but not the bad effects). EDIT: A lot of this work was done in animals.

We don't have any evidence of cannabis interfering with opioid metabolism. The precise mechanisms of the drugs' interactions are poorly understood, and the topic of my ongoing research!

Is there any evidence that cannabis increases the half-life of opioids? Or that it can worsen the most severe side effects such as respiratory depression?

No, in fact there is evidence to the contrary. The timecourse of opioids is unaffected by cannabinoid administration. Opioids induce respiratory depression, whereas cannabinoids induce tachycardia (increased heart rate). I actually answered this very question at my Ph.D. thesis defense! Edit: to be concise.

I'd be hesitant to say that tachycardia cancels out bradypnea. Heart rate doesn't matter if your aren't oxygenating your blood.

However, it's reassuring to know that cannabis doesn't further depress respiration. Thanks for the answers!

I appreciate your hesitation, just trying to keep things relatively readable for the reddit audience. Thanks for the questions!

I am a person who uses both opioids and cannabis for chronic pain, if you have any questions fire away.

/u/CourageousKoala keep an eye on your inbox!

What is your take on the legalization of the recreational use of cannabis? With so many doctors are even wary of it's medicinal uses still, I'd love to hear the thoughts from a Neuroscientist!

I am all for recreational cannabis for this reason: adult-use laws create a genuinely separate market for medicinal use. These laws completely eliminate the guise of "I need it for my (insert bogus condition here)." In this space, we can tackle medical issues rigorously, head-on, and in the absence of haters. With the law on our side, we can conduct the research and collect the data that will benefit science and medicine at large.

Knowing people like you exist makes me happy. Thank you!

:)

Hi! My question is about the obstacles you might face with your research since cannabis remains illegal at the federal level. What has been the biggest setback in that regard? Can you receive federal funding? From whom/where do you receive the majority of your funding? (I'm a physiology PhD student in Colorado, and I've always wondered about funding for cannabis studies.) Thanks for doing this!!

I have been funded by the National Institutes of Health for my entire career. My funding comes from NIDA, the National Institute on Drug Abuse, which is the only federal funding agency that can currently give out money to study cannabis. The rub is, that they will only give you money to study the "addictive" or bad effects of cannabis, rather than the potentially medicinal/useful effects. This is the reason that there is a huge negative bias in cannabis research. The biggest setback to medicinal science is the inability of the NIH to give us money to study the potential benefits. I'm hoping that eventually the controlled substances act issue will go away so that we can overcome this barrier.

The reason NIDA has always had an interest in my work is that my goal has always been to reduce opioid use/abuse/bad stuff. I got in the back door.

Colorado has a state-level grant program, so all is not lost!

Wow. Love how unbiased those grants are. Do you feel this also has an impact in the how published peer-reviewed results are framed?

I would like to think not. Data is data. You can spin it however you like in your discussion, but data doesn't lie. It just is. Regardless of an investigator's hypothesis, bias, or funding agency... ball don't lie.

Have you ever heard of depersonalization/derealization?

Smoked for the first time around 8 years ago and have never been the same since

I have heard of this, and I suspect that some people may experience this based upon the unique properties of their own endogenous cannabinoid system. Mysteries abound, people...

Hay Adie, Thanks for doing this AMA, and for the importaint work you do. From reading your answers, there seem to be many upsides to Cannabinoids. Are there any downsides or dangers?

YES, FOR ADOLESCENTS. Research has clearly shown that consistent adolescent use of cannabis (under 21 yrs of age) is strongly associated with cognitive deficits as an adult. The human brain does not finish developing until approximately 21 years of age, and intervening with its normal development is usually not worth the short-term benefits of cannabis.

Three scholarly articles come to mind: An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. Effects of cannabis on the adolescent brain. Considering Cannabis: The Effects of Regular Cannabis Use on Neurocognition in Adolescents and Young Adults.

Hi /u/CannabisScientist!

As an adolescent (age 17) who hasn't smoked before, how much would it affect someone like me to smoke once?

Also, I actually have SVT, a heart condition that can make my heart rate randomly go up to around 250bpm whenever it pleases. Would cannabis exaggerate this, lower the chance of it happening, or have any heart related effects? I'm curious about its effects, but am worried about trying it out with my condition.

If I were you, I'd be worried too. Definitely discuss this in detail with your doctor.

I use CBD oil to reduce inflammation from my JRA (didn't feel so juvenile before the CBD) and I feel so liberated! I can make a complete fist again and I feel like I have my 25 y/o body back! When I heard that CBD is going to be Schedule 1 I was devastated and wanted to kick a lead ingot. Reading about the side effects caused by "real" RA meds scare me half to death and I'm nowhere near desperate enough to take them. Why is it that the DEA like to keep barbed sticks up their asses?

Dang, what I wouldn't give to know why the DEA insists upon this wretched self-sodomy. I too, was devastated by their recent decision, which, fortunately, seems to be totally illegal and a gross over-stepping of their duties. We'll see what happens there. I'm SO happy to hear that you've found a way to get some relief. I have a close friend with JRA, I truly know your pain, I've had hour upon hour of conversation about this. Thanks for sharing!

In a perfect world, how do you see cannabinoids being used in the treatment of opiate addiction?

I see cannabis as an exit drug, not a gateway drug! That is, I see it as one tool (of several) that could help people transition away from opioids. By substituting a dangerous, potentially fatal behavior, with one that is far less risky, people may be able to re-engage in their lives. Addiction is often discussed as a disease of disconnected-ness. That is, people are looking for a connection with something, and often the only thing they feel connected to is their drug. Why be connected with something that can kill you? Edit: to be succinct.

Have you smoked it yourself... Since you know.. You study it?

Answered earlier; yes, but not in a way that would endanger my career.

I work in a detox facility for people with a wide range of dependencies including Cannabis. We do not use Benzodiazepines to manage anxiety. At the moment the only medication we have available to support the anxiety we see in Cannabis withdrawal or Opiate withdrawal is Quetiapine. I feel this is lacking something.

Could you point me to any studies or give me any suggestions based on pharmacology as to how we might better support our patients?

WOW, I wish I had something less disappointing to say about this, because this is really the reason I got into science in the first place: to help people with substance use disorders. Mindfulness meditation is really gaining traction for a wide variety of psychiatric and biological disorders. This review might be a great place to start: https://www.ncbi.nlm.nih.gov/pubmed/27111302

What do you think about Pharmaceutical corperations in general? They hold alot of lobbying power in government. And seem to only care about profits rather than opioid addiction (big problem here in Portland OR metro area).

Bonus question what's the percentage of success if someone with a GED asked someone with a PhD out on a date? (this is a purely hypothetical question by the way, just random)

We need big pharma, they are a necessary evil. There are a lot of VERY effective, life-saving medicines out there that would not exist if it weren't for them. I agree that their motives are not always the best, but one of the great things about cannabis is it's existence in the public, rather than patented sphere. If they want to develop more cannabis-based medicines, I say bring it on! WE NEED HALP. Bonus answer: hypothetically, if the PhD had a spouse, as evidenced by AMA proof (wedding ring) then the statistical probability of a date would be around 0.001%.

https://img.pandawhale.com/103114-so-youre-telling-me-theres-a-c-Raj0.png

Dang! You beat me to it!

What exactly does "how cannabis interacts with opioids" mean? From a physiological POV?

Having been a heavy pot smoker most of my life.. and having a few years where I was an opiate addict, I've mixed the two more than I'd care to admit..

Yes, from a physiological standpoint.

In my career, I have studied the acute effects of combined cannabinoid/opioid administration (for pain relief). I have also looked at how chronic cannabinoid exposure effects opioid pain relief, and opioid tolerance (the loss of effectiveness with repeated use). I have also studied how chronic opioid exposure effects cannabinoid pain relief.

My ongoing and future studies are to examine the cellular and molecular mechanisms behind enhanced pain relief and reduced opioid tolerance, as well as the addictive potential (or lack there of) of combined opioid/cannabinoid administration.

Considering the attention given to THC, how much of your research focuses on cannabidiol? Has it been shown to be more or less useful than the psychoactive cannabinoids for things like pain management?

CBD does not seem to provide as much pain relief as THC or other CB1 receptor agonists. The reason is that CBD does not directly activate the CB1 receptor. My work and others has shown that CB1 activation in the part of your brain that is the headquarters for pain control (the periaqueductal gray) shuts off pain for the whole body. CBD seems to have some anti-inflammatory effects, probably mediated by the immune system, so this may be a different mechanism for pain relief. My personal research does not involve CBD, but I follow this VERY closely!

1. Wow, good for you! You are a true inspiration.

2. My mother and I argue constantly about the uses of marijuana and she claims that "even if it could cure cancer", she would be against it (which I HIGHly doubt). What are some solid researches/studies I could show her to prove that it is more than just a recreational habit, and some to prove that marijuana in fact does not kill all of our brain cells?

Unfortunately, overcoming stigma like this is going to be a generation-long process. In my experience, this stigma is harder to overcome by showing someone solid data, and the shift really happens when there is an emotional appeal. Lots of videos on Youtube of kids' seizures stopping after an oral tincture, or parkinson's patients having normal conversations after a j. If you REALLY want a list of solid studies, there are literally thousands of them, too many to link here!

Do you use cannabis yourself?

I currently live in the state of Missouri, which does not yet have any legal uses for cannabis. In other legal contexts/states, when I did not have anything at stake (for instance, a DEA license for conducting research), I was known to partake. It would be a bit hypocritical for me to lack a first-person perspective!

I think missouri will be one of the last states to make weed legal.

Not if I have anything to do with it! I was just at the state capitol yesterday, meeting with Republican law makers on the verbiage for the new medical cannabis bill. Headed back in a few weeks once the new legislative session is underway.

I'm about 6 months clean from a crippling opioid addiction. I've used, and continue to use, kratom in my battle. I still smoke cannabis from time to time, but only in very small amounts. I've had more than one cannabis-induced panic attack since quitting opioids. My anxiety is still severe, even after 6 months. Have you done any research on kratom (Mitragyna Speciosa)?

I've found that the two go very nicely with each other. Since kratom doesn't cause respiratory depression, much like cannabis, there's no real danger in ODing. Kratom has literally saved my life, and if you haven't done any research on it, I would strongly recommend that you do. For me, it also does a better job than cannabis at attenuating alcohol consumption.

I'd be more than willing to answer any questions you may have to the best of my ability. Thank you for doing this AMA!

Thanks for the guidance, I think you're really onto something, I will definitely look into this! As far as the anxiety goes, the side effects that cannabis can have on cardiac activity could definitely contribute to that: your mood and your heart rate are very closely related. That's why beta blockers are so good as anti-anxiety meds: they directly reduce heart rate and "trick" your brain into thinking everything is chill.

Hello Adie

Super interesting research you're doing! What kind of results have have you made toward how cannabis effects chronic pain?

Also where do you see the future of your field going?

Cheers from Denmark.

Thanks for the interest!

Cannabis has huge potential in the treatment of chronic pain. The most commonly prescribed pain relievers are opioids, which have very nasty side effects (cue apocalyptic epidemic). When chronic pain patients are given access to cannabis, they drop their opioid use by about half. There is also some recent data that suggests cannabis actually improves cognitive function in these people, probably because they are lowering their opioid usage. The most common reason people seek out medicinal cannabis is for pain relief, and it appears to be very beneficial, because the US states with medical cannabis have 25% fewer opioid overdoses... this is HUGE.

Let me know if you want links to scholarly articles :)

Thank you for you work, first and foremost. I use cannabis for pain management. I was injured in the military and have chronic low back pain, for which I was prescribed many things, starting with ibuprofen 200mg-800mg, Lortab, Vicodin, and Methadone, among others. The side effects of the prescription meds were awful, such as bleeding ulcers, constipation, hemorrhoids, cramping, etc.

I tried cannabis for the first time at age 31, and it has been a life-saver. I don't understand why, but the cannabis does not exactly eliminate the pain, but rather causes me to not really be concerned with it. Can you explain why/how (aside from the high feeling) that cannabis has this effect on pain?

First of all, thank you for your service and sacrifice. What you are describing, in terms of your ability to cope with pain, is the same thing that we observe with cognitive behavioral therapy and mindfulness meditation for pain. I can't, based on data, explain why this phenomenon occurs, but I think what you are describing has serious clinical usefulness!

Damm I wasn't aware it was that significant. That sounds super promising! I really interested in what future research will bring.

I'd love some articles! I'm not involved in any medical/neuroscientific studies or research, I'm just a philosophy student who find neuroscience really fascinating. That said, I'll read whatever you'll recommend!

A colleague in my department used to do clinical pain research in Isreal, where cannabis medicine is booming: https://www.ncbi.nlm.nih.gov/pubmed/?term=haroutounian+cannabis

Same result, this time out of Harvard: https://www.ncbi.nlm.nih.gov/pubmed/27790138

Oh this is great thanks!

I'm curious as to what methods you use, when you're doing research?

Also are there other areas of neuroscience that you find interesting or have made fascinating advances?

I am in fundamental (I hate the word "basic") research. I use animal models, and brain tissue from animals. We observe how animals react to drug treatments, and as an electrophysiologist, I record the electrical activity of brain cells when I wash drugs onto the tissue. COOL, HUH? Some overachieving redditor may dig up my Instagram, where I posted a short video explaining electrophysiology.

Hi, I'm a 45yr old male stuck in a wheelchair, I have C.M.T. and E.D.S. and I suffer from lots of chronic pain, plus depression. For pain I take 2 Tylenol 3s 4 times daily and 1MG of Nabilone twice daily. I don't think my doctor really approves of either, I had to fight a bit to get anything. I don't smoke pot or drink alcohol. I don't think these meds are working very well any more. Do you know of any other options? Or is that it for me?

Honestly, it sounds like you need a more compassionate doctor. You need someone who is supportive of your health and your personal goals. That's where I'd start if I were in your wheels. Best of luck <3

Does recreational use ever become physically harmful at a point? Basically, how often is too often?

I'll refer you to the DSM-5 for the criteria on cannabis use disorder. If those items start to creep into your life (and granted, I'm no recovery professional) it's probably time to chill. Yes, cannabis can definitely become harmful, but probably not in the way you're thinking: more likely in the psycho-social realm than the biological health/longevity realm. Edit: disclaimer.

Can you explain why smoking weed makes the effects of alcohol so much stronger in some people, but not at all in others? (Not sure if your expertise covers this)

Differences in endogenous cannabinoid functionality. Your brain cells are studded with proteins that are the site of activation for cannabis (CB1 and CB2 receptors). Your brain also produces its own endogenous cannabinoid agonists (anandamide and 2AG). The natural variability in this system is most likely reason for differences between people when it comes to cannabis consumption.

I am currently suffering from myeloma and a resultant complete collapse of 4 discs I'm my back. I have been on oxycontin continually for almost 3 yrs. I hadn't smoked weed since the 70's, but I found a dealer, and have been smoking weed daily for the last 6 months. It seems like it helps me in numerous ways, the best being that it seems to help neuropathy. My pain doc doesn't know, but I doubt he would have an issue. My question is does this seem like a sustainable regime? I never feel any desire to take more opioids than prescribed. How safe am I on OxyContin in the long term?

Thanks for sharing your experience! Long-term opioid therapy is NOT sustainable. Anything you can do to maximize your quality of life, and minimize your opioid exposure is probably going to be beneficial. Talk with your doctor. Edit: to be concise.

I recently had knee surgery done and was prescribed Norco for pain. I felt side effects from it that may have been purely in my brain (fever dreams, lethargy, and a few other things), so I stopped using it. My knee still aches during the day and it's still difficult to get a good nights sleep. Since marijuana is pretty much legal here in California now, I was thinking about it as an alternative to popping Advil all the time. My question is this: Aside from trial and error, is there a way to find the right amount and the right type of marijuana to help with the pain and/or help me sleep at night?

aaaaaaaaaaahhhhhhhh! I wish there was a better way than trial and error! This is my life's mission, you shouldn't have to be your own guinea pig, health care professionals SHOULD be able to answer this question for you! Edit: to be concise

Any current research that the community should be aware of?

Personally really interested in potential cannabinoid treatments for epilepsy (Charlotte's web).

I have a strong bias, so I'll use this as an opportunity to push my anti-opioid agenda:

For decades, scientists have been well aware of the analgesic (pain-relieving) properties of cannabis, and its constituent molecules, called cannabinoids. My own research, and that of many other dedicated scientists, provides compelling support for the use of cannabis in pain management.

Opioids are among the most important drugs used to treat pain, however, their use is significantly limited by side effects such as the development of tolerance and the possibility of addiction. Despite their harmful side effects, opioids are very frequently prescribed for the treatment of a variety of pain disorders. Yet, many patients still experience pain that is poorly managed by opioids, either because opioids simply don’t dull the pain, or because people can’t tolerate the drugs’ powerful side effects. The multitude of issues created by rampant opioid prescription, consumption, and diversion (to the black market) has come to a head, leaving us with an epidemic that is arguably the greatest health challenge of the 21st century. How do we begin to tackle this issue?

When pain patients have access to cannabis, we observe some very promising effects. For instance, in states with medicinal cannabis, there is a 25% drop in opioid overdose death. I cannot overstate the impact of this finding; these are millions of lives that are being saved. This powerful effect may largely be due to the roughly 50% drop in the amount of opioids patients consume after beginning cannabis therapy. As a result, Medicare costs go down, and so do the number sick days employees take. A wide variety of studies, ranging from animal models to large-scale human populations, suggest that cannabis can simultaneously protect against the negative side effects of prescription opioids, while maximizing their pain-relieving properties.

Opioids are the most powerful analgesics known to man, and their continued use in the treatment of severe pain is inevitable. Blanket restriction of opioid therapy and replacement with cannabis is not a desirable or realistic goal. However, our understanding of cannabinoid/opioid interactions is rapidly developing, and every day it becomes clearer that cannabis is going to play an important role in modern pain management.

In states with medicinal cannabis laws, the vast majority of patients seek out cannabis to treat chronic pain. Interestingly, 84% of patients report that cannabis effectively provides relief from their symptoms. Moreover, few people report negative consequences of cannabis use, and lethal cannabis overdose is basically non-existent. Unfortunately, legal and practical barriers diminish both the use of cannabis as a first-line pain reliever, as well as our ability to rigorously research the long-term effects of cannabis for pain relief. I’d like to see these things change. I’d like to see knowledge trump perception.

There have been many cases where cannabis has been used to ease chronic pain, as well as instances where using it to treat disease has cured the malady. Now, I understand why more research isn't being done (no money in the cure, only in treatment) but coming from a researchers point of view why aren't more studies being done especially on the benefits?

Most scientific research in the US is funded by the NIH, which is a federal institution. The federal government does not recognize any medicinal benefits of cannabis, because of its status as a Schedule I controlled substance. There is currently no federal funding mechanism to study the medicinal benefits of cannabis. Huge catch 22: we don't have data because it's illegal, and it's illegal because we don't have data to show its safety and efficacy.

Do you live pretty comfortable with your PhD in neuroscience? I have gave some thought about going into virology/immunology/neuroscience/biochemistry and would like to know about your life. Financially, socially, work-wise, what are the good and bad things that comes along with being a scientist?

Thanks

I can only speak about academic neuroscience research (working within the University system), which is incredibly rewarding… and frustrating, and difficult.

The biggest thing you need in order to succeed is a proactive approach to your education/career. I have found that the most successful people treat their science as their own small business: you are in charge of your own success, no one is going to remind you when your deadlines are, or push you as much as you need to push yourself. Some people don’t do well under these circumstances.

Graduate school consists of many, many long days of straining your brain. There are a lot of sacrifices: you might miss your own birthday because you’re in the middle of an experiment (true story).

As a post-doc, you will still be working hard, and all of your friends who don’t work in science will probably make way more money than you. The payoff is huge though: you don’t punch a time clock. You get to decide what you work on, and you often come to work without feeling like it’s actually work: you just enjoy it. The schedule is flexible, and you get to travel a lot to present your work at conferences (if you/your boss has money anyway… money is always an issue).

These things are also true when you become a P.I. (Principle Investigator/professor). At this point you somewhat become a slave to the NIH, and the stress of writing grants and maintaining funding (so you don’t have to fire everyone when you run out of money) is pretty intense.

At some point in this process, a lot of people realize that the stress is not worth the autonomy, and they choose a different path: there are a lot of careers out there that you can use a neuro PhD for, without having to constantly write grants and deal with the super slow/frustrating academic bureaucracy.

If you pour a TON of effort and practice into the thing that you are both good at, and interested in, you are very likely to be happy. Good luck.

any interest or previous experience with psylocin and its serotoninergic properties? opinions on ssris, snris, or maois?

I can say that CBD is a partial agonist at one of the serotonin receptors. Probably not the answer that you're looking for, but that's about all I got!

Have you done any research with kratom?

nope!

Is there ANY negative to smoking cannibas? Anything long term?

Yes, there are plenty of of negative effects, especially for daily adolescent users (detailed answer elsewhere in this AMA). There is also some data to suggest that there may be increased risk for cardiac failures in individuals who have pre-existing heart conditions. Also, the side effects can be really unpleasant, especially if eaten or the dose is too high (nausea, psychosis/feeling like you're going to die, couch lock, fuzzy headed. Granted, the side effects are whole reason some people consume cannabis to begin with).

OH, and specifically, smoking cannabis is really bad for your lungs: tar and hydrocarbons are bad, mmmmkay? Cannabinoid binding to the receptors is the same for smoking as vaporizing, although both forms of consumption are illegal on a federal level. Edit: for clarity.

What are your thoughts on people using cannabis in conjunction with other forms of treatment for drug (opiate and alcohol come to mind) addiction?

First off, I will say that I am making it my life's work to answer this question based upon tangible data. In the absence of that data, and granted, I am not a recovery professional, I think there is a HUGE potential for cannabis to act as an "exit drug" from other forms of addiction. Abstinence clearly is not the answer. Opioid replacement therapy, combined with social support, seems to be the best thing we have for opioid recovery at the moment. Substituting something potentially lethal with something potentially harmless seems very logical to me. Finally, as evidenced by other redditors' comments on this AMA, cannabis seems to curb alcohol craving (hypothesis supported?). Edit: for clarity.

Are you experiencing less regulatory hurdles in recent years with the country moving in a direction to legalize?

No, my personal (funding) hurdles are the same today as they were when I started. It will be an overnight shift when the feds either deschedule, or downgrade cannabis from Schedule I to Schedule II.

Do you work in a "legal" state?

At the moment, no. I currently live in Missouri. However, just yesterday I was meeting with Republican legislators in our state capitol to work on verbiage for a medicinal program here. The ballot measure failed this year, so we're going for a top-down approach.

How hard it is to study drugs? What is the most difficult part? Im majoring at psychology and i really would like to work in that field, specially with researches about psychedelics.

The most difficult part is making sure that your research ideas are fundable. Will the government give you money for your project? If it has the potential to have a big effect on public health or a specific disease, then yes, if you sell your idea hard enough and support it well enough, they will probably give you money. If you are trying to get money to study the benefits of a Schedule I drug... you'll have to look somewhere other than the fed government for research dollars.

What is your opinion on people under 18 using cannabis?

As I've said elsewhere in this AMA, I am totally opposed, unless you have a debilitating condition such as severe epilepsy which is not responsive to traditional medical intervention.

Research has clearly shown that consistent adolescent use of cannabis (under 21 yrs of age) is strongly associated with cognitive deficits as an adult. The human brain does not finish developing until approximately 21 years of age, and intervening with its normal development is usually not worth the short-term benefits of cannabis.

If you or your child are considering medicinal cannabis for your condition, you should have lengthy discussions with your doctor about short vs. long term effects of cannabis.

Hi Adie!

Thanks for taking time to answer questions. I've read several studies that are leaning towards cannabis inhibiting the brains natural ability to create dopamine. So when a regular user tries to quit, they become depressed. Have you witnessed anything like this in your studies?

Frantically trying to dig up the study I think you're referring to, I'll be back later with it.

If it's the one I'm thinking of, the problem is that the participants were cannabis dependent. They were not healthy/control people. Anyone with a physical or psychological dependence, whether it be upon opioids, gambling, or chocolate, is not going to be representative of the population, nor are they going to have a normal dopamine response after being exposed to something they are evolutionarily supposed to enjoy. LOTS of things, chronic cannabis use included, have tangible effects on the brain's reward pathway, and we need a lot more data to really understand what's going on here.

Wow that was a quick reply. I think you're right, it was all people who had been regularly using several times a day. If that is the case, would switching these opioid dependants to cannabis require another weaning afterwards?

Thank you for your reply!

This is an excellent question! I would also love to know whether cannabis could alleviate the withdrawal symptoms of opioids... there just isn't enough data out there about this!

Question about cannabis dependence. To what degree of dependence do you consider dependent? People who have smoked for years daily, seem to experience quite different symptoms when they stop smoking. Would you consider the dependence more aligned with symptoms and what someone has to go through to stop? The frequency of use alone? Both? I know people who have smoked as much as me and then just stopped cold turkey with almost no side effects. I had to stop for legal reasons and it really messed with me. Night sweats, hyperdehydrosis in my hands, I couldn't touch coffee or it really screwed my up. Clearly this is a description of someone who would not be a good test subject, but I am curious where the line is drawn. Can someone who has almost no experience smoking still be a good text subject. I ask this because people react so differently to it, especially when they haven't smoked it much.

I personally, do not give any consideration to what qualifies as dependence. The DSM-5 however, has very explicit criteria for people to qualify as having a cannabis use disorder. Yes, one of the criteria is that withdrawal symptoms appear when people stop using. Withdrawal is seldom pleasant, for those people who do develop a physical dependence. In my opinion, drug naive and drug tolerant people are both equally valuable in scientific research! We need to know everything!

I am an older person and have been prescribed opioids for pain. I tend to avoid their use at all as the side effects for me are so uncomfortable, to me as bad or worse then the pain. I have had one complete shoulder replacement, and both hips (last one a week ago) Would the use of cannabis before, during, or after lessen the side effects for me?

THANK YOU for being here. Honestly, it is people like you that I think could benefit the most from true medical guidance on this topic. Some of your questions are the subject of my upcoming projects (does pre-surgical cannabis help post-surgical pain?). Based on the data we do have, we know that people with a very wide variety of pain disorders achieve very desirable outcomes with the help of cannabis (effective pain relief without the mental fog of opioids, the ability to get a good night's sleep, etc). They also experience very few undesirable outcomes. I would encourage you to talk to your doctor about it, or find a doctor who is compassionate, and in line with your goals!

Would you agree that cannabis isn't really meant to be combusted? I'm truly a supporter of what cannabis could be, but it seems that a lot of users look past the damage it could do to your lungs. What's your thought on this?

I wouldn't necessarily say that it's incorrect, but it's definitely not optimal. Any combusted/burning plant matter creates tar and hydrocarbons that you should, by all means, avoid breathing. The quick onset of inhalation, ease of dose control, and wicked technology of modern vaporizers makes vaporizing the most sensible choice, in my opinion.

I must say, I'm grateful for you replying! This is my first question on an AMA!! One last question please. Say I asked you what you wanted to do with your life freshman year of high school, what would it be?

When I was a freshman, this term didn't exist, but I was really interested in the concepts of behavioral economics. That translated to being a marketing, then psychology major. It worked out!

Thank you for doing this AMA. My question is: Do you need to decarboxylate the cannabis you use in research? If so, what method do you use?

Nope. I get THC directly from NIDA, purified in ethanol. It's crap. I'd much prefer a whole-plant extract, but it's impossible for me to legally obtain.

Have you conducted any research on the different consumption methods i.e. smoking raw flower, edibles, tinctures, or vaporized concentrates, and how the different types of THC interact with opioid receptors?

delta-9-THC is only one cannabinoid molecule of HUNDREDS in the botanical flower. Lots of research has shown (I'll summarize here) 1. Vaping is better for you than smoking. 2. A suite, or combination of cannabinoids (whole flowers) works much better than single cannabinoids in isolation. 3. CBD is a positive allosteric modulator of the mu-opioid receptor (it doesn't activate the opioid system itself, but it gives a little "boost" whenever opioids are floating around in the brain... even your own endogenous ones that are produced naturally). 4. Eating cannabis puts the compounds through first-pass metabolism by the liver... the liver makes 11-hydroxy-THC which is even more potent than delta-9. That's why its easy to have a bad time on edibles, but it's much harder to get "too high" by inhalation.

"3. CBD is a positive allosteric modulator of the mu-opioid receptor (it doesn't activate the opioid system itself, but it gives a little "boost" whenever opioids are floating around in the brain... even your own endogenous ones that are produced naturally)." Exactly what I was looking for, but has there been any research conducted that you know of on Delta-8-THC or THC-A or how effecive Delta-9-THC vs. 11-Hydroxy-THC in different treatments?

None to my knowledge, but this is EXACTLY the kind of rigor we need in cannabis science!!!!!!!!!!

Was getting your P.h.D. the hardest thing you've ever had to do?

Nope. Keeping up with my inbox for this AMA is WAY harder. So many more people will be disappointed by my failure!!!

I just found this question in /r/trees and thought I should forward it to you, maybe you are the right person to answer it:

Out of 100 THC molecules ingested (smoking) at the same time, how many THC molecules are actually absorbed by the human body on average? How many are excreted from the body unused?

original question by /u/KingDingledork

A very disappointing answer, I'm afraid: We have no idea. Even in states with the most rigorous testing requirements, we are still only measuring between FIVE AND NINE cannabinoids. This is a huge opportunity for research.

As a professor of anesthesiology, do you see any cannabinoid compounds that show promise for application in clinical anesthesiology?

Also, any other notable clinical interactions between cannabinoids and other anesthetics and/or opioids?

Thanks!

I can't answer your first question because it's the topic of an R01 grant proposal that I'm writing. Ain't no redditor gonna scoop this gal!

For pretty much every combination of cannabinoids and opioids, we see synergistic pain relief. Morphine, codeine, fentanyl... THC, WIN, HU210... mouse, rat, human... oral, intra-cerebral, spinal... you name it, the pharmacology comes out about the same. Edit: much of this work is in animal models.

How do you know cannabis molecules actually exist since you can't see them with your eyes? Or do you have some sort of X-ray vision which will one day, no doubt, be used for Evil?

Oh, my X-ray vision has been used for evil since DAY ONE, SON!

Don't call me son because back when you were still crapping yellow baby shit in your diapers, I was experimenting with marijuana out in the field.

Thanks for your data, old timer!