Chapters Transcript Show Me THC: Missouri Teen Cannabis Use Disorder in the Era of Legalized Marijuana Paul Glaser, MD, PhD, discusses how the mental health effects of THC on teens and how to incorporate it into clinical practice. Floating OK, you're good to go. Uh, thanks for joining us today for Uh, this next lecture in the Um, pediatric update. Through the Washington University. I'm Paul Glazer, a doctorate professor at WashU and uh been I'm happy to present today on A timely topic which is show me THC, Missouri teen cabinet cannabis use and um disorder in the era of legalized marijuana. So today we're gonna discuss some of the implications of Missouri's um legalization of weed and And uh hopefully give you some practical tips on how you can use it in your clinics uh or or wherever you serve. Um, teenagers or young adults who may have questions about marijuana in this. A new era So here's my disclosures, no conflicts of interest. I think the most important thing to say is I do not work at all for the uh marijuana industry, uh, so I can speak freely on my thoughts of the science behind. Uh, marijuana and it's As I'll say in quotes, and it's medicalness. Um, the objectives are here. I wanna help you understand why marijuana is getting legalized, um, explain some of the ways people use it, and Show how um it potentially does have a lot of Negative mental health consequences for our teenagers, uh, and why this might be important. For your clinical practice. Here are all the different sites where um. Teenagers are seen by Washington University physicians. Uh, I see most of these sites, although some of them are covered by our adolescent psych fellows. Uh, and we all, we do it through our rehab, um, organization called Preferred Family Health Care. And I'll give you some contact information at the Um, end of this talk so that you can contact us should you have a, a teen or a family who's looking to get some treatment for marijuana use disorder. Let's start out with a case. Uh, this was a case that Presented to me with the chief complaint of I wanna stop my medication. It was a 16 year old with a male with cannabis use disorder and recent hospitalization for psychotic disorder NOS. He had had symptoms of auditory hallucinations, um, overthinking, um, it had gone on for about a week, so mom noted this paranoia and took him to the emergency room. Uh, he was hospitalized for the This psychotic disorder. He was 3 weeks out of the hospital when I was finally seeing him and preferred family healthcare. He was doing much better. He did not report any voices. And the paranoia, mom, mom also verified that his paranoia had resolved. He was put on a small dose of um Zyprexa or olanzapine, 2.5 mg at bedtime. Um he had noticed some mild weight gain and some grogginess on it. In the morning, so he kinda didn't like his medicines, but he also didn't really think he needed it. Um, there was no family history of schizophrenia or bipolar disorder, um, only anxiety on mom's side, so that was kind of arguing against this being actual, um, No, psychiatric disorder that we were treating. Uh, the medical status exam on my exam was normal. Um, he did not have any disordered thingy. He did have some anxiety, um, but some of this was baseline anxiety that he usually, uh, managed without medicine in the past. Uh, he did reflect that he's not using marijuana anymore. He does plan to stay off the weed, as he calls it. He wonders if the psychotic symptoms were from from stopping the cannabis use, so he kind of thought the opposite. He wondered, you know, cause he had stopped weed, but he was still paranoid the day before he went to the emergency room, um. And then finally we, you know, we discussed how probably it was uh marijuana itself that could have been causing the psychotic symptoms, but we couldn't prove for sure. But I did agree that we could stop his medications and see how he does um without medication and without um cannabis in his life. Now before I get on to some of uh his case will come up later in the talk, but I wanted to first switch to um One of the first times I encountered marijuana in my life was I was getting my PhD in the Uh, laboratory down in the basement of the East Building in Washington University, and Um, one of the projects my mentor wanted me to help out with was finding ways to synthesize anandamide, and I'm like, well, what's ananamide? And he's like, well, it's just newly discovered as the um endogenous ligand for the CBD or cannabidiol receptor in the brain. Uh, of which TAC is a component of, and there you can see there's a picture of a nanamide. Uh, NANDA stands for Sanskrit for peace peacefulness. And it does have an arachedonal backbone, as you can see uh from the structure. Not entirely um analogous to THC, but for some reason they both hit the um active point of the cannabidiol receptor. Um, We now know there are actually two endogenous ligands. One of them is the ananamide, the other one is 2 arachidonolglycerol, which also has the arachedonic acid as a backbone. Um, these can also, um, you know, they're full agonists at the nabinoid receptors. Of note those, both of these have a very short half-life, um, on the order of maybe seconds to minutes. Um, in the synaptic cleft, they're thought to be, um, post-synaptic um hormones that affect synaptic input, and they're down regulated very quickly after firing. Um, so, so they actually they hit the cannabinoid receptor very differently than THC does. Here's a a quick picture of how the cannabinoid system works endogenously. You can see some of these compounds are generated post-synaptically, and then they hit receptors on the presynaptic or sometimes modulatory aspects of astrocytes. And they modulate how much neurotransmitter is released. I should say here that THC, by the way, is an active agonist for the CB1 and CBT CB2 receptors, whereas CBD cannabidiol, you may have heard of, is actually kind of a modulator of this receptor and makes it less reactive to THC, so it's actually somewhat protective to the effects of THC. Uh, and then Yeah, I think Uh, the, we think that these are involved in the generation of pleasure or peacefulness or um satisfaction, maybe uh oh say you're at a concert where one of your children is performing uh a solo for a choir, and you just have this general feeling of well-being and happiness that that you're Um, offspring is really performing well. Um, some of that perhaps is, um, generated by cannabidiol, or say you're doing yoga or some other form of mindfulness meditation, uh, and you just have a piece about you. That's probably, you know, it's, it's usually gonna be short-lived because these are endogenous ligands that are closely regulated, but, um, that's what we think the brain uses these. Uh, mechanisms for. So, um, you know, there's other factors that may be involved with it, such as a neuroprotective factor or cannabidiols, and, um, No. We hope someday that there might be some treatment, uh, but there's, as of today, there's no known um agonist therapy for THC um use disorders. Now, the difference, the big difference here with THC is it has prolonged exposure to the CBD or CB1 receptors. So it's really going to hit that receptor hard and hit it for a long time. So this is just not very natural. This is not how the natural ligand works. And so we think a lot of these factors, especially if we go to animal models, really cause some of the troubles that THC is causing on any brain, especially the teen brain, but also adult brains. Uh, and as you can see in the, the mouse results show that um chronic THC, uh, use leads to anti-immunosoception, hypothermia, hyperactivity, and catalepsy in mice. So a lot of the, um, temperature regulation which, you know, most teenagers will tell, tell you they, they sometimes will feel that is, uh, especially if they're withdrawing, they'll feel hot sometimes. And then hyperactivity and catalepsy are kind of equivalent to the a motivational state that a lot of uh humans get with THC. And once again, cannabidiol itself is probably protective. And it's useful to have higher ratios. Now, cannabis is a true substance of abuse. It does have this tri trio of addiction that other drugs have. It's certainly is at lower levels, so it's much less addictive than nicotine, but um it's definitely not 0%. We now think with some of the higher concentration THC products, this is probably around 20 to 30% of adults can get addicted to THC. Um, we now have some early theories to say that since cannabidiol is helpful and protective from some of THC's addictiveness and effects on the brain, that probably the most useful combination of a THC CBD ratio in any product for marijuana would be where you have around 1 THC to every 6 cannabidiols. Um, but this product is not very well, does not sell very well, and so a lot of the medical, medical, in quotes, once again, marijuana shops, uh, and a lot of teen users as well, rarely use products that have any CBD in them at all. A lot of them, the current, um, Hybrids of weed, as well as. Um, You know, THC vapes will have little to no CBD in them, and this was shown in this recent study where they went to different states where there's legal marijuana and look to see. What percentage had this very the most protective and helpful medical aspect, the 1 to 6 ratio of THC to CBD. And you can see in the blue that some states don't sell any of it, and those states that do have it have a very low percentage. And most of the most of the the cannabis products in medical marijuana shops. are very high in TC and very low in CBD. So once again, more addictive and more dangerous to the brain. But also, since they are more addictive, they also sell the best, so it's understandable that those wanting to make profit um will sell our our patients the The um most addictive compounds in the, the products that they want, and that that they say are the most useful for them, um, but indirectly we, we know that they are probably not. Um, you know, marijuana has been around for a while, as And FDA approved medicine, mainly for chemotherapy-induced nausea and vomiting, and uh some indications for uh for actual CBD and hard to treat epilepsy in children. Um, there are, I think, also some for um high pressures in the eye. Um, so, but other than this, there's really no indications for a lot of the things people get a medical marijuana card for. There's no indications FDA wise for anxiety, none for depression. There are some PTSD studies in combat veterans that show some positive effects of um smoking marijuana, but um those really haven't led to any FDA approvals. Um, so, a lot, you know, all this is, is off label. Um, and You know, there are other motivations for why People are voting or why companies are pushing a lot of information on the internet to say that there's all these medical indications for weed when really they are not. It's, it's really at the level of a food substance right now, uh, which lacks a lot of regulation. Here's the actual time course for approving medical marijuana back in 2018 in um Missouri, and as you can see, it took quite a while, but um They, they released it. Uh, well, the vote was, you know, about 2/3 of people were voting positively for medical marijuana. And uh here's the sales over since it was legalized and came out in 2020, so it just skyrocketing every year. Um, and I think this is in Millions, so there's so 529. No, I think it's 529,000. Um, Dollars are being spent per year in medical marijuana in Missouri. Uh, they actually, you know, there, there's mostly scientific data out there. Some of it is supported by the marijuana, uh, companies, so they're positive. There are a few anti-marijuana companies out there that support research. One of, this is one of the ones that was against it, and they showed that. Uh, called the Centennial Institute. They showed that for every dollar that a state, Colorado got in tax revenue from marijuana sales, they spent $5 more dollars in healthcare costs, usually from um either high school dropouts or um Trips to the emergency room from, you know, marijuana. induce vomiting and other reasons people might go to the emergency room. So we really don't know much about teen outcomes yet. Um, here's where the, uh, medical marijuana patient license have been mostly sold, as you can see a lot of them are in Saint Louis and Kansas City, a little bit in Springfield and, um, Columbia there, uh, but Uh, if you look at patients per 100,000, Here's where a lot of, and this includes, by the way, adults. Um, you can see some counties actually do have some pretty high use even if there's not a lot of, not as many people living there as, say, in Saint Louis County. Uh, so why, so many implications for teenagers. Uh, but one of the biggest one has been that we've always kind of known from this monitoring the future study that the more teenagers think marijuana is dangerous, the more they don't use it, and vice versa. If they think marijuana is safe, the more they will try it or use it. And so the the basic message that most teenagers have got, and you probably have talked to your Uh, patients, and, you know, they'll tell you, it's not dangerous, it's a lot safer, you know, they should, they should make alcohol legal. It does more danger to us than than marijuana. So teenagers just think of it as being a very safe thing to use, and yet we really have only, you know, the scientific data we have only supports that before the age of 18, marijuana use is not that safe. Uh, the Cato Institute has filed this in Colorado and through the United States, and sure enough, the, the perception of marijuana being a great risk has been um decreasing in teenagers. Uh, why, why, why is some of the neuro neurobiological reasons why we think that maybe this is a problem? Well, we know a lot of the brain is still developing in the teenager years, um, the biggest ones being these prefrontal inhibitory synapses, which are basically from the frontal cortex to the motivational centers and lower centers of the brain, and they basically in an Inhibit behaviors such as making sure you make a wise choice as an adult, not being impulsive, um, saying no when you can have higher level reasons of knowing why a drug might be dangerous to you, even though you're in a situation where everyone is wanting to you know use a drug along with them. So if we don't develop these centers, we end up with fairly immature, um, less You know, adults, um, choosing adults, uh, and that's mainly why we think marijuana is also Dangerous before the age of 18. Uh, and here's some of the other structures that are affected. I think the main thing to know with THC is that it seems to trigger something in the prefrontal cortex that tells the rest of the brain, I'm OK, everything's good. So even if the world is falling around them, or everyone is mad at them for, you know, being lazy or um flunking out of 8th grade because they start Smoking weed. Um, their brain says, no, I'm fine as long as I've got my weed, life is good, and I've got other things in life to pursue. Why do I need to follow all these things that other people want me to do? Um, here was the scariest study that's still, um, we quote the most, which showed that if you use weed heavily before the age of 18, You have a permanent loss of IQ, um, thought to be around 15 points from this study. If you use weed heavily after the age of 18, you don't show those, um, losses in IQ. So, uh, I, you know, I, I do use this paper sometimes when a teenager is open to some of the sciences. Um, not all teenagers believe this. Uh, we know from the monitoring the future study that there were changes in weed use, uh, during the pandemic, mostly an increase, um, whereas other You know, especially like I know it's a lot of my patients said they weren't vaping as much cause they weren't in person at school to share their vapes. And sure enough, cigarette smoking went down as well as vaping. Um, but marijuana, vaping and smoking are one of the rare drugs, and a lot of my teenagers during this period said why, you know, you know, so well, why do you use weed? They're like, well, I'm bored. It's, it's helps me pass the time. Uh, and then we do know from mental health changes from monitoring the future study that everything, including anxiety and depression, went up during the pandemic. Now some of those have calmed down with it back in in-person school, but I would say, especially the rates of um anxiety and depression still remain pretty high and higher than pre-pandemic levels. All right, monitoring the future, um, did show that there were um higher levels of marijuana use. Um, they never recorded it since 1988, so it does appear that there does seem to be some national spike. Um, this data goes up and down a little bit, whereas most other uh drugs of abuse are going down for most teenagers. In the monitoring the future study at least. Alright, let's um If I go back to this slide here, you'll see there's a lot of things going on in the brain. In in utero. This is fertilization to age 0, so many different processes, including migration, proliferation of neurons, arborization, and myelination all start in utero. So we do have this one recent study out to show how dangerous. Um, we can be in utero, and for those of you who do have patients who are pregnant, or may be getting pregnant soon, one of your areas of counseling to say would be that we now know, um, marijuana and THC are very dangerous to the growing brain in utero. And here's an example, for example, on the externalization, um, scale, which monitors like, um, risk of ADHD and oppositional defining disorder, and you can see there's an increase for these 8 to 10 year olds if they were exposed in utero. Uh, here, if they were exposed before the mom knew they were pregnant and then she stopped using weed after she was pregnant. There was still an increased risk over those um that had no exposure at all. So we're, um, and there was, and this showed for many different markers of mental health. I'm just showing here for one marker. Um, so, we now know that uh marijuana is very dangerous during pregnancy. So to summarize, a lot of science, not only that, I prevented presented a little bit, but a lot of other science, we know these things as uh as being true for THC effects on the team brain. that it decreases cognition, it decreases short term memory and long-term IQ, that there are many studies to show that it decreases educational achievement, such as not um passing. Uh, are graduating high school, uh, it also decreases the amount of adults that go to college or get a higher degree. And it also decreases motivational occupational achievement in teens and adults. So, one of the most typical ones I find in my population is they were very involved in in their sports or their hobby, and after smoking weed, they kind of dropped their sport, they dropped their hobbies. Um, and their friends changed to just weed smoking friends. Uh, and then we do know also that there are several good studies now to show that teens have increased risk for anxiety and mood disorders if they smoke marijuana. They definitely have increased risk of schizophrenia and other psychotic disorders such as bipolar, and they have increased risk of other substance use disorder. Marijuana is a is a gateway drug, so to speak, for some patients, not all patients, but for some. All right, let's switch over to some clinical stuff. One is I would encourage you to learn what vapes your patients are using or ask them about um nicotine along with their um cannabis use. Uh, Last Marys are still fairly popular. These are disposable vapes, and the views of the most popular, um, potted vapes where you buy the pot and you charge up your unit like an old jewel would, uh, and all of these have very nice, uh, fruity flavors that keep the sales up. More popular in the last couple months has been geek bars. Here's a blue black cherry one. What the teenagers like about this is they can buy it and it'll last a long time. So here's 15,000 hits from one geek bar, and they like they like that they can tailor um Uh, the Heat and the pressure that's involved behind their hits. So, just ask if you wanna impress your uh team patients, ask them if they've been using a Loss Mary or geek bar lately. You might get some interesting looks. And, you know, even though this is about marijuana, I, I, I think that the co-occurrence of both nicotine and weed use is very high, uh, and we'll go into one of the aspects, which is the blunt. But before I go to blunt, this just shows you the most recent, um, youth tobacco survey showing that that vapes and cigarettes. Uh, cigarettes are going down, but vapes are going way up. Here's for high schoolers and here's for middle schoolers, um, and, and you can see a large rise in red there for both any tobacco product, but especially e-cigarettes in our middle school kids. That's a little shocking. Um, it seems to be fairly um spread throughout all races and ethnicity. Um, so, nicotine definitely practices DEI. All right, so how, how do, uh, today's Missouri teenagers like to use their weed, and here's a couple of YouTubers that are showing you how to Use your weed. Um, this one specifically is showing you, uh, a cigar wrapper and how to take out the tobacco and put in marijuana, so you can make a blunt. Here's what a blunt is, it's a tobacco wrapper with cannabis. replacing the uh Tobacco, uh, of note though is that there's nicotine in The rapper still, even if you've taken out the, the tobacco. So, when using a blood and a lot of, especially my inner city, um, Saint Louis teens, that's their favorite way of doing marijuana. Um, you're gonna get addicted to nicotine as well cause it's in the wrapper. Not as many teenagers use joints, which are just a a rolling paper with the bud or the weed. Uh, dabs are still used somewhat, they're concentrated, uh, use has gone down a lot since there's been, um, THC vapes. Uh, and then here's what a dab cart or dab pen or TCAt, there's lots of different names teenagers use, but here's what they look and they'll have this orangeish liquid, and this is usually around 70 to 80% THC concentrate. Uh, and doesn't, uh, you know, the things teenager likes about, like the thing that teenagers like the most about these is that it's very concentrated, so has a very intense hit compared to a blunt. Uh, and they also like that it doesn't smell as much, so they could get away with maybe doing a couple hits with their window open in their room and their mom won't notice it if they cover it up with a little um. Uh, Lysol spray or um Febreze. All right, we mentioned earlier about the science showing that TC levels um have been getting higher and CBD is getting lower, being, you know, making it less. Making it more addictive and less medical, and here, um, shows you the rates, you know, a tripling of THC levels in the seizure of DA. And this is basically selective breeding by cannabis breeders who know that um if they make a higher THC flower or bud, they're gonna sell more. Uh, So, let's move on to some of the things we see in rehab, so we're, you know, we are able to admit, yeah, especially if a teenager's court ordered because they got in trouble with the law because of marijuana, um, we can get them cleaned for 2 to 3 months through preferred families residential rehabs. Here's some of the actual marijuana withdrawal symptoms. I mean, most teenagers will not have any withdrawal symptoms, but some of them will get some of these. You know, decrease appetite, uh, the night sweats I see fairly commonly, anxiety and depression can go up, um, insomnia, um, so, you know, there are true withdrawal syndromes. We talked a little bit about um cannabis levels again. There are a few companies and a few states that have Um, banned the use of the high concentrate. High percentage THC products. So, Uruguay and Vermont are two very distinct states um that do not use um concentrates, but most other states, Uh, and countries like Canada use the higher THC products, and I, you know, if I, I bet you if you went into any Missouri, um, Marijuana store, they would tell you that the concentrates are are big sellers and make them a lot of profit. Here's just another piece of scientific data to show that in Denmark they have some very well-controlled studies, and they now estimate about 8% of their patients with new onset schizophrenia are caused specifically by cannabis use disorder. So even though we know schizophrenia has a large genetic component, it now turns out that 8% of patients with schizophrenia. are specifically um Cannabis use induced and then they uh have lifetime schizophrenia after that. And no doubt they'd have to have their own genetic risks as well, but Um, the indication here is that they hadn't used cannabis, there's probably about 8% of the population in Denmark that would not have schizophrenia. Here's that um syndrome for those of you who do work in an emergency room, uh, cannabis hyper cannabinoid hyperemesis syndrome, fairly well known now to ER docs because they'd see it a lot in any state where there's legal legalized use, um, and It is hard to treat, but the only treatment we know now is by exposure to something hot. So if you take a hot bath or a hot shower, um, it immediately calms the hyperemesis, um, and a lot of emergency rooms are using this now. Um, we did an evaluation in our teens, uh, and looked at some of our retrospective data from 2018 versus 2022. And sure enough, we found that, um, in 2018, most teenagers were using the lower THC versions, the blunts, um, there was less of the, the, the high concentration damps, and by the way, the vapes, the THC vapes didn't even exist back in 2018 for You know, unless a few rare would get them maybe from California. But in 2022, by the time recreational weed came around, a lot of the teenagers have moved to the higher concentration carts, uh, and much less are using blunts. Um, once again, blunts are still fairly popular in the um inner city of Saint Louis and Kansas City, but not in the rural or suburban areas. And, uh, the inner city kids, they like the blunts because they say they burn slower, they can pass them around. Um, and we get sad comments like, well, it's not like I'm gonna make it to 20. The once again, the suburban kids like their TC cards cause they don't leave a smell, um. You know, my mom thinks it's a vape, so they can sometimes get away with um You know, adults not even knowing what these THC vapes are. Um, so, at least in Missouri, we can say that there have been an increase in use, uh, from our small study in higher concentrate THC products in our teenagers, and, um, you know, what some of the small fringe benefits that we see is at least some of the teenagers are using, you know, the legal safer uh THC products, and they're using less of the unregulated wheat. That that you would buy on the streets. Now that is still cheaper, um, but even those illegal products sometimes are from stores, so they'll be less likely to be tainted by other drugs such as fentanyl. All right, and here's CBD getting more and more um Well, I, I'd say it's since it's so expensive, people don't use use it that often, but you know, now know it's fairly safe, um, and can be used um off label for uh sleep and anxiety uh in dogs and humans. All right, so I think it looks like we're getting Oh, I think we have a little bit of time, so let me, let me do a little quick um talk about other things that people can buy legally, not from an actual marijuana shop, but from these new, um, kind of, uh, health store like shops that sell different forms. Here's outside uh Deer Brooks by my house, where you can buy legal THC without a card, uh, and without, now they won't probably sell to you if you're Underage, but they'll sell you things like Delta 8 and HHC. So what are those other products? Well, it turns out, Delta HTC is about 50% less potent if the store gets this um purified from, especially if it's purified from hemp, which is legal, uh, um, they can sell it. Without any medical marijuana license to any anyone. Um, and they were selling it even before, um, recreational marijuana was legal and Um, Missouri. Here's TCO, which is a synthetic product. It's 3 times more potent, uh, and we were getting some teenagers back when these first came out, uh, 4 or 5 years ago, we were getting some and um going to the emergency room for psychosis cause they would take too many of these products, not knowing how concentrated they were. Here's HHC it's actual, um, hydrogenated um natural version from extracted from cannabis. It also um is less potent than delta 9. Um, but Uh, sometimes since these can take longer to kick in, teenagers will take too many of them before they start feeling the effect, and then by the time they are feeling the effect they've ingested um too much and they start to get psychotic. Um, both the AAP and the ACAP, the Child Adolescent Academy are against medical marijuana being Um, So underregulated in our country, and they really wish um that we would have better control studies for the actual negative health and brain developmental consequences of marijuana exposure in children and adolescents. So here's the ACAP. Um, So I think anyone who works with children and teenagers know um this is really an unregulated industry right now that's making a lot of money, and there's a lot of false information out there. Not that it's gonna put every teenager in danger, but I think we are gonna see some health, um, bad outcomes as this national experiment, um, uncontrolled experiment goes on. And we really, um, we should try to get marijuana off of control class one cause it makes it so much harder to study and you need so many other, um, forms to be able to be in the site to do research on it. Um, so I, I agree that we should decrease the control status of marijuana for that. And this is just some of the critical reasons why they're out there. Now, is there any treatment for teen cannabis use disorder? This, this is really a, a kind of a big no. There's a, there's a few things that maybe help a little bit. Some data to say that anestheial cysteine. There's the dosing there if you wanna try that, and naltrexone. I've had to help a few patients, uh, but most teenagers who have ever tried this say it doesn't really help that much. Um, so, you know, we just need more research there. You know, adding cannabidiol. You know, the protective one there, um, that could be useful. All right, so what, so what happened with my um 16 year old patient back from the beginning of the talk, who went off their um marijuana. Well they um They basically relapsed on marijuana and then they went back into the hospital. Uh, and I by the time I saw him the second time, uh, it was 2 weeks out of the hospital. This was like 6 months after. Um, he had been the head of the first hospitalization. Um, when I saw him the second time, he was still very paranoid and somewhat grandiose. Um, he was now on zipprazodone, or, um, Gdon 20 mg twice a day. He was getting some fatigue on it, um, and he, he did admit that he had used a THC card prior to his psychotic break. Uh, and then, you know, he noted being amazing on um mental status exam. He had been quitting caffeine. As well as cannabis, so he, you know, he, we did go up on the Tan to try to help some of this residual, um. Kind of like Psychotic symptoms? Uh, when he reflected on his marijuana use, he said, well, both times I went to the hospital, I had the same pattern of using weed. I would start casually with my friends, usually just smoking a joint or blunt. Uh, but within a week, I would escalate to daily use and then I would switch to the concentrated dabs or carts to get the same feeling. And eventually the carts would make me paranoid. So, You can see at least in this one patient, um, he did have a pattern of increasing use and increasing addiction, and then that led to his psychotic breaks. Um, so, you know, the bottom line for him is that we, um, No, he did stay off weed and as long as he was off weed, he never had a relapse again. The last I saw him, he was a server at a restaurant. I think I saw him 6 months ago, and he was doing well, and he said, That he, um, yeah, he was just motivated to stay off the weed still because he knew he would put him in the hospital. So you're gonna have patients like that. And this is just to remind you how small of a margin that recreational uh marijuana passed in Missouri, and that a lot of the states um have not been passing it. So, um, although it does seem like most states are slowly getting marijuana. Um, legalized either as medical or recreational. Um, there is some resistance building, um, some of it is being started in Colorado where there are a lot of legal suits against the state, or some of the medical consequences of, of marijuana. So we'll have to see how this pans out in the political world, um, as lawyers go for their Um, Uh, they're a piece of the pie. So, um, as, as I finish up, let me talk about some resources. Here's some, um, Proper websites, uh, here's an AP paper and, uh, uh, a smart approaches to marijuana, preventing another big tobacco. So those are websites you can go to. Here are the numbers for preferred family healthcare. If you do have a teenager that's truly motivated to try to get clean, rehab would be helpful for them. Or if you have parents or, or a caseworker who wants to put them into treatment against their will, um, a little hard to do, but, uh, we could try to help out with that as well. Uh, and if you have questions, please, um, either look, look up, uh, my website on watch you for my email, or you can also contact, uh, The uh CME people at WashU, uh, and they will contact me with your questions. So with that, uh, thank you for your attention. And 420. Created by Presenters Paul Glaser, MD, PhD, Director, Adolescent Substance Use Education View full profile
