Dr. Hurd and I discuss the causes and potential solutions to the opioid crisis in the United States. We talk about the differences in marijuana in the 1960's and now and the benefits and problems with the use of THC and CBD in senior adults
I'm Larry Barsh. And you are listening to specifically for seniors, the podcast, for those of us in the remember when generation
Today's podcast is available, wherever you listen to podcasts and in video and audio on Spotify and on the specifically for seniors, YouTube channel, we are honored to have as our guest on specifically for seniors, Dr. Yaman herd, Dr. Herd is the ward Coleman chair of translational neuroscience and the director of the addiction Institute at Mount Sinai hospital. Her research investigates the neurobiology underlying addiction disorders and related psychiatric illnesses. Dr. Herd's research has put the spotlight on her pioneering work on the effect of cannabis on the developing brain. Her research was featured as the cover story of the time magazine issue in may of 2015, entitled to great pot experiment and in a CNN documentary with Dr. Sanja gutta. Welcome to specifically for seniors, Dr. Herd,
Dr. Hurd (01:36):
Thank you so much for having me.
I'm gonna put on a brief video from your Ted talk
Dr. Hurd (01:46):
Over the past 20 years, more than 800,000 people have died in the United States due to drug overdose. Yes. More than all the lives lost in all the wars. This country has fought in. The majority of these cases are due to opioid drugs. Sadly, while we're having this very conversation, at least one person will die from a drug overdose and a child will be born experiencing severe withdrawals due to in utero. Opioid exposure only recently have some pharmaceutical companies been held legally responsible for the opioid crisis and compared to their multibillion dollar revenues, the economic penalties they're paying seems minuscule.
Dr. Hurd (02:36):
So let me ask a question. Why does addiction and the stigma of addiction make it okay to undervalue human lives? Ironically, I'm often asked the opposite question. Why should we care about addicts? Sometimes I'm even shouted at, by people who think that anyone who suffers from a substance use disorder brought it on themselves. They must be weak. They lack any moral compass and therefore don't deserve any help. But if you know anything about opioid addiction, you know, that this population does not fit that stereotype. Not that any addiction ever really does. These are mothers, fathers and grandmothers, they're teachers, business leaders, cheerleaders, athletes, nurses, and bus drivers. They're your brother or sister. They represent every fiber in the fabric of our society. Each person, yes, each person came to addiction in a different way, but a major cause of the current epidemic is the medical over prescription of opioid drugs for the treatment of chronic pain.
So let me ask you a question, what makes this epidemic different than other epidemics?
Dr. Hurd (03:56):
This epidemic is different in the context of what has driven it. So what drove this epidemic? As I mentioned in that, Ted me piece was the overprescription of really potent opioid drugs for the treatment of chronic pain. And many people obviously trusted their physicians. The physicians trusted the pharmaceutical companies who said that these opioids were safe. And only if you had certain personalities, quote, unquote, that you know, these opioids would not affect you and that we know is not true. So today I, I mean, when I, you know, look at that Ted bed piece, more people have continued to die and, you know, over the past five years, if we've even had nearly a doubling of people die with overdose. And that to me in this country is, is horrible. And, you know, a lot of that is even driven in the past two years with COVID where the isolation and, and continued stress has made a huge difference.
Dr. Hurd (05:05):
Plus today, the opioid epidemic is continued to be driven by the introduction now of synthetic extremely potent opioids, such as fentanyl, they're highly, highly addictive. And you know, the cartels and, you know, the different people who are selling and pushing these toxins, I call fentanyl, it's really a toxin into our society. They only need a few, few little grams to cause tremendous harm because fentanyl is nearly 50 to a hundred times more potent than morphine. So tho that combination of the initial overprescription of opioid pain medications, and now the new synthetic Canna opioid, sorry, that are in on the streets, that has become a huge problem.
So how do you begin to even treat a major opioid epidemic?
Dr. Hurd (06:07):
Yeah, that is the issue. So, you know, I don't know if many people, most people may not realize that we do have significant FDA approved treatments for opioid addiction for actually over nearly over the past 50 years, for example, methadone, but these treatments and now are newer opioid agonist. They're kind of replacement therapy, they're opioids themselves, but they're not as, you know, they're controlled people, they're not as addictive. And so you, you get it from clinics that have to be monitored, right? These opioids may be diverted to the black market. So there's a lot of oversight and clinicians are only allowed to prescribe in a certain way, the, these opioid agonists. So it, it's very cumbersome to treat, you know, hundreds of thousands of people with a medication that they can't get on a pharmacy that it, you know, it has such restrictions COVID has loosened up some of the restrictions, but that becomes a problem. So how do you treat an opioid epidemic? And for me, you know, the question is what have we learned scientifically about developing non-addictive treatments that could potentially treat opioid addiction? And, and that's when part of my research started to look at cannabidiol C, which is a component on the cannabis plant
With the federal restrictions on these drugs, like marijuana. How hard is it to do the research?
Dr. Hurd (07:44):
Well in the beginning I mean, it's a very long story. We don't have that much time, but you know, in the beginning, when I started looking at this, I was actually not looking at cannabis for as a medication. I was looking at it in terms of the developmental effects of cannabis on the brain long term. But I wanted, when we did our animal models, we were always using THC and THCs that component of cannabis that gives the reward the high. And so I wanted to look at at least another cannabinoid that was in the plant and CBD cannabidiol used to be much higher in concentrations in the plant. And I said to my team, let's at least look at that. And I was surprised to see a different effect when to THC, namely, when we normally would give THC, it would increase heroin, self administration, heroin reward.
Dr. Hurd (08:34):
When we gave C B D it actually decreased heroin seeking behavior in our animal models. And so I quickly went to human clinical trials to see whether or not, but indeed decreased craving in, in humans. And it did. And in our small pilots, we then, you know continued those studies, but it was so tough to get CBD to, to, to, for our clinical studies, because it was considered cannabis, even though CBD is not addictive, it doesn't produce euphoria or high. And I remember my clinical coordinator, she had, we had to have like a security guard, follow her from the pharmacy to our, our clinical lab to give it to, to our study participants for a drug that is not addictive, has no abuse potential. And because it was under the federal laws, it took a long time for me to get my research started. And when we did, it was just a little ridiculous. Now the laws have changed federally for C B D that's derived from hemp plant because it's no longer it's under the farm bill. And so you, it's no longer a scheduled drop, but there's still some challenges.
So let's switch direction a little bit and talk about cannabis as a whole. That was the basis of your original research. About 70% of states have legalized medical marijuana, about 15 states have legalized recreational marijuana. So is it safe?
Dr. Hurd (10:19):
You know, that's a, an important question and it is funny many people don't ask me the question in the same way that you have just done. That's very direct. And that's a question that we all have when you're, when we are saying that something can be used by the majority of people in, in the country that it's medicinal and that recreationally, they can use it. Our questions should be isn't safe. And I can say that that's a complex answer because it depends on a number of factors. One, we know that cannabis today is very different from the cannabis that was, you know, when you see the sixties, seventies, hippie love generation and all of that, the cannabis, the THC that's the psychoactive component in cannabis that was in the plant. Then's about 4% today. It's like 15 to 24% THC. And there are strains with over 70% THC and kids dabbling a way of taking cannabis now with nearly 80, 90% THC.
Dr. Hurd (11:24):
So it's a completely different drug. It really is very detrimental, very hard hitting on the brain. So with high concentrations of THC, those are not safe. Another thing that comes back to safety is that these strains that as they've increased the THC concentrations, they have decreased C B, D, and C B D cannabidiol. We see had protective effects. And so that's another thing, but a third thing about safety comes back to who's taking it. So a lot of research I've gone in and seen that the developing brain is extremely sensitive to cannabis. So we see that it increases it, it changes the brain to increase the risk for psychiatric disorders later in life. And that is a huge problem. So that to me is a important aspect about safety. When we are talking about, you know, who can use these, these, these very potent drugs, but they are cannabis is now a very, very potent drug. It's not some mild thing, you know, as I said, that people used to consume, and it it's very different
In a household with kids and parents who smoke weed, does secondhand smoke have a deleterious effect like it does with cigarette smoke?
Dr. Hurd (13:00):
So, I mean, a number of studies are currently going on to look at that, but the CDC, I mean have shown one more children today are indeed being exposed to secondhand cannabis, similar to what you just mentioned as to sick secondhand cigarettes, more so than ever before. And it comes back to that, obviously, since it's now legal, many more parents are using it at home research in mainly when you can look at preclinical, animal models have shown that it does have an impact. So the, you know, early life exposure to THC in particular does change their children's vulnerability to anxiety disorders aggression, things like that. And we see that even in, we have a study that we looked at the prenatal effects of cannabis and have been following their children for a number of years. And you can see that the children definitely have increased behavioral clinical. It's not just observational is clinical behavioral maladaptive, you know, responsive, like I said, aggression, anxiety hyperactivity disorder. So there is something about, you know, as I said, if we are in household that the parents use cannabis, it's really critical that they keep it away from the children and that they should realize that, that there is an issue of secondhand smoke that gets into the kids.
Another thing that concerns me about this recreational use of cannabis is the effect on driving ability. I'm located in Florida, where the driving is bad enough as it is without a immediate test for cannabis. And let me say, intoxication, is there any way to prove a, a disabled driver?
Dr. Hurd (15:07):
Yeah, I mean, so one of the things that's happening more and more, they are trying to de to develop, and there are few devices being studied right now that law enforcement can use just like the, you know, inhaler for alcohol content. They're now developing that for cannabis for particular THC, definitely when they've taken blood levels of people who have been driving, you know, under the influence, they see that there is indeed a, a significant percentage of people and in vehicle vehicular deaths that indeed had cannabis in their system. So we know, you know, we think about when people consume cannabis, you know, recreationally to feel good, get high. One of the things that cannabis also works on in our brains is our, our motor coordination. So it's not surprising that if you, you know, recently consumed cannabis, your motor coordination is gonna be off. And so that's what they are seeing when they look at, you know, the data of people who have been driving quote unquote, under the influence. And it turns out it's not just alcohol, that they do see arise in cannabis THC content in their bodies or blood, I should say,
Mm-Hmm, <affirmative> let me switch over to basically the audience of this podcast, which is mostly senior citizens. The use of cannabis in seniors has increased dramatically. I think, with the lifted restrictions on the sale of medical and recreational marijuana and media articles touting the benefits of cannabis for the elderly, for relief of chronic pain, depression, headaches, insomnia, dementia, everything. Yeah. Is there any validity to this?
Dr. Hurd (17:12):
So there, you know, again, a complex question because the answer is complex because we don't have all the answers BEC there's a lot of research that our net that's now in place to be able to answer those questions. So I'll start with a couple of things, as you know, what we saw in, you know, in the developing brain and cannabis exposure, it, you know, impacting on and anxiety, an anxiety promoting anxiety, promoting cognitive decline, and so on. There are some studies that you actually see can see the opposite in senior adults, meaning that cannabis THC in particular can improve cognitive, but this is where perhaps then, you know, these, those studies gets blown up and get into the media. That cannabis is now the cure for everything. And when you look at the use of cannabis in studies of senior adults, it's low dose cannabis.
Dr. Hurd (18:17):
It's not about the recreational cannabis, it's low dose cannabis. And we're still trying to understand why at the both ends of our developmental you know, life that we see the opposite effects that bad cannabis went early and potentially having some, you know positive impact on conviction. Later in life, we know that our natural and endogenous cannabinoid system, we call it the endocannabinoid system that by many other systems, it decreases as we get older. And the endocannabinoid system is really critical. I mean, aging is a natural physiological process and we all want healthy aging, but that comes with some gradual continuous decline for a number of things, including cognition. The endocannabinoid system might parallel that decline. So perhaps low dose THC might help to bring back some of the homeostatic balance, but we don't know who may benefit and who may not. And as I said, dose matters.
Dr. Hurd (19:24):
So it's not for seniors to go and smoke the cannabis that their grandkids might hand them because those are extremely potent. And in fact, we see the opposite effect. We can see that it produces very detrimental effects even in the seniors and even to the aspect of confusion, increased confusion motor problems, so that people fall down break bones. I mean, that's the, the thing that, so it's the cannabis preparation matters for seniors a lot. And we still are also trying to understand this aspect about chronic pain and cannabis. And there are now studies going on with CBD Canol to see if that could also alleviate pain. We know that it alleviates anxiety. There are not that many studies with CBD in, in senior adults. And those are things, I mean, studies that are, I think a few may starting. And I think that that's important because some animal studies showed that it actually was not beneficial in their senior acts. So it's those matters the combination of THC and C B D matters and what you're trying to alleviate so pain, there's still a lot that people don't know. And then you might need a little THC, but that's the thing that, as I said, you know, there are so many questions that are left unanswered, not only for senior adults, but in large part, that is an important question for us, because as you said earlier, we do see this huge increase in cannabis use in, in, in the elderly population.
But there's no way reliably to tell what the dosage is on the percentage of either component,
Dr. Hurd (21:16):
Not right now, unless you wanna participate in a clinical trial <laugh> so, yeah, exactly. So you're not going to like, you know as I said, if you get it from your grandson or granddaughter, our daughter, you know, in the sense of they're not gonna know what's in there, are, are there dispensaries and that sell cannabis in an, I would say ethical manner. Yes. However, even when they have, they are supposed to have the contents of the, the, the product, the cannabis product, so everyone could understand it, but they've gone in and tested a number of those products and the content is even incorrect.
Mm-Hmm <affirmative>. So
Dr. Hurd (22:01):
I think, you know, it's really critical to whatever decisions, you know, people take about using cannabis or using C P D. They need to make sure they talk with their doctors as well. And as we get older, many of us will start taking, you know, different medications, right. And these cannabis does and can interact with a number of medications. So that's a thing I think as well, people think that cannabis is benign and it does, you know, it's not like other drugs, like heroin or cocaine, but it is a bioactive substance that, you know, interacts with a lot of your, your most organs that will tell you contain cannabinoid receptors. So when you're ingesting cannabis, it's not just your brain, it's a lot of the other organs that's impacted. And those other organs, whether it is your heart for cardiac issues, we know that cannabis and especially chronic cannabis use can cause myocardial infarctions. We, you know, all, so many organs are impacted by our endogenous cannabinoid system. So it's important that you speak with your doctor
Cannabis, interreact with a lot of drugs that seniors commonly take. Like, can you give us some examples?
Dr. Hurd (23:31):
So, I mean, as a hypertensive drugs you know, pain, medications, sedatives, anti-anxiety medications anti-depressants so, you know, it's a broad scope. And that's why, as I said, you know, it's really critical to speak with your doctor because the medications that you're on cannabis and even C B D, which even though C B D doesn't make you high, and it doesn't have those negative effects like THC, it too, is a pharmacological agent and can interact with a number of those things, as I said. So that's why it's really important to, you know, to speak with your doctor, to know which medications that you're taking, how they may interact,
Good advice even C B D. I wanna stress that even interacts,
Dr. Hurd (24:27):
Even CBD can have ADI. And I love CBD. I mean, when I started studying CBD, the world really did not know about CBD. And today, now everybody knows about it. You know, it's in your water, it's in your coffee. And people think, therefore that it is safe and yes, you're, it's not gonna make you high, but it can interact with the medications that you have. It can interact with. You know, I said, antidepressants, it can interact with, you know, analgesic that you're given. It's really critical. There's no drug on this planet that is so completely benign that it doesn't interact with something else. And so even CBD.
So from a scientific standpoint, what is your opinion, our opinion on this rush to legalize marijuana,
Dr. Hurd (25:26):
You know, it's been a journey also for me. So initially I was against legalization because of the population that I was studying, namely the developing brain, young people, where we saw much greater psychiatric vulnerability. And so even though we say we legalize something for adults and teens and kids won't get access to it, we know that's not true. We have a lot of kids who, you know, obviously use a lot of drugs, but the one aspect of the legal, the legalization of cannabis has been to destroy, destroy a lot of communities. So this war on drugs, you know, you arrest everybody, you can't arrest yourself out of addiction. And we have seen that our criminal justice system now is overloaded by so many people because of drugs yet, still it has exacerbated the, the problem. So to me, I would rather them use that money for actually developing treatments for that really work for these individuals to get their lives back, give their, improve their communities, money used for research healthcare.
Dr. Hurd (26:44):
I think that that to me is a much more positive way of than, you know, destroying communities and, and, and individuals also, ironically, when it was illegal, it was tough for us scientists as researchers to actually study it. So many people will say, oh, but cannabis has been around for, you know, thousands of years, they've done all this research. And so we know everything and that's not true. The legalization, you know, the, the fact that was so challenging to work with because of its legal status meant that most scientists did not study it. So it's just, now that we're starting to look at it and it's a very complex plan. So when people think that cannabis is cannabis, it's not, so you have over 140 cannabinoids in that plant plus over 400 other chemicals. And they're now making all these new strains of cannabis, which one is the best one to use for which disorder we don't know.
Dr. Hurd (27:46):
And so unless we have an easier way of doing research, that to me is a problem. But overall, I think, you know, the criminalization and destruction of communities is not the way. So I don't think that not for open legalization. I think that when they legalized cannabis, they should have even consulted with scientists and physicians, which they didn't. So for example, dose matters. And if they had legalized, perhaps, you know, the original plant, which was about 4% THC, that to me, I wouldn't have had a problem with initially, but there's no restriction. And now you have plants that are really a completely different drug. It's so potent. And why do we need, you know, more destructive things for the brain on the body? I don't understand that. I think that we need more, you know, we can develop cannabis in, in as medicine in a much more holistic and strategic manner to help people with research. And that's not what they did. So that's a pet peeve of mine.
<Laugh> the government has a way of doing that sometimes.
Dr. Hurd (29:05):
Yeah. And they go down a very negative path when it could actually have been positive development for, for everybody.
Thank you for coming on. You cleared up an awful lot of information for us. This was extremely thought provoking, and I appreciate you sparing the time to come on.
Dr. Hurd (29:30):
Thanks for having
Me. Thanks again.
Dr. Hurd (29:34):
Bye. Bye. If you found this podcast interesting, fun or helpful, we'd appreciate it. If you tell your friends and family and click on the follow or subscribe button, wherever you listen to podcasts until next time, I'm Larry Barch. And you've been listening to specifically for seniors.
Dr. Yasmin Hurd is the Ward-Coleman Chair of Translational Neuroscience and the Director of the Addiction Institute at Mount Sinai.
Dr. Hurd's multidisciplinary research investigates the neurobiology underlying addiction disorders and related psychiatric illnesses. A translational approach is used to examine molecular and neurochemical events in the human brain and comparable animal models in order to ascertain neurobiological correlates of behavior. A major focus of the research is directed to risk factors of addiction disorders including genetics as well as developmental exposure to drugs of abuse such as cannabis. The group also conducts human clinical trials in developing novel therapies for opioid use disorder.
The push to legalize recreational and medical marijuana has put the spotlight on Dr. Yasmin Hurd and her pioneering work on the transgenerational effects of cannabis on the developing brain. Dr. Hurd's research was featured on the cover story of TIME magazine on May 25, 2015: The Great Pot Experiment. and in a CNN Documentary with Dr. Sanjay Gupta.