Episode 20

  • What is marijuana and how is it used?

  • Why is THC potency important?

  • What does this have to do with therapy?

Marijuana is here to stay and it looks like we’re heading towards legalization. We need to know the facts about marijuana. It comes up in therapy quite often all around the country. Join me for an up-front conversation about weed. Today’s podcast is Part 1 of 3.

Helpful Links

Marijuana as Medicine DrugFacts | National Institute on Drug Abuse (NIDA)

Is there a link between marijuana use and psychiatric disorders? | National Institute on Drug Abuse (NIDA)

Marijuana Use and Insulin Resistance in Patients with Obesity

Big Tobacco 2.0: Big Marijuana – Smart Approaches to Marijuana

8 incredible facts about the booming US marijuana industry | Markets Insider

What Is CBD? Everything You Need to Know, According to Experts | Health.com

Is marijuana safe and effective as medicine? | National Institute on Drug Abuse (NIDA)

Researching the Potential Medical Benefits and Risks of Marijuana | National Institute on Drug Abuse (NIDA)

Top 10 Reasons to End Marijuana Prohibition

Recreational Marijuana – Pros & Cons – ProCon.org

Self-described pothead looks into the science and public policy around marijuana and addiction — WHYY

Ten Things to Know about Medical Cannabis | Epilepsy Foundation

Does CBD help with arthritis pain? – Harvard Health Blog – Harvard Health Publishing

AKT1 genotype moderates the acute psychotomimetic effects of naturalistically smoked cannabis in young cannabis smokers

Scientists Identify The Gene Variant That Influences How Much Cannabis Affects You

Other states show why legalizing marijuana is a bad idea – Hartford Courant

The US Officially Admits Marijuana Isn’t So Bad. So When Is Federal Legalization Coming?

Drug Policy Research Center Hot Topic: Marijuana Legalization | RAND

Medical Marijuana and Marijuana Legalization

Cannabis legalization: Did we make a mistake? Update 2019

How THC Gets Into Your Brain – And How To Increase It – Prof of Pot

Cannabidiol (CBD) — what we know and what we don’t – Harvard Health Blog – Harvard Health Publishing

What are marijuana’s long-term effects on the brain? | National Institute on Drug Abuse (NIDA)

Marijuana DrugFacts | National Institute on Drug Abuse (NIDA)

Marijuana Potency | National Institute on Drug Abuse (NIDA)

Marijuana Concentrates DrugFacts | National Institute on Drug Abuse (NIDA)

What 20 Years Of Research Has Taught Us About The Chronic Effects Of Marijuana

Adverse Health Effects of Marijuana Use

Health Effects | Marijuana | CDC

Study shows marijuana’s long-term effects on the brain – Center for BrainHealth

Know the Risks of Marijuana | SAMHSA

Is marijuana addictive? | National Institute on Drug Abuse (NIDA)

How Marijuana Works | HowStuffWorks

The Science of Marijuana: How THC Affects the Brain | Scholastic: Nida

How does cannabis get you high? | Live Science

What Does It Feel Like to Be High on Marijuana? Smoking and Vaping


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about all things, substance.

Welcome back. This is episode 20 of the All Things Substance Podcast. Right now we’re in a series talking about different substances that commonly get abused. The idea is to go through each of these, their effects long and short-term, withdrawal potential and the implications for therapy. Today we’re going to start with the facts about marijuana. 

So here are the things that I need to have upfront to let you know where I’m at. So as you’re listening  you have a basis for where I’m starting and nobody has to wonder what it is that I’m thinking in the long run. First, I don’t think marijuana is the worst thing on the planet. Second. It’s probably not going to kill you.  Third, it’s not neutral. There are negative things that go along with marijuana. Four,  I get super frustrated with some of the conversations I see online about marijuana,  even from other therapists,  who are sharing misinformation or in other ways acting like marijuana is not a big deal and we shouldn’t be paying any attention to it in therapy at all.

When running a treatment center for chemical dependency, I have a harder time working with people who are chronic marijuana users than pretty much any other kind of drug. No one else is telling me that meth is so good for you and does all sorts of things from curing cancer to helping diabetes and anxiety. No one’s telling me that heroin is from the earth and that God intended for us to use all the plants of the earth and all sorts of other things that I hear about me marijuana.

So over the course of the episodes on marijuana, we’re going to be talking about what marijuana is, how it’s used, what the effects are. We’re going to talk about common claims, things that people say about marijuana and whether or not those things are true.  Then we’re going to be talking about legalization and the implications for therapy.  I think it’s important that we talk about this because it is something that is really commonly used and that we need to be able to have our own informed opinions about.

Some of you may have already picked up on this or heard a talk that I gave in a different setting. I am a person in recovery and the last time I used drugs was over 20 years ago. Marijuana is addictive. There was a time in my life when I was absolutely enamored with marijuana, like would have married it if I could have. I felt like marijuana was my very best friend, because it was the thing that was there for me during hard times.

I do understand what it’s like to be someone who uses marijuana all the time and I know what it’s like to be someone who doesn’t use it anymore. So my experience comes from personal experience and from spending my entire career working with people who have addiction issues and who have been chronic marijuana users.

Facts about marijuana: filtering out the noise

I hope that that sets the stage for letting you know kind of where I’m at. Part of the thing that’s frustrating when trying to find information about substances is that there are a lot of voices on each side and for marijuana it’s even more so. Even in doing research for this podcast, it was very difficult to find actually scientific or balanced information. Things that say they’re balanced, actually aren’t and it’s on both sides. 

On the side of viewing marijuana in a negative light, some of the words they’re using are inflammatory.  Using words such as this “will” happen as though it’s a guarantee when in science, we know that that’s just not the case.   That there are always going to be exceptions or that we can’t say that there’s a causal relationship only that they were correlated. 

On the pro- marijuana side it’s kind of the wild West.  People say a ton of things  and state them as though they are fact. Sometimes the website names sound like something that would be legit, but actually are really just pro-marijuana sites with good marketing. 

There is an incredible amount of money going into the marijuana industry. So that’s where we’re going to start. So with that behind us today, we’re going to start talking about just the facts about marijuana.

Facts about marijuana: Basics

Marijuana refers to the dried leaves, flowers and stems from the Cannabis Sativa  and the Cannabis Indica plant. There are  a lot of different chemicals within the plant, but the two that we hear most about are tetrahydrocannabinol, which is THC or  CBD cannabidiol. We’re going to start with talking about THC.  When we get to the next episode, talking about common claims, we’ll get into talking about CBD versus THC and what the differences are and how they’re used. 

So for today, we’re only going to be talking about the THC component of the Cannabis plant.  THC is the psychoactive part of the plant.  If you remove THC from the plant, then whatever’s left over does not have a psychoactive component.  The chemical structure of THC is similar  to the brain chemical anandamide. Similarities in the structures, allow the body to recognize THC and to alter normal brain communication.

Anandamide  is an endogenous cannabinoid that functions like a neuro-transmitter because it sends chemical messages between nerve cells.   It affects the brain and influences pleasure, memory, thinking, concentration, movement, coordination, and sense of time and space. Because of the similarity, THC is able to attach to the cannabinoid receptors on neurons in the brain and activate them disrupting various mental and physical functions.

THC is able to alter the functioning of the hippocampus and the orbital frontal cortex brain areas that work on the person’s ability to form new memories or shift their attentional focus. It also disrupts functioning of the cerebellum and basal ganglia;  brain areas that are responsible for balance, posture, coordination, and reaction time. Of course, THC is also able  to affect  the brain’s reward system, signaling the release of dopamine, our feel good chemical.

Marijuana is able to cross the blood brain barrier. We don’t know exactly how much of THC gets into the brain. What we know is that it needs to get into the brain to do what it’s supposed to do.

THC levels in the body are going to typically be higher in the brain than in other parts of the body, because the brain is a fatty tissue and marijuana is really lipophilic and has a preference for settling into fat, more than other tissues.

Something interesting is there is some information being circulated on the internet that taking CBD {remember  that’s the other main chemical in the plant that is being extracted and turned into liquid ,pills, gummies, all sorts of things]. There’s some information that taking CBD before you smoke or use marijuana can increase your THC levels, giving you a more intense high.

So there are three main strains of marijuana Indica, Sativa and then there’s hybrids.  Indica is most often what’s used for medical purposes  due to the quality of the high it produces. The most common form is Sativa, which is generally used recreationally because of the more intense high that it produces.  The hybrids are just what it sounds like. It is the different kinds of strains that people are making by crossing different plants and creating different times of highs.

There are substances known as fake marijuana or K2 or  Spice. These have almost no resemblance to the actual plant itself. . Synthetic marijuana is extremely dangerous and can be deadly. Most people who use marijuana on a consistent basis don’t like synthetic marijuana and aren’t using it because it is so different and it’s not the same thing at all. The reason people use it is because you can typically pass a drug test  because drug testing for synthetic marijuana is very complicated and isn’t readily available.

Facts about marijuana: How its used

So the actual plant is used in four main ways.  It’s smoked in its plant form. It’s smoked in its wax form. Smoked in its oil form  or eaten in some food type substance to which THC has been added.

So when I was a kid, my mom used to refer to marijuana as grass. When I was in high school, we referred to marijuana as pot or weed. In current times, I think weed is probably the most common and the one that I choose to use when I’m talking with clients. Saying the word marijuana all the time is pretty formal and it sounds distancing and I think there can be a fair amount of judgment when using that phrase.

It’s sort of like when someone says there’s a lot of curse words or a lot of cuss words in something. That’s not really being just factual; there’s a little bit of negativity associated with it. Our goal here is to be able to talk with our clients  and encourage an open and honest discussion.

If you look up marijuana in a stock image photo, you’re going to find a lot of different pictures. It used to be that  what you would find would be images of joints or “marijuana cigarettes” as some people would call it. Although no one who actually smokes weed would say marijuana cigarettes.  So joints, and they don’t have a filter,  so it looks like a cigarette with the bottom part pinched off.   So the majority of people that we’re going to see, who are chronic users of marijuana, and somewhere in their teens, twenties, up through probably forties, aren’t going to be smoking joints.

If they’re smoking the plant itself, they’re going to be smoking blunts mostly and maybe bowls. So what I’m talking about here is blunts  are cigar wrappers. So think brown cigars like Swisher sweets or  the ones with the white tips that you see at the gas station. So those with the tobacco taken out and marijuana rolled into it. Those are blunts. Blunt is the word that you hear in pop culture the most.

The thing you notice right away about a blunt versus a joint is that there is a much higher quantity of marijuana than in a joint. So when someone’s sharing a blunt versus a joint, there’s going to be a lot more marijuana to get through till they get to the end.

Some people will use bowls. So this is going to be a small handheld device that is going to be made of metal or some sort of heat resistant stainless steel  or ceramic or glass, anything that can hold heat without burning your hands. 

So a bowl usually will have some sort of screen in the bottom so when you take a hit, like you would puff on a tobacco pipe that the marijuana seeds and flakes wouldn’t get into your mouth, you pack that full  of the dried marijuana plant and then light it.  You can make a bowl out of a lot of things.

Like you could make a bowl out of a pop can, can make a bowl out of an apple. You can make a bowl out of pretty much anything that can hold marijuana, and then you can make a tunnel from where you’re lighting it, that is smaller of course, to where you can put your mouth , and extract smoke.  So for a lot of parents finding a pop can with a hole on the side and ashes, that’s not about cigarettes.

In the last decade or so the rise of wax is something that has come to the forefront for any of us working with teenagers and younger adults. This is similar to what would have been called hash back in the day. It is a concentrated form of THC .  It can be made in a number of ways and it’s super easy to find out how; Google it on YouTube and you will find videos on how to make wax.

 So you can buy the marijuana plant from your dealer, or you can buy straight up wax. So some people have a weed dealer and a wax dealer. That way you don’t have to make the wax yourself, which is time consuming and pretty messy.

The most common way of creating wax is by using flammable solvents, like butane  in different forms, but a butane torch is typically what people talk about. It’s relatively inexpensive to do. and it produces a potent high concentration level of THC.  The wax is typically referred to as a dab or dabs. 

So what they do is they have to use the butane torch on the plants to heat it up,  to get the liquid to drip out of the plant and form wax.  The rest of the plant isn’t used then and it’s just the wax that you smoke and you light it just the way you would like the plant.  People usually use a different device though, rather than like a bowl.

So wax  can either be oil, it could be a soft texture like lip balm and that’s going to be the wax, or it’s going to be hard and amber colored, which is shatter.   Oil and waxes can be used using vape pens. So think about vaping, right? So we have lots of people who vape. You can just replace the cartridges or the pods with THC oil rather than nicotine.

The solid can also be put on a platform made out of titanium, quartz or ceramic where they’re vaporized by high heat and inhaled through a dabbing tool, like a rig. Wax is going to be easier to conceal because it’s not going to have the telltale smell that kind of emanates from it. It can be kept in silicone containers. 

So if you go to Amazon and do a search for wax containers for dabs or dab containers, you’re going to find a whole bunch of typically colorful silicone products to hold the wax. They’re usually the size of like Carmex  or they might look like a contact lens container, but that’s how they keep it so that it’s not drying out.

But you can imagine that the smell isn’t going to be coming out of that  the way it would with a plant that even in a plastic bag, you could totally smell it.  It’s not expensive to buy these different containers. You can get a pack of 50 jars that hold three grams each for $7.

The last way is the one that I think people hear about a lot, which is edibles. So this is when you take the THC oil, that’s been extracted from the plant and you put it in something that you eat. Typically, this isn’t going to be put in some kind of dinner or some kind of average food, like we’re not putting it in spaghetti or something. This is going to be in things that are like treats. 

So at dispensaries, in places where it’s legal, you can buy edibles that are rock candy, chocolate.  Or other kinds of gummy candies, like gummy bears, lollipops, any of those different things can be made into an edible. These can be bought commercially through different dispensaries and I’m sure places on the internet, although I haven’t looked. Or people make them at home. 

You can buy molds on Amazon or lots of other places. There are tons of recipes online as well, too. So you would get the THC oil, create something that you’re going to put it in like a brownie or some sort of candy and then drop a certain amount into it.

The trouble with edibles is that they’re not highly regulated. So you don’t know how much you’re getting when you get an edible. You could be eating a gummy bear and a pack of say 20 gummy bears and one gummy bear could have the tiniest amount of THC in it. And the gummy bear next to it could have absorbed a ton.

Facts about marijuana: Why THC potency matters

There’s a few implications for having edibles this way. One is obviously the marketing towards kids. These are shiny, tempting looking packages that  appeal to the part of us that wants treats and things that taste good or make us feel good.   We know from research on nicotine and alcohol, that marketing towards kids absolutely works  and usually has something to do with  different flavors, colors, shapes, textures, that kind of thing.

So when you have a client that’s using marijuana, the way they use it is really important. We need to understand that because  it changes what they’re using. Smoking the actual plant of marijuana in a blunt or a bowl is really different from smoking THC oil or even eating gummies and that has to do with THC potency. 

So the concentration of THC  in that given item, whatever it is.  So there’s an article that I’ll put a link to in the show notes too. That has a table of the percentage of THC in marijuana seized by the DEA from 1995 through 2018.   This shows the fact that we have increasing levels of THC being found in the plant. 

So if you were to buy weed in 1995,  you’re going to have a THC potency from around three or 4% to maybe 10% at the higher end, with the higher price strains of marijuana. So as we move up in years, that number of 1995 on average is around 4% of what was seized. In the year 2000, we’re at about five and a half percent. In the year 2010. We’re about 10 and a half percent. And by 2018, we’re at 15 and a half percent.  This is a really different substance from what was being used 20 years ago. This is just the plant itself. This isn’t what happens when you extract the THC. 

When you extract the THC. potency goes up from like 60% all the way to like 99% and the potency makes a giant difference.  So let’s take nicotine patches for instance.  So a heavy smoker would be encouraged to use a patch that’s like 15 to 22 milligrams for the first few weeks. Then they’re going to drop down to a patch that’s like five to 14 milligrams, and then drop further down.

When it comes to vaping and the liquid used for it, it comes in milliliters.  Each milliliter has a particular milligram to it. . The average is really hard to tell. It’s not something that you can just say, Oh, it’s a quarter of a pack, half pack because the pack of cigarettes has 20 cigarettes in it, pretty standard across all makers. So you can judge based on that. 

With this though, it’s hard because the juice is used with different milligrams. For instance, someone might use 10 to 12 milliliters at eight milligrams per milliliter. That’s 80 milligrams of nicotine versus the 15 to 22 milligram patch a day. 

So I use that to put it in perspective when we’re talking about vaping THC oil. That’s the kind of difference that we’re talking about. And we’re talking about a difference in potency from about 15 and a half percent to upwards of 90, 99%.  It depends and you can order it at higher levels or at lower levels, but typically that level of THC oil is going to be above 60%. 

So 10% THC potency is considered high. Anything above that is absolutely in the high category. And when we’re talking about high potency THC, that is a whole different drug and it is a whole different set of problems.

THC poisoning is a thing. It didn’t used to be a thing. So lots of people would say, “Oh, you can’t overdose from THC”.” It’s totally safe. It’s not going to kill you”, et cetera, et cetera. The poisoning happens every day and is in ERs across the country. Now whether or not someone is dying from THC poisoning, we don’t have clear evidence.

I think it is unlikely that no one has ever died from THC poisoning. Because you can die from acetaminophen poisoning, you can die from an overdose of vitamins. You could die from an overdose of just about anything if it’s concentration is high enough in your bloodstream. Why people end up in the ER is because  at higher levels, THC can have a paradoxical effect.

So instead of working to help nausea, it causes nausea and vomiting, or it can cause extreme psychosis, irregular heart rhythm, panic, that kind of thing.  So they end up in the ER,. It is hard to tell sometimes what kills a person, because there are multiple things happening at a time. Many people who are using that high level of marijuana, aren’t just using marijuana.

 If they end up dying from it  what is the thing that pushed us over the edge?  So we can’t say that THC poisoning is  going to kill you. We can’t say THC poisoning isn’t going to kill you. We know that it’s incredibly unpleasant and can cause really difficult health concerns that may need to have emergency services. 

This is really different from how we used to think about marijuana vaping and using edibles is a much easier way to do it than trying to figure out how to smoke a blunt or a bowl and cover up the smell. Now, lots of people will use the plant itself because the high isn’t as intense. Even on pro-marijuana sites they’re going to caution you about dosage on THC oil. Because for some people, the high gets so intense that it’s not  comfortable anymore and so they’ll caution people to be  careful about it.

Again, there’s tolerance, right? So they have to build up a tolerance.  A lot of times what happens is that people are using marijuana as a plant. So they’re smoking weed as a blunt or a bowl and then eventually when your tolerance goes up you are smoking multiple times a day. That can be kind of expensive and some people will want to switch over to dabs. Remember that’s wax or to vaping the THC oil or eating edibles or whatever. Then they have a higher concentration. So just like any other substance, you build tolerance, you have to use more to get the same effect.    When you’re evaluating someone’s use of marijuana, how they’re doing it is important. 

Facts about marijuana: Short and Long term effects

In terms of effects, we’re going to talk about short-term first. So the short-term effect for marijuana happens pretty quickly. It takes a different amount of time, depending on how you use it. So for smoke, it has to get through the lungs, into the bloodstream and up to the brain.

But through the lungs is a pretty quick way. It’s pretty much a straight shot to the brain from there. If you’re using edibles it has to go through the digestion process and get into the bloodstream that way. But we’re talking minutes here, not hours.

So the high can last on average around four or five hours. As the hours wear on it’s going to get less and less.  When I’m working with someone who’s smoking weed, I ask them to not smoke weed for four hours before they come to see me. It is the same as someone coming to session under the influence of alcohol. I am not doing therapy with somebody who is drunk. 

I’m also not  doing therapy with somebody who just smoked a blunt in their car on the way over and now they’re high, that is pointless. So they can usually tolerate that. Even super heavy smokers can handle four hours. There is withdrawal and so they might be getting to the edge of where they want to smoke again, but it’s tolerable.

So it’s just a conversation I have. It’s not something that I get into a lot of detail about, I just say, “Hey what I want when we’re doing therapy is that you are emotionally present and so I want you to not smoke for four hours before you come see me. Okay”. They can decide how they want to schedule appointments based on that.

So the type of high that you get for marijuana is going to be really different depending on the strain, the dose,  the potency, whether you’re smoking it, vaping it or ingesting it.

Gender, age, physiology, tolerance, et cetera. Different strains of marijuana have different types of highs and that’s what I meant earlier when I talked about hybrids.  That people are trying to create different strains based on the kind of high.

The stereotypical high of being giggly or spaced out or amazed by really mundane objects or really thinking things are funny that you wouldn’t normally think are funny, that exists. And that definitely happens for a lot of people but that’s kind of in the beginning. When you’re smoking marijuana all the time,  it’s a little subtler than that.

So the main effects are going to be that  it’s hard to hold a specific thought and not get distracted, or you might get really distracted and go down some rabbit hole of thought or things are a little fuzzy. It’s a little bit like things in front of you are kind of slightly disconnected and distant.

Mainly it alters the perception of time and space and that is going to be consistent, regardless of tolerance. Now,  people who are using marijuana on a regular basis they kind of get used to it, but it still is there. So people say a lot of things about their use of marijuana and how it helps them and we’re going to go through that a bit in the next episode when we talk about common claims. 

Marijuana is a depressant. Right. So as we’ve talked about  a depressant slows down the central nervous system.  Because of that, it slows reaction times. It does not matter if you have been smoking weed for the last 40 years.  It is a CNS, a central nervous system, depressant and it alters your perception of time but also of space.  

So you’re going to have issues with depth perception.  This makes driving while you’re high dangerous.  In the community of people who smoke weed,  a lot of times people will say they’re better drivers high than they are when they’re drinking alcohol. They’re just different effects, but it’s still a depressant.

Then there’s the idea of being really hungry or having the munchies and that does happen. Certain strands are going to do that more than others. Marijuana is used in some medical ways to help induce appetite, to help people who have wasting syndrome or having issues from chemotherapy.

There are  some side effects to marijuana that some people find unpleasant. Like they might feel more paranoid. They might feel confused or anxious. For some people it induces panic, racing heartbeat, psychosis, those sorts of things.  For people  when they smoke weed and they’re getting negative effects, they just won’t do it anymore because it’s not pleasant.  

So there are plenty of people who are smoking weed on a daily basis, probably numerous times a day, and they are going to work. They go to school, they go to family stuff and not a lot of people would probably be able to tell. A lot of times you can tell right after someone smokes, there’s some glassy eyes; they’re a little bit spacey.  When you first start smoking weed you can’t function like that. It’s way too overpowering. As you get used to it though, you can do that all day and still do other things. 

It doesn’t mean you’re going to be doing them with a clear head or that you’re going to be doing them maybe as well..Of course that’s opinion for me. . It is something that you get a tolerance to and are able to do more normal things. 

Anyone who tells you that weed does not fry your brain it’s because they still smoke. Anyone who has used it for any length of time and quits, knows that that there is a cognitive effect that is muting. It’s like a dimmer switch kind of, and that it fades. When you’re using all the time though that’s not something you really know or notice because this is just normal life for you.

I want to clarify my statement about weed frying your brain. I don’t literally mean frying your brain, like permanently. We’re not talking permanent brain damage, that I’m aware of,  the way we’d be talking about it with inhalants, ecstasy, that kind of thing.

What I’m talking about is that sort of doped out, spacey, kind of ditzy sort of feeling,  that is the thing that I’m talking about when I say it fries your brain.  Where you kind of feel like you’ve just got zapped and you’re like, what? So anyone who tells you that that doesn’t happen it’s because they still smoke and they don’t know the difference.

Your brain does clear over time. Now, if you’ve been smoking for years and years and years, maybe it’ll take longer. But it usually takes a month, maybe two to really come back to where you feel clear again. People who are smoking marijuana or using it on a regular basis think they are clear. They feel clear. Those of us who were using and then quit know that that’s not actually happening.

The immediate withdrawal from marijuana is pretty short.  It’s about four or five days, and the person’s going to be really cranky, irritable. They’re going to have maybe some sleep disturbance. They might have a headache and  just generally not feel good and then that clears up.

In terms of long-term effects this is a harder call. What we know for sure is that adolescents who start smoking weed are going to have more long-term effects. A lot of the research  tends to support the idea that adolescent onset use of marijuana is going to be more detrimental to brain function than someone who starts smoking marijuana as an adult with a fully formed brain.

This makes perfect sense as we think about it.  We know that we have a developing brain until we’re about 24 and that we’re putting chemicals that go through the blood-brain barrier that impact different parts of the brain while they’re developing. This isn’t great, for anyone.  We know  that there are some long-term issues.

There are  longitudinal studies that are being done right now to try to  track and evaluate what those changes are. Now as for long-term effects for other people, there’s not a ton of really solid research. Remember that research has to be paid for by somebody.

Marijuana is a billion dollar industry, multiple billions. When evaluating research, you have to always look at who is doing the research, who paid for this and what their bias might be. We know that inhaling stuff into your lungs is not great. Vaping, smoking cigarettes, smoking the plants, , toxic pollution in the air, any kind of thing.

That our lungs aren’t designed to filter out those kinds of things in a way that’s really effective. So there is chronic bronchitis and other lung problems. We don’t know if just smoking marijuana is going to cause cancer.  We don’t know.  A lot of people who smoke marijuana will say that marijuana is less harmful for you than to tobacco and I don’t know that there is any research that legit proves that. 

It is extremely harsh to smoke marijuana on your lungs. Usually people end up coughing a lot, but they’re also not smoking. 20 times a day, like you would with a cigarette. So it’s kind of unknown whether that’s going to cause cancer, that it causes bronchial issues, for sure.

You might wonder why there isn’t a lot of research on long-term effects. Up until recently, say in the last decade or so,  legalization wasn’t really something that seemed like it was going to be totally likely across the board. 

Marijuana was still classified as a drug and part of the” war on drugs”, so to speak. However, as attitudes across the board have been changing about marijuana now people are asking those questions. Is it safe? The problem with that question is that legal and safe are not the same thing. Alcohol is not safe in large quantities or over a long period of time and it’s legal and it’s going to stay legal. . 

So I wish I could tell you that we knew what the long-term effects of marijuana are. Truth is, we just don’t. Even if we did have information about long-term use of marijuana, being able to point out what it does or doesn’t do, we have a very different product now when we’re talking about marijuana  with such a high level of THC. This is a really different thing. THC poisoning wasn’t really a thing and now it’s happening all the time in ERs across the country.

I can’t speak for what’s happening in other countries, but I know in the States it’s a problem.  So we need research now about long-term use of marijuana when it comes to  smoking the plant version, vaping, wax, edibles, because it’s all really different.

When we get to legalization, we’ll talk more about big marijuana, but the people involved in big marijuana, so to speak, have a lot of money invested in normalizing it,  making it seem neutral, if not good and healthy to smoke marijuana or use it in some other way.  That alone should tell us that we can’t necessarily trust everything that they’re putting out, because there is a ton of money to be made. 

The last part I want to talk about today is what I believe is the danger of marijuana. Marijuana in and of itself  isn’t the problem. I don’t believe that marijuana is a gateway drug in the sense that it’s going to lead you to other things.   That’s not why that happens. 

There are lots of people who smoke weed all day, every day and from what we can tell on the outside they function okay.  So Snoop Dogg, Seth Rogan, Willie Nelson, they all smoke weed all the time  and are pretty upfront about it.

I believe that there are people who can smoke weed and smoke it a lot and for a long time, and they’re not moving on to other drugs. When it comes to addicts though, that’s not the case. Those other people I mentioned probably are physically dependent on marijuana because it is addictive just like nicotine, just like caffeine.

Their body is physically dependent on it and it does have an effect. They might be able to act like everything is fine because they’re used to functioning high, and that happens. When you smoke weed all the time, you just function high. It seems pretty normal to you so that when you’re not high, you feel weird and anxious and kind of jumpy.

High becomes your normal state. The problem here is that if you talk to addicts and you ask them how they got started using drugs, they’re going to go back to weed. There are also people who are going to be talking about alcohol as being kind of their drug of choice until they switched.

For a lot of people, it’s weed. It’s not weed’s fault, though. It is just the nature of why they’re using The thing about marijuana is that it stops working. What I mean by that is because there’s progression because there’s tolerance, you have to keep smoking more to get the same effect.

So you’re always going to have to increase or just accept that this is the level of high you get now. And it’s just not the same as it was in the beginning. Much like someone who smoked cigarettes. You don’t get a buzz from nicotine when you’ve been smoking for a long time. If you quit and come back to it later, you’ll get the buzz again, just not for very long and then it’ll be gone again. 

A lot of the people that I’ve worked with over my career were in treatment for alcohol and drugs.  The amount of people who come through with no trauma is really, really small. A lot of the people who come through treatment for alcohol and drugs are using, because they initially started using because they were dealing with some kind of issue that they didn’t know how to cope with.

It’s not everybody who’s been through trauma, but it is a lot of the population of people who come through treatment. If somebody is using it for the sake of keeping stuff pushed down in their brain so they don’t have to cope with stuff. Marijuana will not keep that at bay forever. Time does not heal wounds, and that will come back. And eventually the amount of marijuana that you have to smoke to try to keep all that at bay is a really large quantity and it’s really expensive. So if you’re spending a lot of money on weed and you can spend way less money on a couple of pills, why wouldn’t you do that? 

People aren’t worried that they’re going to get addicted.  99% of the people I’ve met believed that they were going to be able to know the difference and be able to stop themselves from using any more once they figured that they were in danger of becoming an addict.  Nobody plans on becoming an addict. It just happens.  

So with weed, it’s not that weed in and of itself is the problem. It’s the interplay between weed, their genetics, their life situation, trauma, all of it and weed isn’t as effective when you’re using it for a long time. If you need it to cope, you’re going to have to switch to something else.  

The implications here is that we need to be assessing someone’s use of marijuana. It is not nothing. We don’t know if it’s a problem or not. We don’t know if they’re experiencing consequences. What we know is that it changes their experience of space and time and  distances them emotionally. 

So when they’re in therapy, we need them to be sober. We also need to evaluate what they’re using it for and why and how, and how much and where are they in it. It’s not a matter of legal. It’s not a matter of right and wrong morality. 

Our job as therapists is to evaluate somebody’s entire life and figure out where the problems might be stemming from. And there’s going to be more than just marijuana. It’s going to be other stuff, but it is something that we need to be paying attention to.

As we move forward in this series,  I’m going to be talking about the link between psychosis and marijuana. There are things that are very important for us as therapists.  Our job is not to get on the side of legalization or not. Our job is to be on the side of  bringing healing and freedom to our clients.  It doesn’t necessarily mean we have to go after their use of marijuana and we still have to evaluate and be able to look at it from an objective point of view and see if it’s causing a problem. 

Next week, we’re going to continue our talk of marijuana and we’re going to talk about common claims. Things that people say that marijuana does or doesn’t do. And we’re going to talk about the research and whether or not those claims are true or false. 

I hope to see you next week.

If you’re ready to take the next step in addressing your client’s substance use head on over to betsybyler.com/treatment tool. The treatment planning tool I created will help walk you through the process of evaluating your clients use and deciding how and when to intervene. The tool is completely free and will be delivered to your email so that you can use it right away.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know.  Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast. And until then have a great week.

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.