February 19, 2023 • 25 mins
02/19/23
The Healthy Matters Podcast
Season 2 - Episode 06 - Legalize it!/? The Good and the Bad of Recreational Marijuana
Since many people have found great benefit in medicinal marijuana, and many others have found, well, great benefit in its recreational use - we thought it was high time we had a real conversation around cannabis. As we know, almost nothing is entirely good or entirely bad, so to help gain some perspective on the issue, we welcome back to the show Dr. Charlie Reznikoff, addiction medicine specialist at Hennepin Healthcare and widely held expert in the field. We'll cover the pros and cons of legalization, safe practices, the positive and negative health effects of using the drug, and what's in the pipe for states like Minnesota. Join us!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:21):
Hey everybody, it's Dr.
David Hilden, your host of theHealthy Matters podcast.
Today on episode six, we'regonna talk about recreational
marijuana.
To help me out, I have asked arepeat guest, Dr.
Charlie Resnikoff, to join me.
You may remember his name fromepisode four of the podcast last
season.
If not, I encourage you to goback and listen to that show
because it's a greatintroduction to the field of
(00:42):
addiction medicine.
Today I've asked him to talkabout another area of his
expertise that mean marijuana.
Many states now have legalizedit, both for medicinal use as
well as recreational use.
Charlie, welcome back to theshow.
Speaker 3 (00:56):
I'm happy to be here excited to talk about this.
Speaker 2 (00:58):
So tell us the current state of recreational
marijuana, specifically in ourstate of Minnesota, but
nationally.
Where, where is it?
Well,
Speaker 3 (01:06):
Listeners might know or have heard that this summer a
bill sort of snuck through thelegislature and was signed into
Speaker 2 (01:15):
Law here in Minnesota,
Speaker 3 (01:16):
Here in Minnesota that allowed low dose hemp-based
t hc.
It acts just like recreationalmarijuana.
It a, it behaves in the bodyjust like that, but it's only
low dose.
And it is derived from hemp,which is related to marijuana,
but not the same.
And it has the active ingredientthat is an I intoxicant, so that
(01:36):
that is available now throughoutMinnesota in a variety of retail
stores.
So that was a bit of anadjustment, but now the
legislature is very heavilyconsidering and they're looking
at language and they're craftinglanguage right now to legalize
marijuana for recreationalpurposes in our state.
And I think it is highly likelyor almost certain that the bill
(02:00):
will pass and be signed intolaw.
And in the next couple years,we're gonna see a big change out
there in Minnesota.
Speaker 2 (02:06):
So many other states have done this either through
their legislative process or byvoter referenda.
Yeah.
Right.
Yeah.
How, how prominent is this?
Is this a a, a naturalprogression in, in someday down
the road, it's gonna be legalthroughout our country?
Good
Speaker 3 (02:22):
Question.
I think most people think thatat some point in the future it
will be legal federallythroughout the country.
Now we have many states whereit's recreationally legal.
It is a bit of a change.
I think people notice thechange, you know, walking
through the city, you know,you'll smell it a lot more where
people already smell it.
Quite, huh?
Speaker 2 (02:41):
You'll walk through Denver, Colorado.
Oh yeah.
You get stoned just walking downthe street, the
Speaker 3 (02:45):
Street.
I know.
And the shops are everywhere,and it's more prominent in the
culture.
So yeah, I mean, for sure it is.
It will be a noticeable change.
It won't be a sort ofcataclysmic change.
I think life will go, go onmostly life will go on as
normal, but it'll be a little,you know, a new, a new thing
that we see every
Speaker 2 (03:05):
Day for some people of, uh, maybe aer maybe it's
generational, maybe it's not.
Um, marijuana would've been likeheroin or like other cocaine.
Like I, what are you some drugaddict.
And now we're actually talkingabout making it legal for
everybody.
Yeah,
Speaker 3 (03:19):
That's, that's my parents and maybe your
Speaker 2 (03:21):
Parents' generation,
Speaker 3 (03:22):
Maybe my, the silent generation, the, the generation
that preceded the baby boomers,almost nobody used cannabis.
My 80 year old parents still in80 years have never used
cannabis.
However, from the baby boomers.
And after that, those are allheavily exposed generations.
Most people, baby boomer oryounger have at least tried once
or know many people who usecannabis.
(03:43):
So it's generational.
Speaker 2 (03:44):
I asked my, my son after, when he got back from a
semester at college, he's in hisearly twenties, or he was at the
time, I said, do many kids atcollege smoke?
And he goes, oh yeah, they a lotto, and I said, really?
Speaker 3 (03:55):
Yeah,
Speaker 2 (03:55):
I thought kids weren't smoking cigarettes
anymore, because that's what Imeant.
Oh, he didn't even, didn't evenoccur to him that I meant
cigarettes.
He goes, no, I don't know asingle person who smokes
cigarettes.
They all smoke weed now.
That's what, that's what theymeant by smoking.
Speaker 3 (04:07):
And now a lot of them aren't even smoking weed.
They're vaping or eating ediblesis, those are more common.
There is some smoking stillgoing on though.
Okay.
Speaker 2 (04:15):
So if all these laws are changing, there must be some
positive benefits, either toindividuals or to society.
So I'd like to use this episodenow from here on out talking
first about the good.
What are the good, what are thebenefits of, of legalizing
recreational marijuana?
And then we're gonna shift afterthat to what's the downside?
So what are the benefits eitherto an individual or to society
(04:37):
at large to legalizingmarijuana?
Yeah,
Speaker 3 (04:39):
It's funny, I, and you hear all these talking
points about all the benefits,and some of them are true, and
some of them are kind of, Ithink they're overstated.
But I'll tell you what, the mostimportant number one benefit is
for the vast majority of peoplewho use marijuana.
It brings in pleasure and havingsome joy in your life.
Whether that's, you know, rightnow we, we can drink a cocktail
(05:01):
and nobody looks down upon us.
Uh, and we get a little pleasurefrom that.
And I think it's very reasonablethat a lot of people are saying,
I want to have a little safepleasure in the privacy of my
own home to be able to use thisintoxicant.
It's not that harmful.
I use it appropriately.
So I think the number one upsideis for the vast majority of
people, it's a relatively safeway to have a little bit of
(05:23):
pleasure.
And I, I'm not necessarilyendorsing it, but I, I think
that's the bottom line is that alot of people just use it to
relax.
Speaker 2 (05:30):
You know, it's refreshing actually to hear a
physician say that there's valueto some enjoyment.
You
Speaker 3 (05:36):
Gotta find joy in life.
And I think there, there arehealthier ways to find joy,
whether that be exercise or art.
But, uh, this is a relativelysafe way.
It's a shortcut to joy, let'scall it that.
And, and that I'm quotingactually, Andrew, we, who's a,
who's an MD who now sells herbson the internet.
But he originally was a cannabisresearcher and he talked about,
(05:58):
you know, how like little kidswhen they're, you know, maybe
they're five years old, they'llspin around until they're dizzy.
Yeah.
And then they'll fall andthey'll giggle.
.
That's the childhood equivalentof becoming intoxicated as an
adult.
You've done something toyourself to make yourself dizzy
and giddy.
And then you giggle and fall.
Speaker 2 (06:12):
It was fun for a while.
It was fun
Speaker 3 (06:14):
For a while, and you fall and you get back up and go
on your day.
And that, that's the same thingadults do with a Manhattan, you
know, or whatever.
A glass of wine.
Totally.
Speaker 2 (06:22):
That makes perfect sense.
Are there actual health benefitsother than that, that sense of
pleasure?
Speaker 3 (06:29):
Good question.
So a subset of people get goodpain relief from it.
So people suffering from pain,uh, some of them get some relief
from cannabis and that could bereally helpful and a preferable
alternative to opioids.
Some people with anxiety ortrauma and insomnia.
Um, the, what you're seeing alot, and I've seen it in uh,
(06:49):
literature, is that some peoplereally find that cannabis helps
them sleep and helps their sleepbe less disturbed by nightmares
or bad dreams.
So I think some sleep, someanxiety level, some maybe
helping cope with some pasttrauma they're struggling with.
Those things I would say arebenefits, nausea, you know, and,
and it's
Speaker 2 (07:09):
Cannabis cancer patients have known that for
some time.
Speaker 3 (07:11):
Oh yeah, yeah.
HIV patients with their meds.
Some of the h old HIV medscaused nausea and then they
would find out that the cannabishelped them tolerate their
medications.
So there's some me, uh, nausearelief.
Some pain relief.
Yeah.
I mean, I think those are themain things.
Speaker 2 (07:25):
So there are some benefits to an individual as
you've laid out.
Are there benefits to oursociety?
Speaker 3 (07:31):
Yeah, great question.
I mean, I, this is somethingvery front and center in
Minnesota where the legislatureis very keen on not
incarcerating or penalizingpeople for small time drug
possession or offenses.
And those types of laws areunfortunately disproportionately
applied to people of color.
And so I think there's a lot ofindividuals incarcerated today
(07:52):
for marijuana laws that probablyneedn't have been incarcerated
and, you know, and it goes ontheir record and it affects
their abil ability to get a joband all and housing and all the
rest.
So, so yeah.
I mean that's a huge, uh, plusto society.
That's a huge plus.
Oh
Speaker 2 (08:07):
Yeah.
You look back on that.
It's like what we're thinking,putting a bunch of people in
jail.
Yeah.
It's
Speaker 3 (08:12):
The, it's probably the most important, compelling
reason to do it, in my opinionYeah.
Is to sort of write the ledgeron all the wrongs we've done to
certain people Yeah.
Who use this drug.
And then there will be some taxrevenue.
Uh, that's always nice for, uh,for the states.
Speaker 2 (08:26):
Do states do that?
They add some tax on?
Oh yeah, you get it at a little,I suppose you get it at a little
shop or something like Yeah.
Like you see every other foot inDenver, Washington
Speaker 3 (08:34):
State taxes is at 40% and that's a lot of tax revenue.
And so our state is wrestlingwith what percentage tax to put
it on.
And that's smarter people than
Speaker 2 (08:44):
Because I'll bet, I'll bet there's some
disparities there too.
Poorer folks can't, a sales taxis a bigger chunk of your money.
Speaker 3 (08:49):
Exactly.
So they wanna make it availableto everyone in a fair sense.
But they wouldn't mind therevenue either.
So, so I think they're, they'refiguring all that out.
So tax revenue, criminal justicereform.
And then also there is a blackmarket right now.
And what if, instead of having abunch of drug dealers make money
on a black market sellingmarijuana, it was through IIT
(09:10):
channels.
It was controlled, it was pure,it was secure.
Speaker 2 (09:13):
So Charlie, uh, is what you're saying is that the,
the drug supply will beregulated more for, for purity
and such,
Speaker 3 (09:19):
Right?
Exactly.
So you'll know what it is you'rebuying and what the potency is,
and you'll have a much greatersense of what you're ingesting
versus getting it on the blackmarket.
Speaker 2 (09:28):
But it's not a pharmaceutical type of
regulation.
No.
This is still being sold inlittle shops No, in the street
corner.
Right.
Speaker 3 (09:34):
That's that's true.
But just imagine, if you will,if all alcohol consumed was
moonshine made in someone'sbackyard at a, in a still in
someone's backyard.
Well that would be prettydangerous cuz there's a lot of,
you know, risk to that.
And then finally there arereports, unconfirmed reports
that sometimes marijuana isadulterated with fentanyl.
Yeah, I've
Speaker 2 (09:51):
Heard that.
Speaker 3 (09:51):
Which is just terrifying.
And if there's any chance thatfentanyl is gonna get put in the
marijuana supply, how fast canwe legalize marijuana is what I
would say, you know, to
Speaker 2 (10:01):
Eliminate that
Speaker 3 (10:01):
Risk.
Oh, that the risk is just death.
I mean it's, yeah, it would be avery bad situation if that
became the norm that fentanylwas in marijuana.
So those are all societalbenefits.
So
Speaker 2 (10:10):
There really are some benefits.
Yeah.
There are some individualbenefits, there are some
societal benefits.
We've covered the good when wecome back.
What are the downsides ofrecreational marijuana?
Stay with us.
We'll be right back.
Speaker 1 (10:23):
You are listening to the Healthy Matters podcast with
Dr.
David Hilden.
Got a question or comment forthe doc.
Email us at Healthy Matters hc me d.org or give us a call at six
one two eight seven three talk.
That's 6 1 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (10:46):
And we're back talking about recreational
marijuana with Dr.
Charlie Resnikoff.
Okay, Charlie, we've covered thepotential upsides.
Let's turn to the downsides.
What harms are possible both toan individual and to society of
legalizing marijuana?
Speaker 3 (11:03):
Yeah.
Um, and I'm an addictionmedicine doctor as you know.
You know, and the listenersknow.
So I always think about thosewho are most vulnerable.
So I do spend a lot of my energyworrying about the minority of
people who will be vulnerableand harmed by this.
And I think there are a couplegroups to think about.
People with addictions, peoplewith serious mental health
issues, adolescents and evencollege kids, a little young
(11:26):
adults, adolescents and youngadults and people driving a car.
And we can start with peopledriving a car.
Uh, there's
Speaker 2 (11:33):
Is it dangerous?
Speaker 3 (11:34):
Oh yeah, there's no doubt.
It's, it's actually not hard totest whether someone gets
intoxicated and drives worse.
They put a bunch of orange conesin a parking lot, let you use
your drug and test how well youdrive the car.
And turns out people knock overthose cones more often when
they've used cannabis.
Uh, yeah.
So it's really not hard tomeasure and there's a lot of
(11:54):
concern that cannabis use,especially mixing cannabis with
alcohol now
Speaker 2 (11:59):
That is, that sounds scary.
Yeah,
Speaker 3 (12:01):
That's, that, that is way higher risk for an accident
than either those drugs alone.
You
Speaker 2 (12:07):
Use the word intoxicated.
Yeah.
Most listeners I think wouldautomatically assume intoxicated
means alcohol.
Is that the correct term to say?
I use words like baited, stonedhigh.
Yeah,.
I thought those probably aren'tthe actual
Speaker 3 (12:18):
Terms.
Well, yeah, I mean, you'reright.
I, I mean intoxicated orimpaired.
Impaired impaired would be,would be the two substance would
would be the two words we woulduse to describe
Speaker 2 (12:27):
It.
Can you tell if someone isimpaired while they're driving?
There
Speaker 3 (12:30):
Is no breathalyzer for cannabis or marijuana yet.
And the drug screens ortoxicology for marijuana are
very imprecise in telling whenyou were intoxicated.
So it's, it's pretty hard totell whether the marijuana you
used is causing or contributingto a car accident.
That said, there are forensicexperts that the police officer
(12:53):
can call in a forensic expert todo an exam and to determine if
you're intoxicated.
But boy, it's not easy to
Speaker 2 (12:59):
Tell.
So that's one downside.
Talk about the downside to youngadults and adolescents.
Speaker 3 (13:05):
Yeah, there was an interesting study at the
University of Minnesota actuallythrough Boynton Health, which is
the clinic there.
The
Speaker 2 (13:11):
Student health center.
Yeah, yeah.
At
Speaker 3 (13:12):
The, at the, at the University of Minnesota where
they looked at marijuana use,how much you use and what is
your grade point average.
And it turns out whether you aremale or female.
And they only tested males andfemales.
I know there are some peoplethat don't identify with either
gender, but between males andfemales, the more marijuana you
used, the worse your GPA.
Speaker 2 (13:34):
So there's a whole bunch of parents right now
going, see I told you kid.
Yeah, you're gonna flunk yourmath test cuz you were high.
Speaker 3 (13:40):
Yeah.
And, and there is, um, a varietyof studies in other settings and
I think it's pretty wellestablished now that especially
heavy marijuana use in youradolescence or in your young
adulthood worsens educationaloutcomes.
Speaker 2 (13:53):
Do we know why that is?
Is it, does it harm yourneurologic networks or is it
just that you're kind of sleepy?
Speaker 3 (13:59):
Yeah, I mean, well and also memory, it affects
memory.
The cliche is, I forgot where Iput my keys.
You know, you'll hear the peoplewho use marijuana, where'd I put
my wallet?
Where'd I put my keys?
Wait, what was I gonna say?
That's kind of the marijuanacliche.
Um, well that if you'reintoxicated on marijuana, it
affects your ability to processand remember learning, learning
is memory.
I mean you can't learn withoutmemory.
(14:21):
And, and when they've studiedthis, they found that it takes
three days off marijuana andthen your memory comes back.
You don't remember what youshould have learned in class,
but you regain the ability tolearn again.
So when you're using marijuana,it does impair your memory and
therefore learning.
But if you stop and then ittakes three days, then you
(14:41):
become a sharper student at thatpoint.
Speaker 2 (14:43):
So if you're using every day or every other day,
you never have the chance.
Speaker 3 (14:46):
Never clean out.
Yeah.
Yeah.
And so, so that's an importantaspect of marijuana is affecting
learning in young adults.
Speaker 2 (14:52):
Is it a myth or is it true that marijuana leads to
apathy?
Because I remember, think of thestereotypical person who's
smoking a joint and they're kindof, you know, I don't care about
the world.
Is there any evidence that itkids or young adults are just,
they don't seem to care as muchabout learning?
Speaker 3 (15:07):
You know, the apathetic personality or apathy,
everyone talks about it.
It's kind of a non-medical thingthat's hard to measure.
But socioeconomic status, verbaliq, educational attainment, job
satisfaction, those things havebeen measured and marijuana
users have worse outcomes.
Speaker 2 (15:25):
Now is there an amount of marijuana use in a
teenager that doesn't lead tothose negative outcomes?
Speaker 3 (15:31):
Yeah, I mean it is dose dependent but in my world
the most important question isdaily use.
So a daily user is gonna haveall sorts of worse outcomes,
learning and potentially moodand some other worse outcomes.
So it's the daily users that getthemselves into trouble and
that's only a minority.
There's a lot of intermittent,you know, weekend users, they're
(15:53):
probably not getting into mm-hmm having these bad
outcomes before
Speaker 2 (15:56):
We leave adolescents and young adults.
Is it a gateway drug to otherdrugs?
Speaker 3 (16:01):
Hot topic?
This is a debatable point.
Uh, it is definitely associatedwith other drug use.
There's no doubt that marijuanausers are more likely to be
using or to go on to use otherdrugs.
Did the marijuana cause it or isit just an association?
That's the eternal question.
(16:21):
But for parents, it doesn'tmatter whether it's cause and
effect.
If your kid's smoking marijuana,it's worth, before you yell at
them for smoking marijuana, takea breath and make sure you
understand what else they mightbe using.
Or another way to put it, ifyour kid's not smoking
marijuana, they're unlikely tobe using all the other drugs
either.
So it's kind of a, so you cancut either way.
(16:43):
The association is important forparents.
Did the marijuana cause it, I'lllet someone else debate that
point.
So
Speaker 2 (16:50):
We've talked about adolescents and young adults.
We've talked about impairmentwhile operating vehicles.
Talk about the potentialnegative effects on your average
adult who might smoke a jointevery now and then.
Are there any,
Speaker 3 (17:02):
Well, I think it's really important for the average
adult to consider set andsetting meaning what is the
setting, where am I, what's thecontext?
Is this the appropriate time andplace to be using cannabis?
I shouldn't probably be doing itat a bar at midnight on Friday
when I have to drive home in theprivacy of my own home with
trusted people around me.
(17:23):
I don't need to go out and doanything.
So that's the setting.
And then the set is yourmindset.
You're in a good spot.
You're not smoking marijuana cuzyou're stressed out at work.
If you're using it as that kindof coping mechanism, it probably
doesn't help you at work thenext day.
And it's probably not the idealway of doing it.
So being mindful of set andsetting I think minimizes the
risks.
(17:43):
If someone has an addictivehistory themselves, people can
get addicted to marijuana.
It's usually not a catastrophicaddiction, but it's just becomes
a thing you use every day, allday.
And then maybe your spousestarts saying, geez, I really
wish you'd stop doing that allthe time.
Why do you have to be stonedwhen we're having dinner
together?
Yeah.
You know, like why we we'retrying to go out and hang out
(18:06):
with our friends and you gottabring your cannabis along and
vape in the back alley before wehang out with our friends.
Your spouse is annoyed at youand maybe you find your using at
work a little bit.
Those sorts of troubles canhappen in a minority of people.
Again, it's not catastrophic,but it's a net negative on that
person's life.
So someone with an addictivehistory, I would say this is an
addictive drug.
Be careful.
Speaker 2 (18:26):
Those are really insightful comments.
So Charlie, that sounds not toodissimilar from alcohol.
And you alluded to that earliertoday.
You, or at least you made ananalogy about alcohol use.
Could you put recreationalmarijuana use in that context
and tell us how does it compareto alcohol use, which is legal
in all states?
And could you just compare it toalcohol use in this country?
Speaker 3 (18:48):
Yeah, yeah.
Alcohol is more a part of the, Imean 70% of us or more drink
alcohol.
It's a, it's very common.
I intoxicant it's part of ourculture.
It's part of religiousceremonies and some of that is
true to a much, much lesserextent to, uh, cannabis.
It's much less pervasive in ourculture.
That's said alcohol has adramatic negative health effect
(19:11):
on our, our society.
Like really bad.
Our society pays a premium todrink alcohol in the form of
healthcare expenditure, in theform of criminal justice issues.
Violence happens because ofalcohol.
Alcohol is is a net drag onsociety.
There's no doubt about it.
And the magnitude of the cost tosociety that we drink alcohol.
(19:31):
And I, and I drink alcoholmyself.
So, and I'm lucky to be able todo so in moderation.
So I'm not hating on alcohol.
But the cost to society ofalcohol is almost certainly
greater than what the cost ofsociety will be for marijuana.
Alcohol is an expensive vice, ifyou will.
And uh, cannabis is, in myopinion, likely to be a little
(19:53):
bit of a cost to society.
But I don't think it'll be thescale of alcohol.
Another way of saying it, if yougo to our icu, our surgical icu,
our trauma center, our burncenter, our medical icu, there
are a lot of people in thoseICUs because of alcohol.
There aren't that many people inthose ICUs because of cannabis.
Now on the other hand, if you goto the psychiatric icu, you're
(20:15):
gonna see some people in thepsychiatric ICU because of
cannabis.
Um, and so the psychiatrists arevery intent on the harms of
cannabis cuz they see it in, intheir highest levels of their
care.
But by and large, alcoholcreates more illness and harm
than cannabis will.
But we also have tobacco, whichis outright just a poison.
It's awful.
So if tobacco's awful, itdoesn't mean we have to legalize
(20:38):
everything less awful thantobacco.
Cause a lot of things would belegal
Speaker 2 (20:42):
.
That all resonates with me,everything you just said.
I, um, just got off a week inthe hospital hospital caring for
patients in the hospital.
It's at a great number of mypatients and alcohol related
complications.
Yeah, yeah.
Many, many, many.
And I, well it was just one weekon service, but I didn't have a
single one that had a mar amarijuana related illness.
But then again, I don't work inthe mental health
Speaker 3 (21:01):
Ward and you certainly had people who used
cannabis who came and that justwas sort of incidental to their
admission to the
Speaker 2 (21:07):
Hospital.
That's a really greatperspective.
Before we let you go, Charlie,could I get you to answer a few
questions that have come up?
First question, how willlegalizing marijuana affect
people who need to drug test fortheir jobs?
Like say school bus drivers,right?
Speaker 3 (21:22):
That is going to depend on the job.
Each employer is gonna make adecision on this and it's
hopefully going to beevidence-based based on do we
want someone driving a bus onmarijuana?
Do we want a surgeon to be onmarijuana?
So each employer is gonna maketheir own decision.
And
Speaker 2 (21:41):
I'm gonna go with no and no on
Speaker 3 (21:42):
This two I Yes.
Yeah, I mean, yeah.
And some employers are probably,you know, look, if you're a
barista, they probably aren'tthat worried if their employee
is using, you know, and that'snothing to say about the skill
or the value of barista.
I love my baristas, but it'sgonna depend on the job and it's
gonna, and so I what I counselmy patient, even with medical
cannabis, talk to your employerand just, just have an honest,
(22:05):
honest conversation.
What's the expectation of me?
What do you want to do?
What's the testing protocol?
So you are an informed employee.
Speaker 2 (22:12):
Second question, is there a difference in those
risks and benefits of eatingcannabis versus smoking it?
Speaker 3 (22:20):
So, yeah, I mean, it's hard.
You know, an internist willnever encourage smoking
and there is vaping.
However, there was vapingassociated lung injury that may,
and that was a couple years ago,was, uh, in the news a lot and
that was probably associatedwith vaping cannabis.
Uh, that's a little less commonnow.
So the good thing about inhalinga cannabis or marijuana product
(22:43):
is you know how much you'reusing right away.
So you tend not to use too much.
Uh, use just what you need.
Speaker 2 (22:49):
You mean you feel the effects right away.
You
Speaker 3 (22:51):
Feel the effects right away.
So you don't use too much.
The downside to eating cannabisis you sometimes you have to
wait two to three hours beforeit has a full effect.
And if you get impatient, youuse more, you use extra.
Now
Speaker 2 (23:05):
This isn't doing anything.
I'm have another one.
And
Speaker 3 (23:07):
Then it builds up and then two to three hours later
you have a panic attack.
And so the commonest thing, soeating cannabis is probably a
safer way to go if you start lowand go slow, start with a small
dose and give it a couple hoursto kick in.
If you want something to kick inright away, you're gonna get
yourself into trouble trying toeat enough cannabis to have a
any feeling right away.
So you gotta be careful aboutthat.
(23:29):
But if, if you can pace yourselfand dose yourself appropriately,
eating, um, eating is probably ahealthier way to go with
Speaker 2 (23:36):
This.
Last question, and I don't meanto put you in the hot seat, but
is the legalization ofrecreational marijuana in your
opinion as an addiction medicinedoctor, a net benefit or a net
Speaker 3 (23:46):
Negative?
Yeah, I mean, I, I think this is, um, probably going to be a
small net negative for society.
I think there'll be enoughpsychiatric harms and adolescent
harms and motor vehicleaccidents that it's gonna be a
little bit of a drag on society.
But I don't think it'll benearly the negative of tobacco
or alcohol.
And I could be wrong on this.
(24:07):
This is just, and I'm anaddiction doc, so I definitely
have my No, I appreciate
Speaker 2 (24:10):
Your negative perspective.
I think that's a goodperspective.
Speaker 3 (24:12):
Yeah.
Yeah.
I think it'll be a, a slight netnegative, but I think, I think
the vast majority of people whoare basically average people are
gonna either pay no mind to itat all or get a little bit of
pleasure out of
Speaker 2 (24:23):
It.
This has been a greatconversation.
We've been talking to my friendand colleague, Dr.
Charlie Resnikoff aboutrecreational marijuana.
I hope you've learned somethingon this show.
If you want to hear Dr.
Resn K's previous episode, goback to season one, episode
four, where we talked aboutother issues with substance use
disorders and addiction.
Charlie, thanks for being on theshow today.
(24:43):
This has been a greatconversation.
Speaker 3 (24:45):
So much fun.
Thank you
Speaker 2 (24:46):
And thank you listeners for tuning into this
episode.
I hope you've enjoyed it and Ihope you'll tune in for the next
episode.
And in the meantime, be healthyand be well.
Speaker 1 (24:55):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
Got a question or a comment forthe show, email us at Healthy
Matters hc m e d.org or call 6 12 8 7 3 talk.
There's also a link in the shownotes.
(25:17):
And finally, if you enjoy theshow, please leave us a review
and share the show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
Jonathan Camino and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
(25:38):
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:21):
Hey everybody, it's Dr.
David Hilden, your host of theHealthy Matters podcast.
Today on episode six, we'regonna talk about recreational
marijuana.
To help me out, I have asked arepeat guest, Dr.
Charlie Resnikoff, to join me.
You may remember his name fromepisode four of the podcast last
season.
If not, I encourage you to goback and listen to that show
because it's a greatintroduction to the field of
(00:42):
addiction medicine.
Today I've asked him to talkabout another area of his
expertise that mean marijuana.
Many states now have legalizedit, both for medicinal use as
well as recreational use.
Charlie, welcome back to theshow.
Speaker 3 (00:56):
I'm happy to be here excited to talk about this.
Speaker 2 (00:58):
So tell us the current state of recreational
marijuana, specifically in ourstate of Minnesota, but
nationally.
Where, where is it?
Well,
Speaker 3 (01:06):
Listeners might know or have heard that this summer a
bill sort of snuck through thelegislature and was signed into
Speaker 2 (01:15):
Law here in Minnesota,
Speaker 3 (01:16):
Here in Minnesota that allowed low dose hemp-based
t hc.
It acts just like recreationalmarijuana.
It a, it behaves in the bodyjust like that, but it's only
low dose.
And it is derived from hemp,which is related to marijuana,
but not the same.
And it has the active ingredientthat is an I intoxicant, so that
(01:36):
that is available now throughoutMinnesota in a variety of retail
stores.
So that was a bit of anadjustment, but now the
legislature is very heavilyconsidering and they're looking
at language and they're craftinglanguage right now to legalize
marijuana for recreationalpurposes in our state.
And I think it is highly likelyor almost certain that the bill
(02:00):
will pass and be signed intolaw.
And in the next couple years,we're gonna see a big change out
there in Minnesota.
Speaker 2 (02:06):
So many other states have done this either through
their legislative process or byvoter referenda.
Yeah.
Right.
Yeah.
How, how prominent is this?
Is this a a, a naturalprogression in, in someday down
the road, it's gonna be legalthroughout our country?
Good
Speaker 3 (02:22):
Question.
I think most people think thatat some point in the future it
will be legal federallythroughout the country.
Now we have many states whereit's recreationally legal.
It is a bit of a change.
I think people notice thechange, you know, walking
through the city, you know,you'll smell it a lot more where
people already smell it.
Quite, huh?
Speaker 2 (02:41):
You'll walk through Denver, Colorado.
Oh yeah.
You get stoned just walking downthe street, the
Speaker 3 (02:45):
Street
I know.
And the shops are everywhere,and it's more prominent in the
culture.
So yeah, I mean, for sure it is.
It will be a noticeable change.
It won't be a sort ofcataclysmic change.
I think life will go, go onmostly life will go on as
normal, but it'll be a little,you know, a new, a new thing
that we see every
Speaker 2 (03:05):
Day for some people of, uh, maybe aer maybe it's
generational, maybe it's not.
Um, marijuana would've been likeheroin or like other cocaine.
Like I, what are you some drugaddict.
And now we're actually talkingabout making it legal for
everybody.
Yeah,
Speaker 3 (03:19):
That's, that's my parents and maybe your
Speaker 2 (03:21):
Parents' generation,
Speaker 3 (03:22):
Maybe my, the silent generation, the, the generation
that preceded the baby boomers,almost nobody used cannabis.
My 80 year old parents still in80 years have never used
cannabis.
However, from the baby boomers.
And after that, those are allheavily exposed generations.
Most people, baby boomer oryounger have at least tried once
or know many people who usecannabis.
(03:43):
So it's generational.
Speaker 2 (03:44):
I asked my, my son after, when he got back from a
semester at college, he's in hisearly twenties, or he was at the
time, I said, do many kids atcollege smoke?
And he goes, oh yeah, they a lotto, and I said, really?
Speaker 3 (03:55):
Yeah,
Speaker 2 (03:55):
I thought kids weren't smoking cigarettes
anymore, because that's what Imeant.
Oh, he didn't even, didn't evenoccur to him that I meant
cigarettes.
He goes, no, I don't know asingle person who smokes
cigarettes.
They all smoke weed now.
That's what, that's what theymeant by smoking.
Speaker 3 (04:07):
And now a lot of them aren't even smoking weed.
They're vaping or eating ediblesis, those are more common.
There is some smoking stillgoing on though.
Okay.
Speaker 2 (04:15):
So if all these laws are changing, there must be some
positive benefits, either toindividuals or to society.
So I'd like to use this episodenow from here on out talking
first about the good.
What are the good, what are thebenefits of, of legalizing
recreational marijuana?
And then we're gonna shift afterthat to what's the downside?
So what are the benefits eitherto an individual or to society
(04:37):
at large to legalizingmarijuana?
Yeah,
Speaker 3 (04:39):
It's funny, I, and you hear all these talking
points about all the benefits,and some of them are true, and
some of them are kind of, Ithink they're overstated.
But I'll tell you what, the mostimportant number one benefit is
for the vast majority of peoplewho use marijuana.
It brings in pleasure and havingsome joy in your life.
Whether that's, you know, rightnow we, we can drink a cocktail
(05:01):
and nobody looks down upon us.
Uh, and we get a little pleasurefrom that.
And I think it's very reasonablethat a lot of people are saying,
I want to have a little safepleasure in the privacy of my
own home to be able to use thisintoxicant.
It's not that harmful.
I use it appropriately.
So I think the number one upsideis for the vast majority of
people, it's a relatively safeway to have a little bit of
(05:23):
pleasure.
And I, I'm not necessarilyendorsing it, but I, I think
that's the bottom line is that alot of people just use it to
relax.
Speaker 2 (05:30):
You know, it's refreshing actually to hear a
physician say that there's valueto some enjoyment.
You
Speaker 3 (05:36):
Gotta find joy in life.
And I think there, there arehealthier ways to find joy,
whether that be exercise or art.
But, uh, this is a relativelysafe way.
It's a shortcut to joy, let'scall it that.
And, and that I'm quotingactually, Andrew, we, who's a,
who's an MD who now sells herbson the internet.
But he originally was a cannabisresearcher and he talked about,
(05:58):
you know, how like little kidswhen they're, you know, maybe
they're five years old, they'llspin around until they're dizzy.
Yeah.
And then they'll fall andthey'll giggle.
That's the childhood equivalentof becoming intoxicated as an
adult.
You've done something toyourself to make yourself dizzy
and giddy.
And then you giggle and fall.
Speaker 2 (06:12):
It was fun for a while.
It was fun
Speaker 3 (06:14):
For a while, and you fall and you get back up and go
on your day
And that, that's the same thingadults do with a Manhattan, you
know, or whatever.
A glass of wine.
Totally.
Speaker 2 (06:22):
That makes perfect sense.
Are there actual health benefitsother than that, that sense of
pleasure?
Speaker 3 (06:29):
Good question.
So a subset of people get goodpain relief from it.
So people suffering from pain,uh, some of them get some relief
from cannabis and that could bereally helpful and a preferable
alternative to opioids.
Some people with anxiety ortrauma and insomnia.
Um, the, what you're seeing alot, and I've seen it in uh,
(06:49):
literature, is that some peoplereally find that cannabis helps
them sleep and helps their sleepbe less disturbed by nightmares
or bad dreams.
So I think some sleep, someanxiety level, some maybe
helping cope with some pasttrauma they're struggling with.
Those things I would say arebenefits, nausea, you know, and,
and it's
Speaker 2 (07:09):
Cannabis cancer patients have known that for
some time.
Speaker 3 (07:11):
Oh yeah, yeah.
HIV patients with their meds.
Some of the h old HIV medscaused nausea and then they
would find out that the cannabishelped them tolerate their
medications.
So there's some me, uh, nausearelief.
Some pain relief.
Yeah.
I mean, I think those are themain things.
Speaker 2 (07:25):
So there are some benefits to an individual as
you've laid out.
Are there benefits to oursociety?
Speaker 3 (07:31):
Yeah, great question.
I mean, I, this is somethingvery front and center in
Minnesota where the legislatureis very keen on not
incarcerating or penalizingpeople for small time drug
possession or offenses.
And those types of laws areunfortunately disproportionately
applied to people of color.
And so I think there's a lot ofindividuals incarcerated today
(07:52):
for marijuana laws that probablyneedn't have been incarcerated
and, you know, and it goes ontheir record and it affects
their abil ability to get a joband all and housing and all the
rest.
So, so yeah.
I mean that's a huge, uh, plusto society.
That's a huge plus.
Oh
Speaker 2 (08:07):
Yeah.
You look back on that.
It's like what we're thinking,putting a bunch of people in
jail.
Yeah.
It's
Speaker 3 (08:12):
The, it's probably the most important, compelling
reason to do it, in my opinionYeah.
Is to sort of write the ledgeron all the wrongs we've done to
certain people Yeah.
Who use this drug.
And then there will be some taxrevenue.
Uh, that's always nice for, uh,for the states.
Speaker 2 (08:26):
Do states do that?
They add some tax on?
Oh yeah, you get it at a little,I suppose you get it at a little
shop or something like Yeah.
Like you see every other foot inDenver, Washington
Speaker 3 (08:34):
State taxes is at 40% and that's a lot of tax revenue.
And so our state is wrestlingwith what percentage tax to put
it on.
And that's smarter people than
Speaker 2 (08:44):
Because I'll bet, I'll bet there's some
disparities there too.
Poorer folks can't, a sales taxis a bigger chunk of your money.
Speaker 3 (08:49):
Exactly.
So they wanna make it availableto everyone in a fair sense.
But they wouldn't mind therevenue either.
So, so I think they're, they'refiguring all that out.
So tax revenue, criminal justicereform.
And then also there is a blackmarket right now.
And what if, instead of having abunch of drug dealers make money
on a black market sellingmarijuana, it was through IIT
(09:10):
channels.
It was controlled, it was pure,it was secure.
Speaker 2 (09:13):
So Charlie, uh, is what you're saying is that the,
the drug supply will beregulated more for, for purity
and such,
Speaker 3 (09:19):
Right?
Exactly.
So you'll know what it is you'rebuying and what the potency is,
and you'll have a much greatersense of what you're ingesting
versus getting it on the blackmarket.
Speaker 2 (09:28):
But it's not a pharmaceutical type of
regulation.
No.
This is still being sold inlittle shops No, in the street
corner.
Right.
Speaker 3 (09:34):
That's that's true.
But just imagine, if you will,if all alcohol consumed was
moonshine made in someone'sbackyard at a, in a still in
someone's backyard.
Well that would be prettydangerous cuz there's a lot of,
you know, risk to that.
And then finally there arereports, unconfirmed reports
that sometimes marijuana isadulterated with fentanyl.
Yeah, I've
Speaker 2 (09:51):
Heard that.
Speaker 3 (09:51):
Which is just terrifying.
And if there's any chance thatfentanyl is gonna get put in the
marijuana supply, how fast canwe legalize marijuana is what I
would say, you know, to
Speaker 2 (10:01):
Eliminate that
Speaker 3 (10:01):
Risk.
Oh, that the risk is just death.
I mean it's, yeah, it would be avery bad situation if that
became the norm that fentanylwas in marijuana.
So those are all societalbenefits.
So
Speaker 2 (10:10):
There really are some benefits.
Yeah.
There are some individualbenefits, there are some
societal benefits.
We've covered the good when wecome back.
What are the downsides ofrecreational marijuana?
Stay with us.
We'll be right back.
Speaker 1 (10:23):
You are listening to the Healthy Matters podcast with
Dr.
David Hilden.
Got a question or comment forthe doc.
Email us at Healthy Matters hc me d.org or give us a call at six
one two eight seven three talk.
That's 6 1 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (10:46):
And we're back talking about recreational
marijuana with Dr.
Charlie Resnikoff.
Okay, Charlie, we've covered thepotential upsides.
Let's turn to the downsides.
What harms are possible both toan individual and to society of
legalizing marijuana?
Speaker 3 (11:03):
Yeah.
Um, and I'm an addictionmedicine doctor as you know.
You know, and the listenersknow.
So I always think about thosewho are most vulnerable.
So I do spend a lot of my energyworrying about the minority of
people who will be vulnerableand harmed by this.
And I think there are a couplegroups to think about.
People with addictions, peoplewith serious mental health
issues, adolescents and evencollege kids, a little young
(11:26):
adults, adolescents and youngadults and people driving a car.
And we can start with peopledriving a car.
Uh, there's
Speaker 2 (11:33):
Is it dangerous?
Speaker 3 (11:34):
Oh yeah, there's no doubt.
It's, it's actually not hard totest whether someone gets
intoxicated and drives worse.
They put a bunch of orange conesin a parking lot, let you use
your drug and test how well youdrive the car.
And turns out people knock overthose cones more often when
they've used cannabis.
Uh, yeah.
So it's really not hard tomeasure and there's a lot of
(11:54):
concern that cannabis use,especially mixing cannabis with
alcohol now
Speaker 2 (11:59):
That is, that sounds scary.
Yeah,
Speaker 3 (12:01):
That's, that, that is way higher risk for an accident
than either those drugs alone.
You
Speaker 2 (12:07):
Use the word intoxicated.
Yeah.
Most listeners I think wouldautomatically assume intoxicated
means alcohol.
Is that the correct term to say?
I use words like baited, stonedhigh.
Yeah,
I thought those probably aren'tthe actual
Speaker 3 (12:18):
Terms.
Well, yeah, I mean, you'reright.
I, I mean intoxicated orimpaired.
Impaired impaired would be,would be the two substance would
would be the two words we woulduse to describe
Speaker 2 (12:27):
It.
Can you tell if someone isimpaired while they're driving?
There
Speaker 3 (12:30):
Is no breathalyzer for cannabis or marijuana yet.
And the drug screens ortoxicology for marijuana are
very imprecise in telling whenyou were intoxicated.
So it's, it's pretty hard totell whether the marijuana you
used is causing or contributingto a car accident.
That said, there are forensicexperts that the police officer
(12:53):
can call in a forensic expert todo an exam and to determine if
you're intoxicated.
But boy, it's not easy to
Speaker 2 (12:59):
Tell.
So that's one downside.
Talk about the downside to youngadults and adolescents.
Speaker 3 (13:05):
Yeah, there was an interesting study at the
University of Minnesota actuallythrough Boynton Health, which is
the clinic there.
The
Speaker 2 (13:11):
Student health center.
Yeah, yeah.
At
Speaker 3 (13:12):
The, at the, at the University of Minnesota where
they looked at marijuana use,how much you use and what is
your grade point average.
And it turns out whether you aremale or female.
And they only tested males andfemales.
I know there are some peoplethat don't identify with either
gender, but between males andfemales, the more marijuana you
used, the worse your GPA
Speaker 2 (13:34):
So there's a whole bunch of parents right now
going, see I told you kid.
Yeah, you're gonna flunk yourmath test cuz you were high.
Speaker 3 (13:40):
Yeah.
And, and there is, um, a varietyof studies in other settings and
I think it's pretty wellestablished now that especially
heavy marijuana use in youradolescence or in your young
adulthood worsens educationaloutcomes.
Speaker 2 (13:53):
Do we know why that is?
Is it, does it harm yourneurologic networks or is it
just that you're kind of sleepy?
Speaker 3 (13:59):
Yeah, I mean, well and also memory, it affects
memory.
The cliche is, I forgot where Iput my keys.
You know, you'll hear the peoplewho use marijuana, where'd I put
my wallet?
Where'd I put my keys?
Wait, what was I gonna say?
That's kind of the marijuanacliche.
Um, well that if you'reintoxicated on marijuana, it
affects your ability to processand remember learning, learning
is memory.
I mean you can't learn withoutmemory.
(14:21):
And, and when they've studiedthis, they found that it takes
three days off marijuana andthen your memory comes back.
You don't remember what youshould have learned in class,
but you regain the ability tolearn again.
So when you're using marijuana,it does impair your memory and
therefore learning.
But if you stop and then ittakes three days, then you
(14:41):
become a sharper student at thatpoint.
Speaker 2 (14:43):
So if you're using every day or every other day,
you never have the chance.
Speaker 3 (14:46):
Never clean out.
Yeah.
Yeah.
And so, so that's an importantaspect of marijuana is affecting
learning in young adults.
Speaker 2 (14:52):
Is it a myth or is it true that marijuana leads to
apathy?
Because I remember, think of thestereotypical person who's
smoking a joint and they're kindof, you know, I don't care about
the world.
Is there any evidence that itkids or young adults are just,
they don't seem to care as muchabout learning?
Speaker 3 (15:07):
You know, the apathetic personality or apathy,
everyone talks about it.
It's kind of a non-medical thingthat's hard to measure.
But socioeconomic status, verbaliq, educational attainment, job
satisfaction, those things havebeen measured and marijuana
users have worse outcomes.
Speaker 2 (15:25):
Now is there an amount of marijuana use in a
teenager that doesn't lead tothose negative outcomes?
Speaker 3 (15:31):
Yeah, I mean it is dose dependent but in my world
the most important question isdaily use.
So a daily user is gonna haveall sorts of worse outcomes,
learning and potentially moodand some other worse outcomes.
So it's the daily users that getthemselves into trouble and
that's only a minority.
There's a lot of intermittent,you know, weekend users, they're
(15:53):
probably not getting into mm-hmm
outcomes before
Speaker 2 (15:56):
We leave adolescents and young adults.
Is it a gateway drug to otherdrugs?
Speaker 3 (16:01):
Hot topic?
This is a debatable point.
Uh, it is definitely associatedwith other drug use.
There's no doubt that marijuanausers are more likely to be
using or to go on to use otherdrugs.
Did the marijuana cause it or isit just an association?
That's the eternal question.
(16:21):
But for parents, it doesn'tmatter whether it's cause and
effect.
If your kid's smoking marijuana,it's worth, before you yell at
them for smoking marijuana, takea breath and make sure you
understand what else they mightbe using.
Or another way to put it, ifyour kid's not smoking
marijuana, they're unlikely tobe using all the other drugs
either.
So it's kind of a, so you cancut either way.
(16:43):
The association is important forparents.
Did the marijuana cause it, I'lllet someone else debate that
point.
So
Speaker 2 (16:50):
We've talked about adolescents and young adults.
We've talked about impairmentwhile operating vehicles.
Talk about the potentialnegative effects on your average
adult who might smoke a jointevery now and then.
Are there any,
Speaker 3 (17:02):
Well, I think it's really important for the average
adult to consider set andsetting meaning what is the
setting, where am I, what's thecontext?
Is this the appropriate time andplace to be using cannabis?
I shouldn't probably be doing itat a bar at midnight on Friday
when I have to drive home in theprivacy of my own home with
trusted people around me.
(17:23):
I don't need to go out and doanything.
So that's the setting.
And then the set is yourmindset.
You're in a good spot.
You're not smoking marijuana cuzyou're stressed out at work.
If you're using it as that kindof coping mechanism, it probably
doesn't help you at work thenext day.
And it's probably not the idealway of doing it.
So being mindful of set andsetting I think minimizes the
risks.
(17:43):
If someone has an addictivehistory themselves, people can
get addicted to marijuana.
It's usually not a catastrophicaddiction, but it's just becomes
a thing you use every day, allday.
And then maybe your spousestarts saying, geez, I really
wish you'd stop doing that allthe time.
Why do you have to be stonedwhen we're having dinner
together?
Yeah.
You know, like why we we'retrying to go out and hang out
(18:06):
with our friends and you gottabring your cannabis along and
vape in the back alley before wehang out with our friends.
Your spouse is annoyed at youand maybe you find your using at
work a little bit.
Those sorts of troubles canhappen in a minority of people.
Again, it's not catastrophic,but it's a net negative on that
person's life.
So someone with an addictivehistory, I would say this is an
addictive drug.
Be careful.
Speaker 2 (18:26):
Those are really insightful comments.
So Charlie, that sounds not toodissimilar from alcohol.
And you alluded to that earliertoday.
You, or at least you made ananalogy about alcohol use.
Could you put recreationalmarijuana use in that context
and tell us how does it compareto alcohol use, which is legal
in all states?
And could you just compare it toalcohol use in this country?
Speaker 3 (18:48):
Yeah, yeah.
Alcohol is more a part of the, Imean 70% of us or more drink
alcohol.
It's a, it's very common.
I intoxicant it's part of ourculture.
It's part of religiousceremonies and some of that is
true to a much, much lesserextent to, uh, cannabis.
It's much less pervasive in ourculture.
That's said alcohol has adramatic negative health effect
(19:11):
on our, our society.
Like really bad.
Our society pays a premium todrink alcohol in the form of
healthcare expenditure, in theform of criminal justice issues.
Violence happens because ofalcohol.
Alcohol is is a net drag onsociety.
There's no doubt about it.
And the magnitude of the cost tosociety that we drink alcohol.
(19:31):
And I, and I drink alcoholmyself.
So, and I'm lucky to be able todo so in moderation.
So I'm not hating on alcohol.
But the cost to society ofalcohol is almost certainly
greater than what the cost ofsociety will be for marijuana.
Alcohol is an expensive vice, ifyou will.
And uh, cannabis is, in myopinion, likely to be a little
(19:53):
bit of a cost to society.
But I don't think it'll be thescale of alcohol.
Another way of saying it, if yougo to our icu, our surgical icu,
our trauma center, our burncenter, our medical icu, there
are a lot of people in thoseICUs because of alcohol.
There aren't that many people inthose ICUs because of cannabis.
Now on the other hand, if you goto the psychiatric icu, you're
(20:15):
gonna see some people in thepsychiatric ICU because of
cannabis.
Um, and so the psychiatrists arevery intent on the harms of
cannabis cuz they see it in, intheir highest levels of their
care.
But by and large, alcoholcreates more illness and harm
than cannabis will.
But we also have tobacco, whichis outright just a poison.
It's awful.
So if tobacco's awful, itdoesn't mean we have to legalize
(20:38):
everything less awful thantobacco.
Cause a lot of things would belegal
Speaker 2 (20:42):
That all resonates with me,everything you just said.
I, um, just got off a week inthe hospital hospital caring for
patients in the hospital.
It's at a great number of mypatients and alcohol related
complications.
Yeah, yeah.
Many, many, many.
And I, well it was just one weekon service, but I didn't have a
single one that had a mar amarijuana related illness.
But then again, I don't work inthe mental health
Speaker 3 (21:01):
Ward and you certainly had people who used
cannabis who came and that justwas sort of incidental to their
admission to the
Speaker 2 (21:07):
Hospital.
That's a really greatperspective.
Before we let you go, Charlie,could I get you to answer a few
questions that have come up?
First question, how willlegalizing marijuana affect
people who need to drug test fortheir jobs?
Like say school bus drivers,right?
Speaker 3 (21:22):
That is going to depend on the job.
Each employer is gonna make adecision on this and it's
hopefully going to beevidence-based based on do we
want someone driving a bus onmarijuana?
Do we want a surgeon to be onmarijuana?
So each employer is gonna maketheir own decision.
And
Speaker 2 (21:41):
I'm gonna go with no and no on
Speaker 3 (21:42):
This two I Yes.
Yeah, I mean, yeah.
And some employers are probably,you know, look, if you're a
barista, they probably aren'tthat worried if their employee
is using, you know, and that'snothing to say about the skill
or the value of barista.
I love my baristas, but it'sgonna depend on the job and it's
gonna, and so I what I counselmy patient, even with medical
cannabis, talk to your employerand just, just have an honest,
(22:05):
honest conversation.
What's the expectation of me?
What do you want to do?
What's the testing protocol?
So you are an informed employee.
Speaker 2 (22:12):
Second question, is there a difference in those
risks and benefits of eatingcannabis versus smoking it?
Speaker 3 (22:20):
So, yeah, I mean, it's hard.
You know, an internist willnever encourage smoking
and there is vaping.
However, there was vapingassociated lung injury that may,
and that was a couple years ago,was, uh, in the news a lot and
that was probably associatedwith vaping cannabis.
Uh, that's a little less commonnow.
So the good thing about inhalinga cannabis or marijuana product
(22:43):
is you know how much you'reusing right away.
So you tend not to use too much.
Uh, use just what you need.
Speaker 2 (22:49):
You mean you feel the effects right away.
You
Speaker 3 (22:51):
Feel the effects right away.
So you don't use too much.
The downside to eating cannabisis you sometimes you have to
wait two to three hours beforeit has a full effect.
And if you get impatient, youuse more, you use extra.
Now
Speaker 2 (23:05):
This isn't doing anything.
I'm have another one.
And
Speaker 3 (23:07):
Then it builds up and then two to three hours later
you have a panic attack.
And so the commonest thing, soeating cannabis is probably a
safer way to go if you start lowand go slow, start with a small
dose and give it a couple hoursto kick in.
If you want something to kick inright away, you're gonna get
yourself into trouble trying toeat enough cannabis to have a
any feeling right away.
So you gotta be careful aboutthat.
(23:29):
But if, if you can pace yourselfand dose yourself appropriately,
eating, um, eating is probably ahealthier way to go with
Speaker 2 (23:36):
This.
Last question, and I don't meanto put you in the hot seat, but
is the legalization ofrecreational marijuana in your
opinion as an addiction medicinedoctor, a net benefit or a net
Speaker 3 (23:46):
Negative?
Yeah, I mean, I, I think this is, um, probably going to be a
small net negative for society.
I think there'll be enoughpsychiatric harms and adolescent
harms and motor vehicleaccidents that it's gonna be a
little bit of a drag on society.
But I don't think it'll benearly the negative of tobacco
or alcohol.
And I could be wrong on this.
(24:07):
This is just, and I'm anaddiction doc, so I definitely
have my No, I appreciate
Speaker 2 (24:10):
Your negative perspective.
I think that's a goodperspective.
Speaker 3 (24:12):
Yeah.
Yeah.
I think it'll be a, a slight netnegative, but I think, I think
the vast majority of people whoare basically average people are
gonna either pay no mind to itat all or get a little bit of
pleasure out of
Speaker 2 (24:23):
It.
This has been a greatconversation.
We've been talking to my friendand colleague, Dr.
Charlie Resnikoff aboutrecreational marijuana.
I hope you've learned somethingon this show.
If you want to hear Dr.
Resn K's previous episode, goback to season one, episode
four, where we talked aboutother issues with substance use
disorders and addiction.
Charlie, thanks for being on theshow today.
(24:43):
This has been a greatconversation.
Speaker 3 (24:45):
So much fun.
Thank you
Speaker 2 (24:46):
And thank you listeners for tuning into this
episode.
I hope you've enjoyed it and Ihope you'll tune in for the next
episode.
And in the meantime, be healthyand be well.
Speaker 1 (24:55):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
Got a question or a comment forthe show, email us at Healthy
Matters hc m e d.org or call 6 12 8 7 3 talk.
There's also a link in the shownotes.
(25:17):
And finally, if you enjoy theshow, please leave us a review
and share the show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
Jonathan Camino and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
(25:38):
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
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