"Cannabis Medicine" with guest Kevin P. Hill, M.D., M.H.S

In a comprehensive dialogue, Dr. Mark Gold converses with cannabis expert Dr. Kevin Hill to explore the clinical implications of cannabis use, focusing on its increasing potency over time and the implications for public health and addiction treatment. Dr. Hill recounts his journey from premed to cannabis specialization, sparked by his work in a partial hospital program helping patients with cannabis use disorders. He highlights a significant evolution in understanding cannabis use disorders, with recent statistics indicating that 30-35% of adult users may develop such disorders, soaring from the previously noted 10%. This rise correlates with the increased potency of cannabis strains currently available, which contain much higher THC levels than in past decades, raising alarms regarding potential health risks.

Throughout the discussion, Dr. Hill advocates for informed consent and better education for both patients and healthcare providers, particularly regarding the risks inherent in cannabis use for vulnerable groups, including those with psychiatric conditions and pregnant women. He stresses the alarming effects of regular cannabis consumption on individuals predisposed to psychotic disorders and points to the emergence of cannabis hyperemesis syndrome (CHS) as a byproduct of higher potency strains, with existing treatments often inadequate.

Moreover, the conversation touches on the inconsistent regulatory environment surrounding cannabis, where state laws sometimes lack a scientific foundation. Dr. Hill strongly encourages evidence-based policymaking to mitigate risks associated with cannabis use. Dr. Gold brings to light the growing negotiation between traditional addiction recovery models and newer paradigms, such as the “California sober” approach, which embraces limited cannabis usage.

Both experts underscore the significance of relying on peer-reviewed research over anecdotal evidence in guiding treatment decisions. By sharing experiences from the NFL Pain Management Committee, they address the delicate balance of supporting athletes facing substance use issues while monitoring their substance use. The discussion ends with a call for holistic, patient-centered therapies that integrate psychotherapy and tackle co-existing mental health disorders, underlining the pressing need for advanced treatments for cannabis use disorder.

GUEST: Kevin P. Hill, M.D., M.H.S., is an addiction psychiatrist, Director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center (BIDMC), and an Associate Professor of Psychiatry at Harvard Medical School.

HOST: Mark S. Gold, MD, DFASAM, DFLAPA: Dr. Gold is a world-renowned expert on addiction-related diseases and has worked for 50+ years developing models for understanding the effects of opioids, tobacco, cocaine, and other drugs, as well as food, on the brain and behavior. He is professor (neuroscience), chief, Dizney distinguished professor, chairman (psychiatry), University of Florida College of Medicine, emeritus eminent scholar, and 17th U.F. distinguished alumni professor. He is also an adjunct professor in the Department of Psychiatry at Washington University School of Medicine, St. Louis, MO.

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