Originally appeared at: http://www.npr.org/templates/story/story.php?storyId=130592638 Next month, voters in four states will consider whether to change laws regulating marijuana use. But how much is known about marijuana's effects on the body? Ira Flatow talks with psychiatrist Julie Holland, editor of a new collection of essays titled The Pot Book, about the plant. IRA FLATOW, host: Up next, a psychiatrist examines marijuana, though she doesn't like to call it marijuana. We'll find out why because next month, voters in four states will be deciding on whether to loosen laws regulating marijuana, even though federal laws still say it's an illegal drug. For example, in California, where a medical marijuana already is sanctioned, voters will decide whether to allow marijuana for recreational use and regulate it in the same way we regulate alcohol. But how much do we know about marijuana's affects on the body? Even those in favor of legalization admit that we need to study it more. Maybe cannabis is effective for pain or nausea of cancer. But how much should people use, even if it is effective? What is the dosage rate? And what kind of marijuana might help a patient? Do we know enough about the science of the plant to play it safe? Joining me now to talk about these issues and her views on the legalization of marijuana is Julie Holland. She is clinical assistant professor of psychiatry at New York University School of Medicine. She is author of "Weekends at Bellevue: Nine Years on the Night Shift at the Psych ER," and she's now editor of a new volume, "The Pot Book: A Complete Guide to Cannabis." Welcome back to SCIENCE FRIDAY. Professor JULIE HOLLAND (Psychiatry, New York University School of Medicine; Author): It's good to be back. FLATOW: Now, you were telling me that you didn't want to put the name marijuana on the cover. Prof. HOLLAND: Right. I didn't. FLATOW: Why not? Prof. HOLLAND: Well, marijuana is actually a political slur, basically. When they made alcohol legal, there were a lot of feds who were out of work and they decided to make cannabis illegal, right around that same time, 1937. Before that, cannabis was a medicine, and the doctors knew it as a medicine and the patients knew it as a medicine. So they introduced this new word, marijuana, and they called it loco weed, and they basically tried to tar and feather this medicine as a drug that was making people crazy, that was being smoked by Mexican migrant workers. And, you know, it became sort of a racist issue, to some degree, and I think that pot prohibition still is a racist issue. I mean, in New York City, which is the arrest capital of the world for marijuana, the percentage of people who are African-American or Latino who have been arrested is much higher than Caucasians. FLATOW: All right, we're going to come back and talk lots more with Julie Holland, author of "The Pot Book." Our number: 1-800-989-8255. You can also tweet us @scifri, @-S-C-I-F-R-I. Stay with us. We'll be right back after this break. (Soundbite of music) FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR. (Soundbite of music) FLATOW: You're listening to SCIENCE FRIDAY. I'm Ira Flatow. We're talking this hour about cannabis with Julie Holland, author of "The Pot Book: A Complete Guide to Cannabis." Our number: 1-800-989-8255. You wrote you've written a book on MDMA, on ecstasy, which I know you studied extensively. Why taking on marijuana now? Prof. HOLLAND: Well, you know, the book that I edited on MDMA and the book that I'm editing on pot – on cannabis is really similar reasons. I mean, these are illegal drugs that have the potential to be useful as medicine. And certainly, with the case of cannabis, this was a medicine – you know, for thousands of years, this was a medicine. And all of the sudden, it's made illegal, and it's a Schedule I drug, and the same thing with MDMA. This was a medicine that psychiatrists and psychotherapists were using with their patients, and then all of a sudden, it became a Schedule I drug. The problem with Schedule I is it's illegal, and it's very hard to do research on it. But it just becomes underground, and people can still buy it. You know, it's unregulated, and it's black market, and that is really a problem. FLATOW: And you think that you're in favor of legalizing it. Prof. HOLLAND: Well, I'm in favor of it being regulated. You know, it's – right now, like in New York state, for instance, we don't have any medical marijuana, you know, laws here. So if a doctor thinks that a patient maybe should use cannabis to help with their symptoms and the patient says, well, I don't know where to get it, and the doctor says: Well, do you know any kids? That's wrong. You know, kids have an easier time getting cannabis than they do getting cigarettes and alcohol because dealers don't card. They don't ask for any proof of age. And when you go to the dealer, you may end up with other drugs besides marijuana. If it's regulated, at least things you know, it gets out of the hands of the black market, and it gets more controlled, and it can also be taxed. So it's less chaotic. FLATOW: That's what they're thinking of in California, making… Prof. HOLLAND: Right. FLATOW: But it also, according to the research you point out, if it's legalized, you can then standardize it, right, for medicinal uses? Prof. HOLLAND: Right. I mean, you know what – the thing I spent three years editing this book. And the one thing I'm really absolutely convinced of – I didn't know a lot about pot going in. But this really is a medicine. There really are, you know, this is a medicinal plant with a lot of potential to help a lot of different patients. But one of the things that people need to learn more about is there's a lot of constituent molecules in cannabis. There's over 400 components, and there's over 60 what are called cannabanoids. And some of them help different symptoms. And there's THC, and there's something called CBD, which is a really interesting molecule I would like people to learn more about, and I never knew what CBD was. But it's cannabidiol. This is something that actually is not psychoactive. It doesn't make you high or giddy. But it helps to decrease anxiety. It may be helpful for decreasing psychosis. It doesn't cause the memory issues that THC caused. And if you get certain strains of cannabis with a different THC-CBD ratio, the higher CBD strains end up helping more it's an anti-inflammatory. It's a free-radical scavenger. So it's an antioxidant. And the most fascinating thing that I learned that I really want everybody to understand is that there are some anti-cancer properties to cannabis, that it can trigger the cell death of cancer cells while leaving normal cells intact, and it can decrease what's called angiogenesis, which is you know, when a tumor is growing, it sends out these chemicals telling the blood vessels, you know, we need more blood here. And that's angiogenesis. And cannabis can interrupt that and stop the blood supply to the tumors. FLATOW: Mm-hmm. But there have been a lot of chemicals that have been shown to kill cancer cells or stop angiogenesis that never result in a cure. Prof. HOLLAND: Yeah. FLATOW: I mean, it's not like if you smoke a joint, you have no cancer. Prof. HOLLAND: Right. But what's interesting about this plant is that it's non-toxic. You know, most chemotherapeutic agents cause hair loss and nausea, and you get very sick and debilitated because not only are they killing the cancer cells, but they're also killing the healthy cells. And it looks to be that the components of cannabis don't do that. They leave the healthy cells absolutely unaffected, and there's no toxicity. So that's important, and that really makes it a unique medicine. FLATOW: But what do you say to the parent who says, you know, if we regulate it, if we legalize it, it's go
ing to make it easier for my 12-year-old. I don't mind my 18-year-old getting some pot every now and then, but my 12, my 13, my 14-year-old is going – it'll to be much easier for he or she to get it. Prof. HOLLAND: The thing I would tell that parent is unfortunately, right now, it's already very easy for kids to get it. And the idea with regulating is that it would actually be more difficult. I mean, Prop 19 in California is age 21 and above. FLATOW: Mm-hmm. And what other there are other states now that also are looking to regulate it. And do you think that did you time the book now because of the elections coming up? Prof. HOLLAND: I have to admit I really – I did. I mean, one thing I want everybody to know is that this is a nonprofit project, this book. All proceeds from book sales are going to be funding for therapeutic research, looking at whether cannabanoids can be therapeutic in different clinical settings. But originally, this was slated for February, 2011, and I asked the publishers to please try to get it out before the November election because I really want to help educate people so that they can make an educated choice when they go to the polls. FLATOW: Mm-hmm. The status of marijuana, legal versus illegal, I think is a little confusing to a lot of people because it is illegal on a federal level, but it's legal in some states. Can you explain how that works? Prof. HOLLAND: Yeah. You know, it's confusing to me, too. And my assumption is that the federal law really trumps the state law. But, you know, the Obama administration has basically decided that they're not going to go after these dispensaries, and they're not going to interfere with medical marijuana. But what remains to be seen is whether they will interfere. I mean, if Prop 19 does pass in California, I don't know what the federal response is going to be. And I don't – it gets confusing. I don't know what all the rules are about this, actually. FLATOW: Let's go to the phones, 800-989-8255. Sara Jane in Ashville, Oregon. Hi, Sara. SARA JANE (Caller): Hi, there. Well, I'm it sounds like good things could happen using it for medicinal purposes with marijuana. And I really don't have a problem with that. But I think my biggest issue is, as a mom and as a person who dislikes the smoke of marijuana or cigarettes or anything else, I'm very concerned about the idea of allowing something to become legal that would be smoked. I feel like it violates my rights and – as a person to choose what to put into my body. So, you know… FLATOW: You mean from… SARA JANE: …if someone is ingesting a capsule of marijuana for medicinal reasons next to me, it has no impact on me. But if they're smoking it around me or my children, I'm not okay with that. FLATOW: Julie? Prof. HOLLAND: Well, I think that, actually, Prop 19 is set up so that you cannot smoke in public places. SARA JANE: But what about children? I guess my concern is, like, if I were a single mother and my son is off with his father, and he were smoking in his home, you know, like once the smoking is legalized, you know, I know people who suffer from that with their – you know, the people that they're no longer in a relationship with, and the other ex-spouse is smoking cigarettes, and it has an impact on the children, asthma and for various things like that. And there's no way that this parent can really deal with it because it's legal to smoke cigarettes. So you can't say that somebody can't smoke cigarettes around a young child. Do you know what I mean? Prof. HOLLAND: Yeah, I do know what you mean. You know, one thing I wanted to address is this issue of taking a capsule of THC and what that means. You know, these you can, any doctor can prescribe THC capsules to somebody who has nausea. But the thing about taking something orally, cannabis in particularly, it takes a couple hours to come on, and it lasts a very long time. And actually, it's more psychoactive to take this orally. Your liver creates a new byproduct called 11-Hydroxy-THC, which is very psychoactive, a little bit hallucinogenic, sort of psychedelic, and it lasts a long time. So, you know, these the idea that the doctors are saying well, you know, we can just, you can just take these pills, the pills are more incapacitating than smoking is. Now, no most doctors are not comfortable with the idea of people smoking their medicine, and I certainly understand that. But, you know, typically, people are just taking one or two puffs, and that's all that they really need. And I think a lot of people are eating, you know, cookies and brownies, things like this. But one of the you know, I have a whole chapter in the book written by Mitch Earleywine, this chapter, talking about the pulmonary risks. And it absolutely is a big deal, the risks to the lungs and lung tissue. And, you know, the harm… FLATOW: So there are some people who should not, under any circumstances…? Prof. HOLLAND: Well, there's plenty of people who should not, you know, partake of cannabis. I think people with significant lung pathology shouldn't. And, you know, what Mitch Earleywine talks about in the book is using a vaporizer, which is a way to ingest cannabis through vapor that isn't particularly harmful to the lung tissue. And the other people, I think, who need to be very careful with this drug are people with psychiatric histories or family history. If you've ever been psychotic or you've got blood relatives who get psychotic, it may be that particular strains of cannabis are going to make you very uncomfortable or paranoid. And so people with psychiatric histories really need to be very careful, also. FLATOW: If we're talking about expanding the use of cannabis as for medicinal purposes, do we know enough about it, are the restrictions on its usage restricting the research that we need to know about it as a drug? Prof. HOLLAND: Yeah. I mean, this is very important, and I go off on long tangents in the book about this. This is sort of a pet peeve of mine. The fact that it's a Schedule I drug, and it is so tightly regulated and prohibited by DEA makes it very difficult to do research. We've got a lot of bureaucracy in this country and a real monopoly going on. There's only one place you can get research-grade cannabis right now, and it's a farm in Mississippi. And one of the chapters in the book is interviewing the farmer, Dr. Elsoli(ph). But there's a real monopoly going on, and a lot of people think that the research grade cannabis that is available – first of all, it's very hard to get it. There's a lot of hoops you have to jump through, more than any other researched chemical I can think of. But some people just think that – it's not very good pot, basically, that's coming out of this farm. So there's a lot of bureaucracy here, and it's real – you know, the problem is that politics are sort of trumping science right now, which is very frustrating. FLATOW: Talking with Julie Holland, author of "The Pot Book: A Complete Guide to Cannabis. The Role in Medicine, Politics, Science and Culture." And it's really a collection of essays and articles by other scientists. Dr. HOLLAND: Right. There's over 52 contributors in this book. And I sort of edited. I assigned different chapters to all the experts. And then the people who were too busy, basically, to write a chapter, I did interviews and transcribed them. So people like Andrew Weil and Michael Pollan, the really interesting interviews in there, talking to them. And then Tommy Chong of Cheech and Chong who got busted for selling bongs, basically, I did a fun little interview with him in there, too. So, you know, it's people from normal – I mean, there's plenty of politics and then there are some people who write about the sort of sociological implications, people like Doug Rushkoff and Neal Pollack, really interesting contributors, lots of MDs and PhDs and experts. FLATOW: There's an economic side to this, not just about taxing marijuana growth, but it'
s also about hemp as – hemp in the old days, before World War II, was an incredible cash crop. Dr. HOLLAND: Yeah. Right. FLATOW: It was very versatile. You can make all kinds of stuff about it. And that's still not allowed to be grown here. Dr. HOLLAND: Yeah. You know, I feel like it could do a whole separate book on hemp. It's a really interesting… FLATOW: There have been. (Soundbite of laughter) Dr. HOLLAND: Yeah. There are. There are plenty of books on hemp. FLATOW: Yeah. Yeah. Dr. HOLLAND: You know, back in the 1600s, you had – you were required to grow hemp. If you wanted to be patriotic, you were supposed to grow hemp, and that's what would, you know, make America great. And I do think on some level, hemp could make America great again. We could be exporting it instead of importing it. Not only economically could it be helpful, but environmentally. You know, this is a renewable fuel source and a renewable food source. And you could replace plastic bags and Styrofoam and paper. So, you know, I really wish that hemp – we could grow it legally in this country. FLATOW: Can you grow it without the THC level? Dr. HOLLAND: Well, that's – yeah. I mean, hemp is very low. You know, it's not psychoactive. It is very low THC. It's like a version of cannabis that has very little THC in it. FLATOW: Mm-hmm. 1-800-989-8255. Scott(ph) in Grand Rapids. Hi, Scott. SCOTT (Caller): Hi. Thanks for taking my call. My dad has struggled with depression for quite a long time. And I was just curious, just kind of intrigued by your previous comment about there being, like, potentially medicinal uses for marijuana, like relieving anxiety. Is there any research or is there any potential that you know that marijuana might help people that have depression or struggle with any diseases similar to it? Dr. HOLLAND: Well, absolutely. I mean, the chapter that I wrote in the book is about cannabis in psychiatry and how it could be helpful to the field of psychiatry. CBD, in particular, seems to be a good anti-anxiety agent. And there are plenty of strains of cannabis that seem to help with mood. I mean, obviously, you know, the reason that this drug is illegal is because it makes people laugh and giddy. So, yes, it's probably – could be helpful with depression. FLATOW: Mm-hmm. Dr. HOLLAND: But the problems is that because it's illegal and you don't know what strains you're getting and you don't know what THC-CBD ratio, that's a problem. FLATOW: Mm-hmm. We're talking with Julie Holland, author of "The Pot Book: A Complete Guide to Cannabis" on SCIENCE FRIDAY from NPR. I'm Ira Flatow. So do you think there are going to be – in this election season, there are going to be major shifts? California, you think the voters are going to… Dr. HOLLAND: You know, it seems sort of neck and neck. But, I mean, what is interesting – I've been watching Prop 19 and who's coming out to endorse this. It's so interesting. I mean, moms are coming out and endorsing it. Law professors, law enforcement officers, black churches, unions – there's a lot of people who keep coming out in favor of Prop 19. So it'll be really interesting to see what happens on November 2nd. FLATOW: And one of the most controversial, and we've talked about this for years, is the question of whether marijuana is addictive or not. Dr. HOLLAND: Yeah. FLATOW: What is the story on that? Dr. HOLLAND: Well, you know, I'm a psychiatrist. And I believe that any behavior can – you know, any behavior that is reinforcing and pleasurable has the potential to become addicting. But if you're talking about tolerance and dependence and withdrawal and sort of the physical hallmarks of addiction, cannabis is very low on the list. It's – you know, nicotine and tobacco is the most addictive thing around, and then you've got heroin and cocaine and alcohol. And cannabis comes far down the list below all of those. FLATOW: Mm-hmm. But there's a chapter in book on addiction there and you say that chronic cannabis use have the potential to contribute to the occurrence in severity of symptoms associated with mental health problems, anxiety depression, and schizophrenia. Dr. HOLLAND: Right. Again, I mean, you're talking about different strains that can potentially exacerbate – you know, there is something called skunk, which is a very high THC percentage cannabis, that seems to increase anxiety and self-consciousness and paranoia. So, yeah, you absolutely have to be careful what you're taking. FLATOW: Mm-hmm. What do you hope the message of this book is, the take-home message? Dr. HOLLAND: Well, the message is we need to know more, you know? We need to do more research. It's – this is a thousand year – I mean, you know, this is a plant that we have co-evolved with on the planet from (unintelligible). FLATOW: But we have receptors in our brain, right? Dr. HOLLAND: You know, we have receptors in our brain for this substance. And even if you've never smoke pot in your life, you have endogenous cannabinoids in your system, and it helps to regulate things like metabolism and autoimmune functions. We need to understand this a lot more. I think what you're going to see in the next decade is that we will understand the endocannabinoid system better and that the big pharma will realize that there are a lot of medications that can be sort of standardized and brought to market that aren't plants. So… FLATOW: Well, but do they think that there is a market for them if you – if everybody can grow marijuana, why should… Dr. HOLLAND: Well, this is the issue, isn't it? FLATOW: Yeah. Dr. HOLLAND: You know, it's a bit subversive. And big pharma is not going to be happy if you can grow your own medicine in your backyard, right? FLATOW: Mm-hmm. But there might be ways that they can take it and make special drugs out of it. Dr. HOLLAND: Absolutely. Right. I think that they can standardize things. I think that you'll end up seeing CBD be a medicine down the road. FLATOW: And why don't we see it now? Why can't they just say, we can we want to make this medicine, a CBD. Is it because it's regulated as type 1 drug that they can't do this? Dr. HOLLAND: I don't know. I mean, my understanding is that you know, I mean, there is this medicine called Sativex, which is an extract from the plant that a lot of countries have legalized, but we haven't legalized it here. But I imagine that there will be, you know, a pill, a CBD pill down the line. I don't know why it hasn't happened yet. FLATOW: All right. Well, thank you very much for taking time to be with us. Dr. HOLLAND: My pleasure. FLATOW: Julie Holland, author of "The Pot Book: A Complete Guide to Cannabis. It's Role in Medicine, Politics, Science, and Culture." We're going to take a break. When we come back, we're going to talk about punk rock. How is punk rock similar to scientific research? Answer to that question if you stay with us. We'll be right back after this break.
A transcript from an interview with Julie Holland, M.D., author and clinical assistant professor of psychiatry at New York University School of Medicine, about the medicinal properties of cannabis and the implications of changing marijuana regulation laws in four states in the next month.